TMJ examination

Diagnosis and treatment of masticatory system disorders.

Do you experience pain in your temples, forehead or cheeks after the night?
Do you experience morning stiffness of the facial muscles?
Does anyone in your family say that you grind your teeth at night?
Have you noticed that you clench your teeth while working or when upset?
Have you had a headache for a long time?
Have you noticed changes in your facial features? Has your face become more square?
Does your dentist tell you at check-ups that you are wearing down your fillings or "eating your own teeth"?
Has your dentist noticed that your teeth have become more mobile?
Do you have trouble opening or closing your mouth? Has your jaw ever locked?
Do you have ringing or buzzing in your ears?
Do you hear any clicking, popping, cracking or crunching?
Have you noticed exposed tooth necks?
Or have you already worn through yet another splint and feel that something is not working here?

An affirmative answer to even one of these questions should concern you.

It is worth checking and learning more about what causes this and whether it can be remedied.
Only a thorough analysis - a conversation with the patient together with an examination of the masticatory system - can answer the question of whether and how the above ailments can be treated.
In addition, if you are about to undergo orthodontic or prosthetic treatment (dental restorations such as dentures, crowns, bridges), it is worth being examined to find out whether there are any contraindications to starting such treatment.
Whatever concerns our body directly - the pain that appears, acoustic symptoms and even changes in facial features - can be worrying. It is worth being examined, all the more so because "The best medicine is peace of mind" (Celsus).

Here is a conversation on this topic:

A conversation with dental practitioner Katarzyna Chmielińska-Popiołek
Doctor, how often do patients affected by a temporomandibular joint problem come to you?

For some time I have been noticing an increase in the number of patients coming to the surgery with symptoms of abnormal function of the masticatory system. It is assumed that this phenomenon can be explained by the fact that we live in a civilised society where loudly expressing one's opinion or dissatisfaction is not considered appropriate. Few people are able to unceremoniously "bang their fist on the table"; far more meekly accept certain things imposed from above.
Even though we come out of such skirmishes with a smile plastered on our face, inside we are dealing with an emotional catastrophe. The body cannot be fooled. It will fight the emotions that have already appeared and has to release them somehow. How? It depends on the person. Some will often have headaches, around the temples and forehead. Others literally "eat" their own teeth, which become shorter, cracked and unsightly. Still others feel that their teeth no longer fit together. There are also those who, for some time, have been hearing crackling, popping or crunching in front of or in the ear. I also deal with people who were told some time ago that they are bruxists and accepted it without a fight.

What does such an examination look like?

In treating masticatory system disorders I rely on a careful examination of the patient. The examination takes about 1 hour and consists of two stages.
• an interview,
• an examination of the muscles, temporomandibular joints and teeth.
In many cases the patient is able to describe their ailments very precisely themselves. My task is to draw the right conclusions and, if necessary, to begin treatment.

What is important in the interview?

I pay attention to the patient's working posture and physical activity. If I detect any systemic abnormalities, I often refer the patient to a physiotherapist. Sometimes it is worth working on relaxing, for example, the muscles of the shoulder girdle.

What methods are used to treat the patient?

It depends on the cause of the ailment. We have at our disposal specific muscle exercises, hard relaxation splints and various relaxation techniques. Sometimes, after treatment of the masticatory system, the patient needs occlusion rebuilding or orthodontic treatment.

How is a relaxation splint made?

• Impressions of the upper and lower jaw must be taken.
• The masticatory muscles must be relaxed and deprogrammed - that is, the memory of how they tensed must be erased.
• The correct position of the mandible in relation to the maxilla must be registered. I also use a facebow in my practice, so that the technician knows how the patient's jaw is inclined to the horizontal plane. It is not set parallel to the ground, even though it seems so to us. This eliminates many mistakes.

How long does treatment with a relaxation splint last?

At least one quarter; the upper limit is not defined - it depends on the cause.

How often must a patient with a splint come for a check-up?

As long as they use the splint - once every 2 months.

What do you do when the teeth are worn down?

To put it briefly, they have to be rebuilt to the correct height. It is always necessary to check whether such reconstruction is possible. Teeth can be rebuilt with composite or with fixed restorations in the form of porcelain crowns, bridges or implants - but always after an adaptation period.

Doctor, do you see patients with pain in the face or head, but after examination it turns out that your treatment will not be effective for them?

Yes, of course. These are patients whom I refer for treatment by a neurologist, ophthalmologist or ENT specialist. The oral cavity is only a certain area separated from the whole human body. I look, I listen and I try to arrange what the patient tells me into a single puzzle. If I see that there is some general problem, I refer the patient on. A splint is not a cure for all pains and ailments related to the head area.

How can you tell that you have the problem we are talking about?

Patients often feel themselves that "something is wrong". Dentists often point out to patients that they are wearing down their teeth or that they open their mouth very "poorly" during treatment. Sometimes, when opening wide, the chin trembles and the mouth closes by itself. These are signals indicating that we are dealing with a problem. It is worth getting examined.

Thank you for the conversation.

Thank you too.