Curing TMJ!

Dr. Shapira Blog, Causes of TMJ, Clicking & Popping, TMJ, Uncategorized 2 Comments

The idea of curing TMJ needs to be looked at in several ways.
Doctors do not actual heal anyone but what they can do is remove the impediments to healing.  The body has a natural capacity to heal, the best medicine allows it to heal.
TMJ disorders are a type of repetitive strain injury often made worse by parafuctional habits such as clenching or bruxing.  The underlying structure often has percipitative problems but the natural adaptability of the tissues, especially muscles allows function until the demands exceed the ability to adapt.  The system gives out at it’s weakest link.

Physiologic Dentistry positions  the jaw ideally to require minimal adaptation. Excessive adaptation causes the  problems but reducing the need for excessive adaptation creates an environment for healing.  The physiologic orthotic positions the jaw in  the ideal position for healing.

Can you really cure any problem you have had for many years?
The answer is no, because living in pain for years has changed you forever.  The process called neuroplasticity creates permanent changes in our nervous system and how we perceive pain The only cure would be a “DO-OVER” ON YOUR LIFE WHICH IS NOT POSSIBLE

If a  total cure  (do-over) is not possible what are the goals of treatment?
Living a high quality of life without pain is a good start. Healing, normal function are all parts of healing. When you jaw problem is no longer a negative issue in your life it is enormous.

Physiologic Dentistry and diagnostic orthotics, airway appliances for snoring and/or sleep apnea,  Trigger Point injections, Prolotherapy, Sphenopalatine Ganlion Blocks, DNA Appliances to orthopedically correct the underlying issues may all be tools used to treat TMJ problems.

The most important tool a dentist has in treating patients is his ears.  Understanding of the problem is understanding the patient.  Each and every patient is unique and there is never a one size fits all solution, but the basic principles remain the same.  The SOAP narrative is the way physicians are taught to evaluate a problem

S is the subjective information that we learn from the patient

O is the objective information such as radiographs and use of computerized scans, EMG, Sonography

A is the Assesment when this information is assimilated to establish

P a plan.  A method to address the subjective and objective information after Assesment.


TMJ Surgery

Dr. Shapira TMJ is a painful condition 0 Comments

Think twice about non-emergency TMJ surgery

tmj-surgeryTMJ is a painful condition, and there are a variety of treatment options. While surgery is one of them, going under the knife comes with risks. That’s why dentists typically only suggest TMJ surgery as a last resort for patients who tried other TMJ treatment without success.

Surgical procedures use unique methods of supporting the jaw and cartilage and removing the factors that cause pain and discomfort. Before choosing surgery, your doctor will talk with you about the risks and rewards, and some potential TMJ surgery risks include problems swallowing, difficulty talking and issues with eating.

TMJ treatment comes in three distinct phases

Phase 1

This phase is all about relieving pain and restoring physiological health to your jaw. Typical treatments include:

  • relaxing your jaw muscles with a TENS machine
  • a diagnostic physiologic orthotic sometimes called a bite splint to correct jaw function
  • practicing simple exercises
  • changing your behavior (putting and end to habits like nighttime teeth grinding, jaw clenching and pencil gnawing).
  • This is the most important phase of treatment.  The orthotic is utilized to correct the jaw position so the muscles and nerves can function ideally. This will properly load the TMJoints to prevent damage.   This is the DIAGNOSTIC Phase of treatment.  This is a preview for the patient as to what can be accomplished during phase 2 treatment.   Do not proceed to phase two treatment unless you are happy with the results of phase 1.

Phase 2

The objective of phase 2 treatment is to bring longer-term stabilization to your jaw. This involves the use of:

These treatments straighten, replace, repair or rebuild teeth in order to stabilize your bite in a balanced, healthy position.

Phase 3

It’s only when none of the aforementioned, less-invasive treatments help, that surgery should be considered an option.

Though temporomandibular joint (TMJ) surgery is a last resort, some patients find that they cannot improve their symptoms with the use of other remedies. Surgeries can involve:

  • an arthroscopic procedure
  • arthrocentesis
  • microsurgery
  • open surgery


Arthocentesis is the least invasive procedure to the TMJ.  It involves washing out the joint and removing adhesions.  It is often done with hydraulic pumping movements   While this is listed in Phase three it can also be considered a phase 1 treatment for some joint issues.  Dr Shapira does arthocentesis on awake patients in his office.  Other patients are referred to Oral Surgeons to have the procedure done with OV sedation.

With an arthroscopic procedure, the dentist will insert needles straight into the infected joint and use enough saline or another liquid to force the jaw open and loosen the cartilage.   Microsurgery uses tools and equipment that let the doctor repair damaged cartilage inside your mouth.

Open surgery surgery is a much more complex and dangerous surgery.  It is usually best avoided.

Is surgery right for you?

The effects of TMJ surgery on patients before and after varies from person to person. The popping or clicking noise that you might hear generally dissipates after a surgical procedure, but some patients still experience headaches, muscle pain and other symptoms.

