TMJ Orthotics

Dr. Shapira Chicago, Deerfield, Evanston, TMJ Orthotics 16 Comments

How do orthotics help your TMJ?


TMJ is a medical condition that affects your muscular and nervous systems, which explains why many patients experience pain in their shoulders, backs, and necks.

While some think the only symptoms of the condition are a popping in the jaw and jaw pain, it can manifest in various ways, including keeping you from getting a good night’s sleep and preventing you from chewing your food properly.  Chronic headache or migraine is one common symptom that is often misdiagnosed.

There are a number of different causes of TMJ, including trauma to the mouth, clenching your teeth, joint inflammation, arthritis or another degenerative bone disorder. Any type of damage to the joint, including damage caused by a disease or injury, can lead to symptoms of this disorder, but an orthotic can provide some relief.

What are TMJ orthotics?

Orthotics are orthopedic appliances designed to correct underlying orthopedic or occlusal pathology.  A diagnostic physiologic orthotic is an orthopedic appliance utilized to evaluate treatment positions and effect of reversible treatments before long term corrections are made. TMJ orthotics are ideally made to a physiologic position and they are worn 24 hours/ day seven days a week.  The changes that occur are not only in the position of the jaws and jaw joints and jaw muscles but rather changes that occur through the entire postural chain from head to toe with the majority of changes taking place between the head and the sacrum.

All orthotics are not alike.  Depending upon the design and fit orthotics can have little to no effect or even increase symptoms. The orthotic is designed to unload the joint (a mechanical effect) and to relax the muscles and give a physiologically health landing position.  Some patients may require seperate daytime and nighttime orthotics.  During the day the orthotic is used for all aspects of daly living and must be comfortable and attractive.  Orthotics must be worn continuously to allow healing to occur.  Part time orthotic wear may give some relief but full-time wear is ideal when permanent correction is sought.

A TMJ orthotic is distinctly different from a Bruxism Appliance.  A Bruxism appliance is a small device designed to prevent the symptoms of bruxism, which is the medical term for teeth grinding. Also known as mouthguards, mouthpieces and bite plates, these devices fit inside your mouth and provide little to no discomfort. Made from a multitude of strong  materials, your dentist  can chose from a variety of materials whether he or she wants a hard or soft appliance or a combination appliance.  The bruxism guard is fit over your upper teeth or your lower teeth, and it will keep you from causing damage when you are grinding your teeth.  Instead of wearing down your teeth you wear out the plastic which is softer than your teeth.

The motion of moving your jaw back and forth can slowly wear down the enamel and cause cracks and chips to form in your teeth. This motion can also increase your TMJ symptoms and cause additional pain. Bruxism appliance are similar to the some mouthguards that you might use while playing football or another sport, and these products offer a temporary solution to the pain and discomfort that you feel.  The TMJ orthotic can also be used for sports but is designed to improve performance  and idealize physiological function as well as protect the teeth from trauma.

Other phase one treatments

tmj-bite-orthoticIn addition to a TMJ mouth guard, there are other non-surgical TMJ treatments available to you. During the first phase, the doctor will look at remedies that won’t interfere with your life or daily activities.

Physical therapy, which includes using heating pads or cold packs and exercising, is one way to strengthen your teeth and reduce your TMJ symptoms. Your physical therapist will work with you in the office and give you exercises that you can use at home, including exercises that show you how to reduce your bite and increase the strength of your upper or lower jaw.

Spehnopalatine Ganglion blocks are frequently used when there is an autonomic portion to the pain.  This is frequent in chronic daily headaches as well as many types of migraines as well as other issues.  They stimulate a relaxed condition that frequently alleviates pain and prevents it return.

Trigger points in muscles are also looked at during phase 1 treatment.  Ultra low frequency TENS can eliminate much or the muscle spasm and chronic hypertonicity.  Trigger points are sometimes resistant to general treatments but respond well to trigger point injections and spray and stretch techniques utilizing vapor coolants.

