TMJ Splint Therapy

Splint and Other Names.

Discussions about splints can often be confusing as there are many other words used for splints:  bite plate, bite applicance, mouth guard, night guard, night splint, occlusal appliance, orthotic, brux guard, mouthpiece.

Have You Tried Conservative Treatment Options?

It is true that most TMJ disorders will be helped with natural, home and professionally non-invasive treatments.  There is no harm in trying these options in conjuction with Stress Management and possibly Psychotherapy. The decision to wear a mouth splint for TMJ syndrome should only come after you have tried more conservative treatments and are certain that none of them can help your TMJ
disorder.  In addition, you have found a reputable TMJ specialist with experience in orthodontics that you feel comfortable with and trust.
Preferably, given your condition, the TMJ specialist will have encouraged you to exhaust all home remedies and non-invasive medical procedures prior to a discussion about Splint Therapy.  Even though the wearing of a splint is not an invasive option the follow up to a splint will very likely be invasive.

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Splints Types

Stabilization splints prevent night-time Bruxism, the clenching and grinding of teeth.  This type of  splint covers all the teeth and can be manufactured using a hard or a soft material.
Repositioning splints are worn 24 hours a day and are adjusted regularly by an orthodontist to get the joint (TMJ) to slowly end up in the correct position in the socket. 
Wearing a correctly made splint is said to allow the muscles to relax and therefore help rid you of jaw and face pain.  A splint will also protect teeth from wear and tear, stress fractures and chipping.

Why You Need a Splint

Your TMJ or joint and teeth are correctly positioned when all your teeth make simultaneous contact at the exact moment the condyles are seated in the most stable position in the sockets.  In this ideal position , there are no forces to damage the disc, joints or teeth and the muscles are relaxed or in a neutral position.
For TMJ disorders, your teeth may come tgether but the joint is pulled out of the socket.  This position leads to Buxism , the grinding and clenching of teeth at night.  Another TMJ disorder has the joint positioned correctly but the teeth do not come together correctly or only partially.
Treating a damaged joint with splint therapy is not a cure.  The splint will help manage the problem by placing the joint in a less traumatizing position so pain and future damage are minimized.  You may experience difficulties with wearing a splint such as a problem speaking, sleeping and it may be uncomfortable at fiirst. You will have to modify your diet somewhat, choosing softer foods.
A correctly made splint will put the joint in the right position and provide a bite where teeth, muscles and joint do not work against each other. If your symptoms improve from splint use then it can determined that the problem is definitely TMJ dysfunction. 
Some people who are having success with their splint in relieving their TMJ symptoms opt to continue the therapy instead of proceeding to the next phase.

Phase One - Getting the Splint

Apart from giving your medical history the doctor should also know about any dental history and if you have had any accidents or injuries. Give a detailed account of your TMJ symptoms such as headaches, pain and any sleep disorders. The doctor will examine you thoroughly and take X-rays of the jaw and a panoramex film.  An MRI or CT scan, though expensive, are well worth the money to get a good diagnosis from the doctor.
 
Once the doctor has his diagnosis he will discuss a treatment plan and what it may include.  Obviously a splint and perhaps medication to help reduce pain and muscles spasms and inflammation.  He may also recommend physical therapy to strengthen and increase range of movement which will help to prevent further joint injury.  The doctor may suggest injections to relieve trigger points in muscles or
alleviate inflammation.  In some cases, severe myofascial pain and headaches can also be treated with Botox injections.

Dental moulds of your teeth will be taken and precise measurements made.  Lastly your splint will be checked for fit and the doctor will inform you about care of your splint device.

Next Phase After Splint

You have been getting good results now for several months from wearing a splint 24/7 and it is time to take it out.  However, once a splint has been worn for a period of months or in some cases years, you will likely find that it has changed your bite and jaw position. 
At this point you will enter the next phase of therapy which can include the following treatments:

 Reshaping and/or grinding the teeth
 Braces
 Crowns, bridges or veneers
 Surgery

These treatments are permanent, cannot be reversed and there is a possibility that they may not work.

Splints and Research

It is important to note that there has been no significant or extensive research done on splints as a treatment for TMJ.  Be very caution
before beginning any treatment option that can cause irreversible harm.  Seek several independent, professional opinions prior to
commencing any treatment.


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The Anatomy of The Temporomandibular Joint

Dem Bones.

