TMJ Diagnostics

Appropriate TMJ Diagnostics:
TMJ in most instances is primarily due to an underlying  jaw misalignment.  In cases of trauma, but for the underlying misalignment, the TMJ would self correct. Knowing this dictates what TMJ diagnostics should be taken.
Definition: Jaw misalignment – a condition in which the teeth do not support the jaw in the same position where the muscles suspending the jaw want the jaw to be. This requires the jaw muscles to accommodate to the tooth position, thus causing the jaw muscles and trigeminal nerve to become hypertonic / hyperactive. This condition is present in varying degree in over 95% of the population from suspected multigenerational dietary inefficiencies.  Dental therapies can also cause this condition to become worse.
The records that a doctor uses to assess a condition are dependent upon his model of pathology.  For me, I view jaw dysfunction to be a musculo-skeletal discrepancy.  This is a condition that is present and covertly impacts the vast majority of patients facing orthodontic treatment.  Hence, for TMJ diagnostics, I want as a minimum jaw motion analysis

kinesiograph

(computerized jaw tracking with a kinesiograph), CAT scan or tomographic x-rays of the temporomandibular joint, and photographs and models of the teeth.  Occasionally, an MRI is required if jaw function so indicates.  If there are medical conditions that are possibly interacting, blood tests may also be required (substance P levels are often beneficial). Jaw motion analysis is now required in Japan for orthodontic treatment if payment is to be forthcoming  from the national health insurance.  Unfortunately, in this country few orthodontists have yet to comprehend the need for functional tests in order to get the jaw aligned as well as the teeth.

16 Responses to TMJ Diagnostics

  1. Alison says:

    Dr Jennings your name was given to me – I have a four year old daughter with CP and PMG. She has a very high upper jaw and an overbite – both typical in CP kids. Can you point me to more information on how you would treat this?

    Thank you
    Alison

    • Dr. Jennings says:

      Alison:
      Treatment with CP children can take various paths depending upon cooperation level. Ideally, the patient is treated orthopedically by placing the lower jaw on an ideal open/close trajectory (this corrects overbite) at the ideal height (height is a major influence on systemic muscle tone). This is most often accomplished with upper and lower removable appliances that places them on an ideal open/close trajectory. Once anterior/posterior position is determined, the same appliances can be used to develop width as necessary. In many cases this is done at a pace that suits the developmental status of the patient, cooperation level, and the response to treatment. Treatment is primarily driven by medical needs based on thorough knowledge of how dental orthopedic factors influence musculo-skeletal development. At a consultation appointment, a much better assessment can be made, with the exchange of a lot of information as to how bite correction can influence CP and PMG. Dr. J

  2. M. Tanner says:

    Does Medicare cover any of these expenses?

    • Dr. Jennings says:

      Medicare does pay for splints, but I do not take Medicare because it requires that I service the splint for free for 6 months (they don’t understand that treatment is a process, not a procedure).

  3. Nikki says:

    Dr. Jennings,
    I was listening to a podcast you did with Dave Aspry. Do you have anyone that you recommend in the chicagoland area? Also, what is considered a perfect bite? Should there be no element of an overbite whatsoever, even if it is slight? Curious more about the bite as I am undergoing splinting treatment for TMJ.
    Nikki

    • Dr. Jennings says:

      Nikki: There are biomechanical reasons why most persons end up tip to tip. Some with underbites. I would check out either Tim Crowe, DDS or Jim Mckee, DDS in Chicago.

  4. Paul Holmes says:

    Hi Dr Jennings,

    I also just finished listening to your interview with Dave Asprey and was blown away. I’m a chiropractor and have been aware of the neuromuscular links with TMJ and overall function. However, it is far more than I previously understood. I live in the UK, in Edinburgh Scotland, and would really value any guidance you might have of dentists you know who are working in a similar way to yourself.

    Many thanks for the invaluable information and service you are providing to the world.

    • Dr. Jennings says:

      Paul: My approach is unique though there are other dentists doing good things. In England I would check out Dean Richard, Patric Grossman, and Noel Stimson.