A locked TMJoint can cause excruciating pain if you try to force it open.  The body frequently utilizes muscle splinting to protect an injured area.  The muscles tighten up in a patterned response to protect the injury. This is not the same as muscle spasm which is uncontrolled muscle contraction often due to inflammation or injury of the muscle.  The sooner a “lock” is reduced the faster pain will diminish and muscle tightness will dissipate

Myositis is an inflammation of a muscle usually from organic causes.  It is very painful with function and function is severely limited.  There can be different types of muscle pain occurring concurrently.

If you have frozen muscles that do not move or loosen over time, the doctor might suggest steroid injections. A small needle inserted into the jaw or neck forces the steroid deep into the muscle to unfreeze the area. Some forms of medication, including anti-inflammatory medications, can also reduce your symptoms. Steroid are usually not a first choice for treatment but can give relief.

Depending on the severity of your TMJ, your dentist may either recommend over the counter medications or give you a prescription for an anti-inflammatory or pain medication.  The best is treatment is to eliminate the causes of the pain and inflammation and to allow healing to occur.  Use of strides or anti-inflammatory meds will give poor results if the underlying cause is not addressed.

There is no “CURE” for TMJ but treatment can eliminate the pain and dysfunction vastly IMPROVE YOUR QUALITY OF LIFE!


There are permanent changes that occur from long term TMJ disorders and/or pain.  A “TRUE CURE” would give you a do-over on the years you spent in pain which changes you physically and mentally.  Many life choice are altered when we are in pain.  We will make recommendations on multiple treatment options.  The final option always belongs to you, the patient. We strive to find treatment that works perfectly for you, but we rely on you to defining what perfect is.  A TMJ orthotic helps improve your bite, unloads the joints from excessive pressure and allows muscle relaxation while preventing damage from bruxism.   The more advanced physiologic orthotics are designed for 24 hour continual wear.

Other treatments include braces, cast orthotics, DNA Appliances and surgical procedures, but your doctor will work with you before determining that you need one of those more complicated procedures. You shouldn’t feel tied down because of the TMJ symptoms that you experience on an average day. Patients today will find different products that will let them recover and beat their conditions.

If you have questions about whether TMJ orthotics can improve your health, smile, posture, breathing and reduce your symptoms, please read my e-book on TMJ today.

TMJ Treatment

Dr. Shapira Chicago, Deerfield, Evanston, Highland Park, Kenilworth, Lake Bluff, Lake Forest, Libertyville, Lincolnshire, Mettawa, Morton Grove, Northbrook, Northfield, Skokie, Treatment of TMJ, Vernon Hills, Wilmette, Winnetka 4 Comments

How TMJ is treated by a dentist

tmj-treatment3Finding the reason behind the pain that you feel is the best method for a dentist to determine how to treat your condition. Though many patients assume that all type of TMJ treatment are the same, treatments vary significantly from patient to patient.  There are a wide variety of TMJ disorders and frequently there are multiple factors to account for.  Your TMJ problem may be as individual as you are.

The discomfort that you feel typically relates to the way your condition affects your body.

With TMJ, a patient’s nerves, muscles, ligaments and tendons all function in less than ideal ways that causes the patient to feel uncomfortable or in pain. Your dentist will work with you to determine which combination of  remedies and treatments will bring you the most relief.  Dr Shapira is your partner in finding your path to the life you deserve.

TMJ treatment phases

When Dr Shapira determines your diagnosis of TMJ or associated disorders, he will describe the three different phases of treatment. The first phase is the most important phase which is to restore your quality of life as quickly as possible.  It involves non-invasive procedures that do not require surgery. Those treatments can include orthotics, physical therapy and other non surgical TMJ treatment options as well as minimally invasive procedures such as trigger point injections, prolotherapy or SPG (spenopalatine ganglion ) blocks. Orthotics may include a diagnostic physiologic orthotic, nocturnal bite splints, pivotal appliances for TMJ locking or other modalities such as an Aqualizer that uses a basic law of physics to equalize pressure on both joints and relax the musculature.  The second  phase is long -term management after pain relief is accomplished.  It is all about maintaining comfort for life.