TMJ is really the hinge that allows us to open and close our jaw. However,we commonly refer to any pain or dysfunction in the hinge as TMJ or TMD (Temporomandibular Dysfunction).  Right now we are just looking at the anatomy of the temporomandibular joint .

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Let us start by taking a look at the bony structure of the TMJ or temporomandibular joint.  There are two TMJ joints, one on each side of the skull.  The name comes from the two bones that make up the joint.  One is the bone on the side of the skull called the temporalis bone and the second is the lower jaw bone which is called the mandible. Hence the name temporomandibular joint.  These joints are located just in front of your ears.  These joints are nothing more than hinges which allow us to open and close our jaw.

Between the Bones.

Surrounding the TMJ joint is a capsule of fibrous material.  Between the bone joint is a special disc which is an extension of the capsule called an articular disc which is formed from a flexible, tough yet elastic tissue called fibrocartilage  Our ears are made up of this fibrocartilage.  This thin disc divides the joint into two cavities.  When the joint is in motion or there is pressure on the articular disc it releases synovial fluid into the cavities and this fluid acts like a shock absorber and reduces friction.  There is only one other place in the body that require an articular disc and that is where the top of the sternum, clavicle and first rib all meet.  At first, when you open your mouth a rotational movement occurs with the lower jaw and the disc but when you open the mouth even wider there is a second movement called the translational or forward and downward sliding movement of the disc and the jaw.  The two ends of the mandible or jaw are called condyles which comes from the word ”condyloma” which is derived from the Greek word ”kondylos” which means a knuckle or a knob. Further, “condyle” refers to a rounded articular surface.  This knob or condyle butts up to the underneath side of the TMJ disc.  On the mandible the glenoid or mandibular fossa meets the upper side of the disc and is a depression or concave-shaped.

Joining It All Together.

Ligaments are strong, tough, rope-like connective fibres. They connect bones to each other and connect cartilage to joints.. There is one primary and two secondary ligaments of the TMJ.  The temporomandibular ligament is the primary ligament which consists of two parts; the outer oblique portion or OOP and the inner horizontal portion or IHP.  The two minor or secondary ligaments are the stylomandibular ligament and the sphenomandibular ligament of which neither is directly attached to any part of the temporomandibular joint.

During movement only the jaw moves. Muscles attached to the bones and joints allow a variety of movements.such as yawning, chewing, talking, singing, shouting and swallowing, making the temporomandibular joints the most flexible in the human body. These sophisticated joints can move up and down and side to side in a wide range of motion and in a normal healthy jaw there is no pain or discomfort with these movements.

Muscles and The Nerve of It All.

The four muscles of mastication move the jaw or mandible.  They are the masseter, the medial pterygoid, lateral pterygoid and the temporalis.  The Trigeminal nerve is the sensory nerve for the face and the motor nerve for the mastication muscles  As the name suggests, the trigeminal nerve is made up of three branches.  The ophthalmic V1, sensory, the maxillary V2, sensory and the mandibular V3,motor and sensory branches.

TMJ Disorders, Pain and Discomfort.

Muscle fatigue from clenching the jaw or grinding your teeth, arthritis, and jaw injury are some of the causes of TMJ disorders. Understanding the anatomy of the joint will help you to better understand the workings of the TMJ and how surrounding bones,ligaments, nerves.and muscles can be affected when you experience temporomandinbular disorder.


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TMJ and Stress

Chronic Stress Can Lead to Physical Disorders

Anyone who has TMJ  or TMD will have their own unique profile.  There will always be several factors contributing to their dysfunction for instance, stress, arthritis, trauma or accident, even birth defects to name but a few.  Stress is one of the primary contributing factors leading to TMJ.

If you are feeling threatened in any way the body's natural automatic stress response is designed to protect you from aggression or predators.  This is often referred to as the "fight or flight response" which prepares the body to "fight" or "flee" from a threat to your survival.  The body releases chemicals and hormones to provoke action on your part as well as communicate to areas of the brain controlling motivation, mood and fear.  Once the situation that triggered the  response has been dealt with the body and mind will return to a relaxed state.

Stress is a normal reaction to all the demands you must meet everyday and while some stress is beneficial long-term stress can be harmful.  Long-term stress puts you at risk for diseases  such as high blood pressure, heart disease, depression, weakened immune system and  many others. With chronic stress in your life, the mind and body will suffer. 

