Our temporomandibular joint allows us to bite, chew, swallow, and talk. The joint combines a hinge action with sliding motions, forward and back and side-to-side. Problems with the joint leading to TMJ can often be traced back to misalignment of the patient’s bite, as that creates obvious stress. When the jaw is out of alignment it is continually trying to get into the correct position, which causes destructive force in the wrong areas. But TMJ can also be caused by more subtle issues such as clenching your teeth due to stress or grinding your teeth at night. Prior injury to the jaw can lead to TMJ. There even appears to be a genetic predisposition to developing the condition.

Here are typical causes of TMJ:

• Grinding teeth during sleep
• Clenching the teeth
• Movement of the soft cushion (disc) between the ball and socket of the joint
• Arthritis in the joint
• Stress, which can cause a person to tighten facial and jaw muscles
• Traumatic injury to the jaw

Your temporomandibular joint is an essential part of your mouth. Any time you talk, bite, yawn, or even breathe heavily, this joint engages. This disorder can lead to chronic pain that can radiate far away from the joint. We have patients with pain and tenderness across their face, in the jaw joint area, the neck and shoulders, even in the ears. Headaches are common. Some patients even find their TMJ creates dizziness. TMJ pain can be life affecting and damaging.

Patients often underestimate the effect their TMJ is having on their lives. They assume they are simply going through a stressful period of life, maybe difficulty with the boss at work, and when the stresses lessen so will their TMJ. But if your jaw is out of alignment, that is not going to fix itself. You need to come see Dr. Agnini for treatment of your TMJ. Correction may be as simple as creating a custom night guard to wear while sleeping to stop teeth grinding and clenching, or treatment may be much more involved. Every case is unique. In extreme cases, surgery could be necessary.

When Dr. Agnini diagnoses your TMJ, treatment may start with some exercises that are designed to strengthen and stretch your jaw muscles. This will help to relax the jaw, increase mobility, and reduce any clicking that may be occurring.

These are some exercises to try:

• Relaxed jaw exercise — Place you tongue on the roof of your mouth behind your front teeth. Consciously let your lower jaw relax downward, slightly separating your teeth.
• Goldfish exercises — Place an index finger in front of your ear where your TMJ is located. Put another finger on your chin. Open your jaw either halfway or all the way and feel the slight resistance.
• Chin tuck — Lightly link your hands behind your bottom to push your shoulders forward. Now pull your chin straight back as if you’re trying to create a double chin.
• Jaw resistance — Put your thumb under your chin and create some resistance as you open your mouth. Pinch your chin with forefingers and thumb of both hands to hold it when your mouth is open. Then close your mouth feeling the resistance.
• Tongue up — Hold your tongue up against the roof of your mouth, and then slowly open and close your mouth.
• Side-to-side and forward jaw movement — Place an object that’s about ¼ inch between your front teeth. First move your jaw slowly from side to side with the object between your teeth. Then do the same thing, but this time move your bottom jaw forward so your bottom teeth are in front of your top teeth.

Sleep apnea and TMJ are two very different conditions. In obstructive sleep apnea, tissues in the back of the throat sag and actually block the airway causing the person to stop breathing. The brain senses the problem and immediately awakens the person to start airflow again, although the person usually doesn’t come fully awake. This pattern can happen hundreds of times per night, and the lack of sleep has destructive health complications.

In TMJ the jaw is out of alignment leading to the problems discussed on this page.

Some research points to underdeveloped jaws in modern times in children, which can also impact nasal development. The jaw is the common denominator between TMJ and sleep apnea in some patients.

Dr. Agnini has found that the most common treatment for TMJ, the use of an oral appliance to correctly place the jaw into proper alignment, also helps with sleep apnea. Oral appliance therapy is the first line of treatment for sleep apnea, moving the jaw forward a bit to better open the airway in the back. Often treatment of either TMJ or sleep apnea separately can have beneficial effects on the other.

TMJ may have its roots in misalignment of the jaw or the overall bite, but as it continues the disorder will invariably cause damage to the patient’s smile, both functionally and cosmetically. Most patients have no idea they are suffering from TMJ (or even what TMJ is), so they keep living with the pain and grinding, clenching, and damaging their teeth.

That’s why having dual expertise in temporomandibular joint disorders (Dr. Agnini has over 1300 hours of continuing education with TMJ, orthodontics, and sleep apnea) and cosmetic dentistry is an advantage for our patients. First, we know to look for and can correctly diagnose TMJ. From there we can target correcting your jaw alignment. After that, the role changes to a cosmetic dentist as we move on to repairing the damage caused by TMJ and giving you back a beautiful smile.

After all, many of the treatments for TMJ — porcelain veneers, Invisalign, the placement of inlays and onlays, porcelain crowns, and dental bonding — are all cosmetic dentistry procedures.