TMJ Chicago

TMJ Alphabet Soup: TMJ, TMD, TMJD,CMD, CMCD, CFP, OFP, MPD, CCPS, CRPS, TN, NMD, CR, CO, EMG, MKG, CMS, TENS, ULF-TENS, SPG, AES, ICCMO, NUCCA, A/O, AAOP, CBT, SPG

Dr. Shapira Always tired cause by lack of sleep, Blog, Blog migraine, Causes of TMJ, Clicking & Popping, Diagnosis of TMJ, SPG Block Anxiety, SPG Block Cluster Headache, SPG Block Migraine, SPG blocks, Sphenopalatine Ganglion Blocks, TMJ, TMJ - General, TMJ affects your posture, TMJ ARTHRITIS, TMJ CREPITUS, TMJ Neck & Back Pain, TMJ Specialist, Treatment of TMJ, Trigeminal Nerve, Trigeminal Nervous System, Trigeminal Vascular System, Uncategorized, Unsorted 0 Comments

The number of abbreviations in medicine and dentistry is amazing.  In this short post I am going to give only a small number of definitions routinely utilized in literature and culture concerning TMJ disorders, often called “the Geat Imposter”  This will be an open Blog and will be added to over time.  Please come back and visit and if you have abbreviations you think need explanation please send the to me.

The most obvious is TMJ.  It is not a disease or a disorder but an abbreviation for the TemporoMandibular Joint.  The TM Joint is made up of the Temporal Bone of the skeuu “T” and the Mandible “M” where the come together is the Joint “J”  TMJ is not a diagnosis but a body part, like saying knee or Elbow.  The Fossa of the TMJ is located in the Temporal Bone which also forms the articular eminence.  The condyle is the part of the mandible in the TM Joint.  There is also an articular Disc the divides the Joint into upper and lower compartments, the lower is where rotation takes place and the upper is where translation or sliding takes place.  Both of these movements happen simultaneously in a heathy joint as the condyle dick assembly slides forward and back, side to side or obliquely while retaining ability to rotate.  The right and left joints always work in tandem but do not mirror the actions of each other in most movements.

TMD stands for TemporoMandibular Dysfunction or TMJ Disorders and is a disorder.  It can include internal derangemets which are problems inside the joint capsule.  These can include different types of arthritis and inflammatory conditions, the can include disc displacement disorders which are often referred to as clicking.  The clicking noises often represent the sounds of the condyle going on or off the disc.  Disc displacement can occur in different dimensions and to different extents.  There are reducible and not reducible clicks which refers to the ability to recapture the disc during function.  There are also closed lock dislocations of the disc where it is displaced without reduction. A displaced disc can be extremely painful. There can also be an open lock of the TMJ which is a subluxation where the condyle hyperextends over the articular evidence.  There are disorders like joint mice that are often diagnosed incorrectly as disc disorders.  You can also have inflamation , tearing and destruction of the retrodiscal lamina that connects the disc to the posterior parts of the joint including the joint capsule.  It is also possible to hacve a capsulitis of inflammation of Joint Capsule.

TMJ DISORDERS OR TMD DO NOT ALWAYS HAVE CLICKING, POPPING OR JOINT PAIN!  The disorder can be related to joint function without having internal derangements.

TMD also includes extracapsular Disorders and this is where the fun begins.

MPD is the most common extracapsular disorder.  It stands for Myofascial Pain and Dysfunction as defined by Travell and Simmons.  It is a muscular disorder that is distinct from Muscle Spasm or Myositis.  It is a disorder of muscle dysfunction secondary to improper muscle usage.  The muscle disorder is the result of a repetitive strain injury.  Myo is for  muscle and Fascia is connective tissue.  This is NOT Myo Facial Pain referring to the face though it is frequently seen written that way.

Myofascial Pain has muscles that contain taut bands and trigger points that can cause referred pain often far from the trigger points.  There are common patterns of referred pain that are often shown in textbooks but these patterns are not for a single patient but rather a frequency diagram based on thousands of patients.  The website www.triggerpoints.net is interactive and is an excellent reference for anyone with chronic pain anywhere in the body.

