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Got Those Temperomandibular Blues?
By Dental Patients Magazine

"Maybe you need to have your TMJ equilibrated," said one young mother to another. "Before my dentist equilibrated my TMJ, our youngsters nearly drove me out of my mind."

This may sound like something out of Alice in Wonderland, but, if you know what the mother's talking about, it makes a whole lot of sense.

TMJ stands for "temporomandibular joint." This is such a mouthful that dentists like to use just the initials. It's the name of the joint just in front of the ear where the lower jaw hinges. There is one on the right side, and one on the left. When one of them or both is forced out of place, it may lead to such distressing or painful conditions as earache, headache, head noises, clicking sounds, dizziness, nervousness and even mental troubles.

For such ailments as these, doctors may prescribe hot and cold packs, diathermy, massage vibration, rest, surgery, psychological treatment or drugs. While all of these remedies are useful at times, they often do not bring permanent relief if stress in the joint is the real cause of the trouble.

When the cause is stress in this joint in front of the ear, as it often is, a safe and highly successful dental treatment may be the solution. This treatment is known as "equilibration" (pronounced ee-quil-i-bray-shun); it simply means equalizing the muscle forces to restore the lower jaw and its joints to their normal unstrained or neutral positions.

How do the joints get out of adjustment in the first place? It might be from a blow on the chin, a muscle spasm, or opening the jaw too wide (as when biting or yawning). In some cases, chronic tension, anxiety or anger can exacerbate or even initiate the problem. Probably the most common cause is chewing with teeth that come together in a wrong way. Dentists refer to this condition as "malocclusion."

We close our jaws in chewing food, of course - and most persons also press their teeth together one or two thousand times a day between meals in swallowing. If the teeth do not meet properly, the pressures on them during chewing and swallowing may force the lower jaw into a strained position that pinches the joints in front of the ears.

If you could see through the skin and get a side view of the TMJ, you would see how the mandible, or lower jaw, hinges to the skull (see diagram below). The joint consists of a ball-and-socket arrangement, with the ball being a rounded mass of bone in the back part of the lower jaw that fits into a socket at the base of the skull. When you open and close your jaw, this "ball" rotates in its socket, and - if the teeth push the jaw too far in any direction - the soft tissues between the bones are pinched.

One trouble that sometimes follows this pinching is a slow loss of hearing, according to some authorities on TMJ disorders. For example, there is the case of a man who was losing his hearing and had been wearing a hearing aid for two years before he learned of equilibration. He had not noticed any discomfort at the joints in front of his ears, nor that his teeth were not meeting properly, but suspected that his teeth might somehow be causing stress. So he went to his dentist, who made the necessary changes on the chewing surfaces of his teeth. Three days later, the patient's hearing had improved to such an extent that he discarded his hearing aid. He has not needed it since. That was nine years ago, and his hearing is still good.

Not all patients respond so quickly nor so completely as that, of course, and there are many other causes of deafness, the authority points out - but pressure at the TMJ should not be overlooked.

Besides hearing trouble, equilibration experts say, stress in the TMJ can cause neuralgia, stiff neck, running ears and itching ears. There was a woman who so much suffered from itching ears that in company she often had to excuse herself from the room to scratch her ears. X-ray pictures showed both temporomandibular joints to be out of normal adjustment. After her dentist corrected the chewing surfaces of her teeth, the itching gradually left. X-ray pictures showed that the joints are now in proper alignment.

It is not uncommon for stress in the TMJ to bring on head noises. A patient who wore artificial dentures in which the teeth were out of adjustment, forcing the left side of his jaw backward until the joint on that side was under considerable stress, experienced almost immediate relief from roaring sounds in his ears after being treated by his dentist. This was several years ago, and the roaring sound has not returned.

Although the connection between stress in the TMJ and troubles cited is not fully understood, it is known that there is a connection, because when the condition in the joint is corrected, the troubles often disappear.

How does the dentist restore the joints to a normal condition of equilibrium? As part of the treatment he may change the slopes of the natural or artificial teeth, or make the teeth higher or lower to bring the chewing muscles into proper working relationship. Sometimes he reduces pressure on the front teeth so that the chewing forces fall more on the back teeth. (If the ball parts of the lower jaw have been pushed too far up into their sockets, this "pivoting" allows them to settle down again into their normal relaxed positions.)

As the TMJ authority notes, one advantage of equilibration treatment is that it can be done in the dental office and, in many instances, saves the patient from the more radical treatments of surgery or injection of chemicals into the joints. Quite often, in fact, equilibration is the only treatment needed.

As with other treatment, prevention is an important aim of TMJ diagnosis. Because TMJ stress sometimes builds up gradually, with the patient suffering no inconvenience at first, the lower jaw and its joints should be checked regularly for equilibrium to prevent troubles down the line.
Reprinted from YOUR SMILE, the Dental Patients Magazine.

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