In today's society there are many stresses that you often cannot fight or run from and so you must sit and wait until a later time  to deal with a situation.  This can cause aggressiveness, hypervigilancy and over-activeness and then you act in ways that are self-defeating and work against our emotional  and physical well-being.  The build up of stress hormones in the body can lead to psychological and physical disorders.  Examples of physical disorders are teeth-grinding, muscle tension or headaches.


It is no wonder then that stress is a major factor in TMJ or TMD. The same nerve that is activated in the "fight or flight response" , the Trigeminal nerve or fifth cranial nerve, is also used by the Temporalis, Masseter and Pterygoid muscles used to chew, bite and swallow your food.

Research tells us that more women have TMJ than men.  Even though men have more stress than women the research shows that men have better outlets for relieving stress than women do in our society.  In the human body the autonomic nervous system and endocrine system are the control mechanisms by which stress is translated into a physical response. High stress levels have been associated with TMJ pain.  What physical responses do you have to stresses in your life?  Do you bite your fingernails, chew on a pen or pencil, clench your jaw,  gnash your teeth.   Perhaps your posture changes from being standup straight to being hunched over or head and jaw jutting forward which puts added weight on neck and shoulders.  You may even be asleep while your body manifests its stress in physical ways such as bruxism, the clenching and grinding of teeth.  Have you ever woken in the morning with a headache or migraine and experienced a dreadful pain behind one eye or on one side of your head?  Have you ever felt a throbbing pain on one side of your head that is very sensitive to the touch?  Do you suffer from stiff neck and shoulder pain?

How to Deal With The Stress

Dealing with stress is your best defense against the resulting symptoms of TMJ. Take a good look at areas of your life that are causing you stress. Make your home environment soothing and free of clutter.  Have an tranquil spot where you can go to relax.  It may be a home spa decked out with  soothing music, aromatherapy or delightful bubble bath or a shady spot in the garden where you can read your favorite book. Give your home positive energy with Feng Shui and add live flowers and well placed items that have meaning for you.

How is your attitude?  If you can perceive your life in a positive way this can help you lower stress levels. Most people I meet seem to have a degree of "perfectionism" in them which often causes them stress as they can never live up to their own idea of perfect. Overcome that need to be "perfect" and let yourself relax.  One way is to be happier and laugh at yourself when something does not turn out just the way your wanted.  Remember Bridget Jones and her "blue soup"?  Find your sense of humor by looking for the humor in everyday events or rent some funny movies that will make you laugh.  

Try positive affirmations if you recognize that the little voice in your head is too negative.  Get that voice to start speaking positively.  Try visualizations to send your worries and stresses up in a balloon, high into the sky until it disappears from view and then relax by letting go of those stressful thoughts and issues in your life.

Are you overloaded with too many things to do? Learn to say "No" and do not overload yourself with more than you can handle. If you find saying "No" too hard then say "Yes, but I wont get to it until next week" or "next month".

Take a close look at your relationships and end any relationships that are toxic to you.  Make new relationships with people that make you feel better not worse.  Let their "feel good" behavior rub off on you.  Mimic their behavior even if it feels awkward to you at first  and pretty soon you will find that your attitude becomes more positive and you are happier.  If you cannot totally avoid people that cause you stress then try to see them as little as possible. Why would you invest in a relaationship that makes you feel stressed?

Deal with resentments and let go of anger. Learn to communicate your feelings and not hold them in.  If you cannot talk to the person or a friend write down the issues that are giving you stress.  Realize that you cannot change other peoples' behavior.  You can only change your own  and by doing so you will see a change in their behavior.

 It is important that you take good care of yourself.  Make sure your diet is healthy and you are avoiding eating foods like sugar and caffeine.   Make sure you are getting a good night's sleep.  Eliminate late nights and excessive intake of alcohol.  Invest in a good pillow that will allow you to sleep on your back.  Get plenty of exercise and fresh air. Any exercise whether gentle and slow like Yoga or demanding and fast like running will help relief built-up stresses.  Make time for a hobby that gives you pleasure.

TMJ and You

Evidence shows that 75% of TMJ sufferers will benefit from stress-relief techniques.  Do the TMJ exercises and methods of relaxation that best suit you.  Continue with your chosen treatments and medications.  However, if your teeth are misaligned then you need to seek out the help of a professional doctor or dentist. The goal is to relief TMJ pain and getting rid of stress will be a major contributing factor to your recovery from TMJ or TMD.


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