NUCCA and AO or A/O  are all terms for treatment directed at the complex articulation of the head to the first and second vertebrae of the Neck.  The occiput sits on top of the first vertebrae which is the Atlas.  It is named after Atlas of Greek Mythology who held and carried the world on his shoulders.  The head sits on two shoulders of the Atlas.  The TM Joints and The Atlas Occiput joints will tend to match three dimensionally.  The Axis is the second Vertebrae and has an upward protruding part called the Dens.  The Quadrant Theorem of Guzay is a mathematical explanation of the movements of the mandible after looking at both rotation and translation and shows that the middle of these combined movements is on the Dens of the Axis.  The DENS is the centrer of rotation for mandibular movements.  NUCCA is the National Upper Cervical Chiropractic Association which is a group of Chiropractors with special traing and focus on the upper cervical spine.  A?O or Atlas Orthoganol Chiropractors utilize a specific adjustment technique for the upper cervical spine.  

This is an important area of concern for TMJ Patients because of postural connections of the jaw, jaw joints, head and upper cervical areas in creating homeostasis.  Even small changes in jaw position can affect the upper cervical spine.  Changes in head position due to upper cervical spine can crearte TMJ symptoms.

CO stands for Centric Occlusion.  It describes where the upper and lower teeth fit together with mouth closure.  MIP .is the Maximal Intercuspal Position where occlusion is totally seated even if it means a pathological slide.

CR   or Centric Relation is a more complicated issue, it is an artificial location that has at least 26 different definitions and is utilized to transfer information to an articulator be CR dentists.  CR Dentists believe that joint position of the condyle in the Fossa are key to Occlusion.  CR may be very different depending on who is determining the position.  A CR Occlusion or Centric Relation occlusal scheme will usually have a CR-CO slide because most patients cannot tolerate the CR border position and create a new centric occlusion to function.    I Do Not Utilize CR or Centric Relation position.  Long Centric is another definition of this discrepancy between CR and CO.  CO is sometimes called MIP maximum intercuspal position or a fully seated CP which may actually require some adaptive movement of the tooth in the socket which is allowed by the periodontal ligament.  This freedom disappears with implants that are immovable.

Myocentric is the neuromuscular occlusion utilized by Neuromuscular Dentists.  NMD is short for Neuromuscular Dentistry.  There are many amazing videos about NMD at https://www.reddit.com/r/NeuroMuscularDent/.   It is where the teeth meet when the muscles move the jaw from rest position to closure.  There should be minimal muscle adaptation and following closure the jaw should return to rest position and the muscles should maintain health and normal function.  Myocentric is a reset position for the mandible that allows function without inducing muscle pathology.  It is specifically designed not to induce MPD or myofascial Pain.

TENS and ULF-TENs are abbreviations for Transcutaneous Neural Stimulation and Ultra Low Frequency TENS.  Neuromuscular Dentistry utilizes ULF TENS to relax the muscles to create a healthy physiological condition in the muscles which is necessary to find neuromuscular rest and to determine neuromuscular occlusion.  Creating a healthy musculature is an important first step in neuromuscular dentistry.  EMG is Electromyography which is used to measure the electrical activity of the muscles.  MKG is a Mandibular Kinesiograph often called a CMS or computerized Mandibular Scan.  It measures in real time three dimensional movement of a magnet attached to the mandible that allows precise measurement of the magnet and infer what is happening during mandibular function.

The ULF-TENS sends current thru the coronoid notch bilaterally and causes a single synapse contraction of all of the mandibular elevator muscles as well as all other Trigeminal Nerve and Facial Nerve innervated  muscles.  The underlying basis of NMD is healthy muscles.  The condyle assumes a position within the joint based on health muscle tone.  The condyle is never forcer into an unstable orthopedic border position like CR but it can go there.

Changing the position of the head can change jaw relations and changing jaw position can change head position.  It is important to establish a very stable jaw position in neuromuscular dentistry, this is done with a diagnostic neuromuscular orthotic.

The AES is the American Equilibration Society and is the oldest TMJ organization.  I have been to their meeting for 30 years but in general the majority of members believe in CR Based occlusion.

ICCMO is the International College of CranioMandibular Orthopedics and it is primarily Neuromuscular Trained dentists  It was founded by Barney Jankelson the “Father of Neuromuscular Dentistry” as a non-commercial scientific organization.  Typically, the best neuromuscular dentists are ICCMO members.