Before committing to surgery, it’s important to weigh the pros and cons of all TMJ treatments carefully. It’s also critical to involve a dentist like Dr. Shapira, one who understands the principles of physiologic dentistry. If you have questions and concerns about the treatments for TMJ, please come in for a consultation.

TMJ Diagnosis

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How TMJ is diagnosed by a dentist


TMJ is a type of complex disorder that frequently goes undiagnosed or worse misdiagnosed. Patients feel that they can handle the popping they hear in their jaws when eating and ignore the headaches that the condition causes. The physiologic approach to treatment that Dr. Shapira uses gives his patients relief from their headaches, muscle pain, back pain, shoulder pain and all the other symptoms of TMJ.

A large number of patients suffering from the condition develop problems sleeping and with chronic pain. The trigeminal nerve is one of 12 sets of cranial nerves that go directly from the brain to the body without passing through the spinal column.  The Trigeminal nerve is at the heart of the physiologic system controlling the jaws, teeth jaw muscles, jaw joints, and controls blood flow to 2/3 of the brain thru the meninges.  The trigeminal  nerve that controls  the flow of blood to the brain and  can cause headaches, migraines and other types of pain when impaired, and disruption of normal function of that nerve can lead to TMJ.

Diagnosing TMJ through patient history and examination

Your TMJ diagnosis requires a detailed history and interview prior to performing an examination.  I usually like when my patients have pain to start by eliminating all or most of their pain.  I then understand their problem better and can discuss what the cause of the pain and decide the best way to eliminate your problems.  A patient history, also known as a medical history, lets you inform me of any symptoms you experienced in the past that might relate to the pain you feel.  The check list nature of the history and exam insure an approach that does not miss important information.  You also need to explain to me any medical conditions you currently have, any medications you take and any surgeries you had in the past.

Depending on your specific history I will chose a  long or short examination that looks at your mouth, jaw, neck and other areas of your body. If a doctor previously diagnosed you with the condition, or you received a different diagnosis in the past, arrange for your former doctor to deliver your test results to your current dentist. After the examination, the dentist will determine if you need any further testing.  If a shorter exam is chosen to save the patient time and money it is possible a more thorough exam may later be required.

Tests used in your TMJ diagnosis

Physiologic Dentistry uses sophisticated computerized scan that show how the jaw functions in real time.  When utilized with ultra-low frequency TENS it is possible to evaluate the physiologic health of the bite.  This is often used in conjunction with surface EMG that allows the TMJ Dentist to evaluate muscle health, function and most important symmetry.  Sonography is used to measure joint vibrations to give functional information about joint status.  These test are more specific for treating TMJ dysfunction and eliminating pain and dysfunction.

tmj-k7-2Dentists typically use several types of imaging as well, when looking for TMJ problems.  A screening panoramic radiograph is usually the best study to evaluate the entire dental system including the jaw joints and to screen for other problems.  An MRI scan is specifically used for evaluating the soft tissue in the joint including the disc and is usually used prior to surgery or following a motor vehicle accident .  The MRI is ideal when evaluating soft tissue growths, saliva gland, lymph nodes and other areas where organic disease may exist. CT scans are used to evaluate bony structures.  There is always a balance between radiographic exposure to x-rays and the information obtained and CT scans expose patients to more addition.  Cone beam CT’s are becoming more popular with dentists and patients due to lower exposure than medical CT scans  These tests get an inside look at your the soft tissues, bony structures and the  muscular system, which helps the doctor get an idea about the cause of your problem.

Other common tests include an EEG or a Pet scan. Doctors often use these exams when searching for the cause of your headache, and potential diagnoses can include cluster headaches or migraine headaches.

If you also have problems sleeping, pain in your neck, shoulders or back and pain in your jaw or mouth, the doctor might diagnose TMJ disorder. Though many people think that the condition involves popping or locking of the jaw, some patients never experience any of those symptoms. A large number of patients seek treatment for their headaches and later find that they suffer from TMJ.

Finding relief from TMJ

Finding relief from your TMJ is easier than you might think.  The majority of patients see 50-80 % improvement within a couple of visits and many patients have almost miraculous relief after only one treatment visit with their diagnostic orthotic.

I had one patient who had a continuous headache for over 50 years that went away after one visit. Headaches, migraines and jaw pain (TMJ) are the most common symptoms.  Some  other common symptoms of the condition include difficulty sleeping, problems opening your jaw,ear pain and stuffiness, tinnitus or ringing in the ears, issues eating or chewing and poor speech skills. TMJ can affect people of all ages, and left untreated, the symptoms can worsen. The longer that you leave your condition untreated, the worse your problems can become in the future.

It is important that you talk to a TMJ doctor or specialist as soon as possible about your TMJ and the type of treatments that are available to you. Your doctor will take your medical history, talk to you about your symptoms and perform the necessary tests before diagnosing you.  Frequently, Dr Shapira will temporarily eliminate the pain during the consultation appointment to help understand the root causes of the pain.

Today is the day that you talk to a TMJ specialist and finally find relief for your medical condition. To learn more about how doctors diagnose you with this medical problem, the types of treatments available to patients and what you can do to find relief, download a copy of my e-book.