Phase 1

Fotolia_35843554_XS2This phase of TMJ treatment is all about restoring your quality of life.  Dr Shapira will dissect your problems to answer each of the problems that make up your specific issues.  The mainstay of Physiologic Dentistry is a diagnostic orthotic, a device that lets you experience the life improving results before committing to extensive treatment.  Patients are told to expect 50-80% improvement within just 2-3  visits.  There is no “ultimate cure” for TMJ but many patients experience almost miraculous cures while other patients have a longer road to reach their goals.  The use of behavior modification, which teaches you how to do simple daily activities without causing additional pain or discomfort is often needed initially but are goal is a complete return to normal function.  Dr Shapira will make you his partner as the guardian of your health and welfare putting you in charge of your future health!

Simple TMJ jaw exercises can  provide relief for some patients but others require guided treatment to relieve the pressure on your nerves can lead to increased pain. Just  strengthening  the muscles in your jaw is not a promise of success.  The creation of an environment where healing occurs is actually the most important aspect of treatment.  We use our jaws twenty-four hours a day for breathing, eating, talking, kissing and to maintain proper postural health.  Dr Shapira builds that healthy bite into your diagnostic orthotic.

Phase 2

Phase two is embarked on when you are feeling good and your body has had a chance to heal.  There is no “Cure” for TMJ because you have changed due to your months or years of pain.  A cure would entail a do over on the part of your life lost to pain.  I want you to have the best life possible moving forward where TMJ and MPD do not adversely affect your life.  Many patients feel as if they are “Cured” but they are not the same as if they never had a problem to begin with.

This phase of TMJ treatment includes the use of occlusal equilibration or coronoplasty for some patients.  This is minute adjustments to the bite to make it function better.  Other patients may require orthodontics or reconstruction to achieve long term stability.  Dental implants can be used to replace missing teeth when necessary.  Phase two can utilize cast onlay orthotics, partials or dentures.

Bruxism which occurs when you grind your teeth at night may require treatment with a night appliance to protect the muscles, joints, teeth as well as the restorations.

The use of other orthodontics can reduce your discomfort and give you a healthier bite.  This can be through standard orthodontic procedures.  The DNA Appliance is an exciting and more comfortable alternative to braces that is worn during sleep and a few additional hours a day.  It allows us to grow your jaws to a more ideal size and shape while permanently correcting your bite.

Crowns, also known as caps, let the dentist repair damaged teeth and reduce the gaps between teeth, while braces are a good option for those with healthy teeth who still suffer some pain.  A full mouth restoration can restore your entire mouth in just a few visits and is an exceptional treatment for many cases.  Due to the cost many patients feel they cannot afford this treatment but financing can make it available in affordable monthly payments.

Phase 3

The majority of patients never need this phase.  The goal of phase 1 and 2 treatment is to avoid temporomandibular joint surgery whenever possible.  Orthognathic surgery is also a phase 3 treatment that can create an ideal situation but carries significant risk.  The DNA appliance can comfortably create orthopedic growth without surgical intervention in may patients.

This phase of TMJ treatment is the most invasive option and typically requires some form of surgery. If the dentist can determine the root cause of your pain, the doctor can do microscopic TMJ surgery, which lets the dentist carefully repair a damaged joint or nerve from an incision made in an out of the way spot.

If you suffer from lock jaw, which is one of the more common symptoms of the condition, your dentist may recommend arthrocentesis. With this procedure, the doctor places needles inside the affected joint and pushes a saline solution through the needles. The liquid slowly works its way through the jaw and loosens the joint and surrounding cartilage. Other forms of surgical intervention can give you some pain relief.

Need to know more?

tmj-questionsA TMJ orthotic is almost alway the starting point for therapy.  Surgery is rarely the first option but in the case of severe degenerative changes it must sometimes be considered.  TemporalMandibular Joint surgery should always be approached cautiously.  Almost all patients can be managed without surgery.  The longer that you live with your condition, the more work you need to do towards repairing your mouth and jaw. While surgery is one option, it’s often the last resort.

Remember Quality of life is your most important outcome.

Your dentist will suggest that you use jaw strengthening exercises, bite plates and other remedies before recommending jaw surgery, braces, tooth grinding or crowns. To learn more about TMJ and the best treatments for the condition, download a copy of my e-book today.