DentalTwins Dental Chat

I had jaw pain last year and my ENT dr. injected the area and the pain left, not to return. A month ago my jaw (same side) popped out and then popped right back in. It hasn't occurred since. My dentist of almost 20 years wants to do an occlusal analysis using a full mouth impression, seeing where the teeth strike unevenly and then grinding down those spots. The second phase, occlusal adjustment, is to manipulate/massage my jaws to realign.
This all seems a bit strange, especially the adjustment part. Before I spend over a thousand dollars (insurance won't cover), I'd like some feedback (groan) and input.
Thank you! Judy

Dear Judy,

Perhaps more than any other part of dentistry, the diagnosis and treatment of temporomandibular joint (TMJ) disorders is fraught with controversy and dissatisfaction. This reflects the relative shortage of hard information to correlate subjective symptoms with objective and measurable physical signs. TMJ (also sometimes referred to as temporomandibular dysfunction, myofascial pain, and other terms as well), has over the years been blamed on muscle spasm, geometric bite discrepancies, true joint pathology, and even psychogenic factors. The available treatments reflect the diverse theoretical causative bases of the disorder-- if it is indeed only one disorder. Treatment may include the use of night guard appliances, orthodontic tooth movement, occlusal equilibration (the selective re-shaping of the teeth to which you refer), and even psychological stress management.

The problem with random implementation of treatment without some investigation of the true nature of the disorder is that it risks causing irreversible change, with no guarantee of improvement, or perhaps making the problem worse. For that reason, the only therapeutic measures that perhaps should be empirically taken without more intensive diagnostic effort is a conservative type of treatment that causes no permanent change-- perhaps construction of a night guard, or gentle physical therapy, or application of moist heat over the affected area. Haphazardly grinding the teeth may help, but may not, and may actually further confuse the diagnostic picture. In short, I am not enthusiastic about the treatment recommended to you.

A more rational approach is to have a formal diagnosis, performed by a dentist who is experienced and skilled in the diagnosis and treatment of TMJ. Now, this area is not recognized as a distinct specialty by either dentistry or the state licensing boards, but there are a small and courageous group of dentists who have filled this very important niche. It is one of these dentists who are more likely to be able to clarify exactly what is causing your pain and joint dislocation, and from there derive an appropriate line of treatment. Many of these dentists achieve board "diplomate" status in the American Board of Orofacial Pain, and you can search the Board's web site directory for one near you at: http://tinyurl.com/ytyfky

Dr. Bornfeld: Thank you so much for a detailed and quick reply. My gut feeling was to approach this slowly and with more input. Grinding away seems a bit of a chance. I will follow your advice and get a second opinion. Judy