NMD stands for either NeuroMuscular Dentistry or Dentists.  This is the philosophy of treatment where muscle health is center to all treatment.

OFP is short for OroFacial Pain or Oral Facial Pain.  This is pain centered in the head and facial regions.  Some orofacial pain doctors do not look at TMJ disorders as primarily physical medicine issues but believe they are best managed by medications.  There is a wide spectrum of doctors who treat orofacial pain but there is a group that is seeking specialty even after being denied specialty by the ADA or American Dental Association multiple times.  They are now creating a specialty outside of the ADA, a dangerous precedent.  The AAOP is the American Academy of OroFacial Pain.  This group does not believe occlusion or how teeth meet have anything to do with TMJ disorders.  They tend to utilize prescription medications and CBT or cognitive behavioral therapy a lot.  Cognitive Behavioral Therapy is valuable for many disorders.

CMD stands for CranioMandibular Dysfunction or dysfunction it the articulation which would include TMD and MPD and maybe cervical issues.  CMCD is CranioMandibular Cervical Dysfunction.

AACP is the American Academy of CranioFacial Pain and was previously the AAHNFP or the Academy of Head Neck and Facial Pain.

SPG Blocks were made famous in the best selling book “MIRACLES ON PARK AVENUE!   Celebrities and patients flocked to see Dr Mlton Reder in NYC for these blocks.  

SPG stands for Sphenopalatine Ganglion also called the Pterygomandibular Ganglion, Sluders Ganglion, Nasal Ganglion or Meckel’s Ganglion.  It is located on the maxillary branch of the Trigeminal Nerve and is associated with many of the autonomic and stress related aspects of TMJ and MPD disorders.  Many believe the TMJ disorders were first described in 1908 by Sluder as Sluder’s Neuralgia others believe this is the first description of cluster headaches.  SPG Blocks can be self-administered and are one of the most amazing treatments for a wide variety of issues.

SPG Blocks  are often used in treatment of TMJ Disorders, Migraine and Cluster headaches.

Learn more about SPG Blocks at https://www.SphenoPalatineGanglionBlocks.com

ADD and ADHD are often associated with TMJ disorders because of common developmental patterns of sleep apnea and TMJ.  Sleep disordered breathing is primary cause of both Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder.

RSD stands for Reflex Sympathetic Dystrophy more commonly called CRPS today or Complex Regional Pain Syndrome.

In Sleep issues we have AADSM or American Academy of Dental Sleep Medicine, the AASM or American Academy of Sleep Medicine, DOSA the Dental Organization for Sleep Apnea.  SA or Sleep Apnea, AHI= Apnea-Hypopnea Index, AI= Apnea Index, RDI = Respiratory distress index, RERE is Respiratory Related Arousal , UARS is Upper Airway Resistance Syndrome which is related to Fibromyalgia via the Alpha Intrusion into Delta Sleep.  REM is short for Rapid Eye Movement seen during dream sleep.

NIH is National Institute of Health.  The NIDCR is the National Institute of Dental and Facial Research who believes TMJ (TMD) is not related to occlusion but the NHLBI or National Heart Lung and Blood Institute  of the NIH wrote the report “Cardiovascular and Sleep Related Consequences of TemporoMandibular Disorders”  The HPA Axis is the Hypothalamus-Pituitary- Adrenal System that includes the reticular Activating System and is part of the Limbic system where we feel emotions.  Pain is an emotional response to noxious input.  Neuromuscular Dentistry addresses the HPA by stimulation of the SPG with ULF-TENS.  The is control of the autonomic nervous system with science .  This has been shown to increase permeability of the Blood Brain Barrier.…

TMJ Treatment: Across Illinois, Wisconsin and the Midwest

Dr. Shapira Blog 4 Comments

Why do patients travel long distances for TMJ treatment.
What I find is patients have had pain for years and think there is nothing else that can be done and then severity increases and they desperately look for an answer.

They want a comprehensive approach to diagnosis and treatment but most of all they want to QUICKLY IMPROVE THEIR QUALITY OF LIFE.

They come across a world of treatment different than what was ever discussed with their general dentist.

It turns out most dentists know very little about treating TMJ disorders beyond simple splints.

A small group of dentists become obsessed with knowing more and more about the condition and become more and more expert about very arcane little details.

