Neuromuscular Dentistry

TMD and Cosmetic Dentistry

Temporomandibular joint disorder (TMD) is an often-misdiagnosed condition where the patient’s jaw joints are out of alignment. This can affect various areas of the patient’s oral health, and the pain can radiate throughout the face, head, neck, and shoulders.

The term temporomandibular joint (jaw joint) is often abbreviated as TMJ, and that same acronym is also often applied to TMD. That can create some confusion, but we will talk about the jaw joint as TMJ and reserve TMD for the disorder.

Dr. Marshall has extensive training and experience with TMD and she uses a combination of neuromuscular dentistry and cosmetic dentistry practices to help her patients not only get their bite aligned, but regain a beautiful smile at the same time.

What Causes TMD?

When something puts the jaw joints out of alignment, affecting the position and movement of the lower jaw, discomfort and pain can become severe and chronic. The jaw muscles become strained: When you think of how many times we open and close the mouth each day for eating, talking, laughing, yawning, etc., it is not surprising that inflammation would develop.

TMD can be caused suddenly by an accident or injury, such as an auto accident that delivers a blow to the side of the head, or gradually by misaligned teeth preventing the lower jaw from closing comfortably. A tooth grinding or jaw clenching habit continued in sleep can also be a cause.

TMD can be caused or influenced by a number of different factors, including:

• An injury to the jaw
• Tooth grinding
• Teeth clenching
• Osteoarthritis
• Rheumatoid arthritis
• Bad dental work

TMD can be treated and repaired through a combination of neuromuscular dental training and cosmetic dentistry procedures.

TMD Symptoms

When the jaw joint is misaligned, the result is malocclusion (a misaligned bite) which can cause extreme pain and discomfort – not just in the jaw itself but in the entire face and head, the neck, and the shoulders. Typical symptoms of TMD that are often misdiagnosed include:

• Migraine-like headaches
• Tinnitus (ringing in the ears)
• Facial and jaw pain
• Clicking, popping and locking of the jaw
• Tooth pain
• Unexplained wear on the teeth
• Earaches
• Pain and pressure behind the eyes
• Tingling or numbness in the hands
• Depression – because the symptoms are fatiguing and a failure to obtain permanent relief is frustrating

The reason that TMD symptoms are so diverse is that the large trigeminal nerve enervates the entire face and head. It is the fifth cranial nerve, the largest facial nerve, and is both sensory and motor. It has three large branches on each side of the head:

• The ophthalmic nerve – covering the upper nose, eyes, forehead, and crown of the head
• The maxillary nerve – covering the lower nose, cheeks, upper jaw and part of the temples
• The mandibular nerve – covering the lower jaw, part of the temples, and part of the ears

Each branch has sub-branches that carry sensory data to the brain, as well as enabling movement. When the jaw muscles become inflamed, swelling puts pressure on one or more parts of any of these nerves, causing pain in that location. Compression of one part of a nerve can affect other areas served by that nerve; you may feel pain in more than one location.

The Road to Pain Relief

The most common and painful TMD symptom is headaches that seem to the sufferer like migraines. If you have such headaches and have been to several physicians in a fruitless search for permanent pain relief, your headaches may be TMD headaches rather than migraines. Most people, including most doctors, never think of a headache as having a dental cause.

Dr. Marshall is a fully qualified neuromuscular dentist and has invested in the best technology for diagnosing and treating TMD. If you wonder whether you might have TMD, it would be worthwhile to see a neuromuscular dentist to rule it out. If Dr. Marshall finds that you do indeed have a misaligned bite causing your pain, you will be on the road to permanent pain relief.

How can cosmetic dentistry practices treat TMD?

Although it would seem that cosmetic procedures and treating TMD wouldn’t have much overlap, that’s not true. Often bite issues can be a combination of a misaligned bite, plus prior dental work that may have broken down due to tooth grinding and jaw clenching.

While it’s assumed that the placement of crowns or inlays/onlays is often for purely aesthetic purposes, when helping align a person’s bite they function in a double role as TMD treatment.

See a Cosmetic Dentist Who Treats TMD

Although TMD can be due to an inherent misalignment of the jaw/bite, it also creates various cosmetic problems with the patient’s smile as it endures. Many patients don’t have any idea they are suffering from TMD, so they keep grinding, clenching, and damaging their teeth without knowing any better.

That’s where Dr. Marshall’s dual expertise comes into play. First, she can correctly diagnose your TMD. Then she can target the alignment problems that need to be addressed. Once your bite is in alignment, then her job changes to that of a cosmetic dentist, repairing the damage and making your smile look great.

What cosmetic procedures does Dr. Marshall use for TMD treatment?

To permanently relax your jaw position and movement, the jaw muscles need to be re-trained and the factors that have been maintaining the misalignment must be removed. Dr. Lindsey Marshall uses cosmetic procedures to help align your bite and assist in treating TMD.

• Invisalign^® — One of our most popular cosmetic procedures, Invisalign^®, can play a valuable role in treating TMD. Usually, the misalignment that accompanies TMD can be relatively minor, but it makes the jaw muscles and joints work hard to try and create alignment. Invisalign^® is perfect for mild to moderate tooth movement, and it does so basically invisibly, thanks to its use of clear plastic aligner trays to move the teeth. This is a far cry from the metal mouths of traditional orthodontics.

• Inlays and onlays — Dr. Marshall uses these restorations (where they are on the tooth dictates their name) to replace former amalgam fillings that may have failed or to repair a tooth with extensive decay or a serious crack. In a cosmetic sense, they become invisible with the porcelain used for these restorations, but they can also be adjusted for bite problems, lowering or raising cusps as needed.

• Porcelain crowns — When nightly tooth grinding causes TMD, dental crowns can be used to return height to teeth that have been ground down. This is critical for TMD treatment, especially after the teeth have been moved with Invisalign^®, to maintain proper bite.

• Porcelain veneers — Again, if the patient has been grinding his or her teeth, chances are the teeth are now visibly shorter. After the bite has been corrected, Dr. Marshall uses porcelain veneers to return length to the teeth. These thin porcelain shells are placed onto the fronts of the teeth, masking various imperfections.
• Tooth bonding — As with veneers, Dr. Marshall can change the shape of a tooth that has been damaged by TMD problems. Bonding uses ceramic resin painted onto teeth to change the shape and size, or to cover issues such as minor cracks.

For information on how we can help with financing, please see the Affordability page.

K-7 Evaluation System

The K-7 Evaluation system allows Dr. Marshall to measure, record and store malocclusion and jaw joint data to accurately diagnose TMD. During your visit, you wear lightweight equipment over the head or around the neck to transmit information to the K-7 computer.

Using this technology allows Dr. Marshall can obtain information on:

• Jaw muscle electrical activity
• Jaw muscle movement
• Jaw joint sounds

Longer-Lasting Dental Work

The principles of neuromuscular dentistry can also help ensure your regular dental work lasts longer. When Dr. Marshall performs any kind of dental procedure, she will pay close attention to the way your bite fits together and where your jaw’s resting position is to make sure the restoration affects your bite in a positive way and not a negative way.

Experienced Neuromuscular Dentistry

Dr. Marshall received her neuromuscular dentistry training at the prestigious Las Vegas Institute for Advanced Dental Studies (LVI). As an LVI graduate, Dr. Marshall has received the most complete hands-on and theoretical neuromuscular dentistry training available. In her decade of practice, Dr. Marshall has helped hundreds of men and women in our area restore proper alignment and live a life free of the pain and discomfort associated with TMD.

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