The vast majority of patients get a night guard and simple habit changes and the TMJ problems are fixed. The difficult patients either learn to live with pain or end up seeking speciatly care.

There is no specialty in TMJ treatment so usually patients seeking specialty care first go to the oral surgeons (OS) office. This is appropriate for TMJ surgery but is the last place to go for occlusal therapy for TMJ problems because most OS never look at fine tuning occlusion. OS making splints that don’t work often look for surgical answers. The one rule in TMJ treatment is avoid TMJ surgery whenever possible.

So who are the TMJ Specialists? There is a group who want to create a specialty of Oral Facial Pain and have been denied specialty status by the ADA or American Dental Association so the are creating their own specialty board and declaring themselves specialists in oral facial pain a dangerous precedent but also rather pointless becaust they want to use the medical model of treating everything with drugs.

The real specialists are dentists who come together to study the intricacies of TMJ disorders. I often call them a small group of old doctors who learn more and more about less and less eventually knowing everything about nothing. Joking aside they delve very deeply into the most minute details.

I am currently the Chair of the Alliance of TMD Organizations and there are several groups who focus on different methods of treating the disorders.

I am a Fellow of the International College of CranioMandibular Orthopedics the Physiologic Group most dedicated to the underlying science involved in treatment utilizing physiologic dentistry protocols taught by the father of physiologic dentistry, Dr Barney Jankelson.

I am also a life member of the American Equilibration Society which is the oldest and largest TMJ treatment organization. They approach the disorder from a more mechanistic approach.

I always go to their annual meeting because I learn new aspects from doctors who approach treatment from a completely different approach. This group is also very focused on intricate details of treatment.

Both of these groups treat the same condition coming from a different direction. Doctors in both groups are successful.

The is another group the Academy of Craniofacial Pain (formerly academy of head neck and facial pain)who are very diverse in their approach. I would describe it as knowing less and less about more and more until they know nothing about everything (in jest) I am also a member of this group and I find they bring into the picture a wider scope of treatment possibilities.

Still another group is the American Academy of Physiological Esthetics (formerly American Academy of Comprehensive Esthetics) They are also a Physiologic Group affiliated with the Las Vegas Institute. They are very focused on physiologic Dentistry as approach to esthetic and full mouth reconstruction. LVI teaches a watered down approach to physiologic dentistry and the science but aree excellent (probably best) at hands on teaching of technique. They take a cookbook approach to Physiologic Dentistry and almost all of their work is based on scientific foundation of ICCMO and Barney Jankelson. I learned Physiologic Dentistry at ICCMO and from Barney Jankelson, Jim Garry, Barry Cooper, Dayton Krajiec and others at ICCMO but I learned to efficiently utilize it for Full Mouth reconstruction at LVIn for magnificent rehabilitations.

There are also orthodontic approaches to TMJ disorders as practised byInternational Association of Orthodontics, another excellent group primarily focused on orthodontics and secondarily on TMJ disorders but consider TMJ in all of their cases. This group is actively preventing development of TMJ disorders during orthodontic treatment.

The Sacral Occpital Chiropractic group, The Nucca Chiropractors, the At;as Orthoganol chiropractors and the Cranio/ Chirodontics group all integrate with dentists to trat TMJ disorders as part of full body function.

The field of Epigenetic Orthodontics is very new and is not yet represented by a group but ist is changing the method of treatment . I utilize Epigenetic Orthodontics routinely to finish TMJ cases after pain is resolved.

The Academy of Dental Sleep Medicine does not consider itself a TMJ organization because they treat sleep apnea. As a Diplomate of the organization I will clearly state this is their biggest failing. The American Academy of Sleep Medicine recommends that dentists treating sleep apnea with oral appliances should have expertise in treating TMJ disorders.

The NHLBI (National Heart Lung and Blood Institute) of the NIH consider Sleep Apnea to be a TMJ disorder and wrote a paper “The Cardiovascular and Sleep Consequences of YTemporomandibular Disorders”

There are two other Organizations that, in my mind have lost their way to some extent in treatment philosophy, one is the American Academy of Pain Management of which I am a Diplomat and the other is the American Academy of OroFacial Pain. Both have moved into treating functional and structural problems with drugs rather than correcting the underlying physiological issues.

I am still a member of the American Academy of Pain Management but that group is no longer part of the TMD Alliance.…