  5. Donna says:

    Dear Dr. Jennings,

    Thank you for your valuable site. I have several questions: (1)Do you have thoughts regarding the customized NTI orthotic? (2)Is it possible to get a good diagnostic workup without an MRI. I am sensitive to everything and fear that the electromagnetic fields might not be a good fit for me. (3)And finally, do you have any recommendations for dentists using your approach in upstate NY area? I am in Albany, NY and could travel to surrounding areas. Many thanks for your time and expertise.

    • Dr. Jennings says:

      Mri’s are rarely of benefit in early diagnosis. Best person in your area is Barry Cooper, he also has office in Manhattan. NTI is not good in that bite needs to be supported on molars not front teeth

  6. Donna says:

    Dear Dr. Jennings,

    You mention that folks come to see you from a distance. I am in upstate NY and you kindly recommended Barry Cooper. However, I am wondering if you feel it is possible to assist me even though I live on the opposite coast. Is it possible to predict how many trips I would need to California and generally how long would I need to stay for a diagnostic workup and treatment plan. Your skill set sounds very unique and a good fit for my set of circumstances. However, the travel sounds challenging, though not impossible if I am granted a leave from my work.

    Do you feel Dr. Cooper is able to use an approach similar to yours? Also does Dr. Fred Abeles in Atlanta, Georgia use your approach? He is on the east coast, also far, but drive-able.

    Thank you for being so generous with the information on your site.

    • Dr. Jennings says:

      Donna:
      Both Dr Cooper and Dr. Abele use neuromuscular equipment and knowledge, which is good.Both will have techniques in common with what I do, but parts of treatment will be different.

  7. Donna says:

    Donna here again, with one additional question. My TMJ symptoms came immediately after my first crown (October) — terrible stiffness and discomfort has graduated to clicking, grating, tinnitus…really has dramatically altered my life. Will the crown eventually need to be replaced even though the crown itself is comfortable? (It is not high — probably low if anything). Is it important to first work on the muscles and jaw before going to the tooth? Honestly, I can’t imagine holding my mouth open for a crown treatment — very difficult to open my mouth wide. Thank you, again.

    • Dr. Jennings says:

      Donna: Not likely the crown will need to be replaced, though possibly in rare situations. It will likely need to be moved or equilibrated.Dr. J

  8. Tammy says:

    Hello, my name is Tammy. I’ve suffered a bad head:ear concussion, vertigo and temporary amnesia last Oct and are are now feb and I am still not back to work. Its been brutal. Not one day has been spent without pain, physical, emotional and mental. I am in physio therapy twice a week and cognitive once a week. Two weeks ago I stared having stiffness in the jaw a swelling in the face. Last week it got worse and Ive been to two clinics and they said it was muscular and suggested massage therapy. Now the fun part. She said it was the whiplash from that accident that is resurfacing. My neurologist is saying its the no sleep because of the migraines and snoring because of the weight gain because of the I cant because of the vertigo. My physio therapist says he doesn’t understand what I did because two weeks ago I was fine and now I am all swelled up. I ended going to the hospital yesterday because I m not eating from the pain in my jaw and pressure in my jaw. It feels like all my teeth will explode in my mouth. My lips are numb and I am literally drooling, very appealing. I have clicking in my jaw, ring in my ears and there is a build up of pressure that causes me to hold on for dear life as I drift into paralyzed state tunnel vision. They said it was tmj because of the pain in my teeth, neck, face and jaw, ears plus I have mild sinuses and the migraines from the concussion still. And lets not forget the effects of the concussion and lets throw in some occasional panic attacks because lets face it, life isn’t as easy any more. I feel like my head is going to split open from the pressure. It comes on like a contraction. in some moments I feel like my heart will give out because its beating to fast and hard and its almost like I can feel my heart turning in my body and my head will literally break open but no one hears me, no body understands me. The gave me some pills and sent me home. I cant eat anymore, my friends made some soup but couldn’t even swallow the crackers. Since the beginning of this concussion, everyone has been telling me, be patient. its been so long. I am scared and I want my life back! why is it getting worse and not better?

    • Dr. Jennings says:

      I have seen many cases where head trauma or whiplash cannot heal when there is an unerlying bite imbalance. The bite imbalance causes too much constant microtrauma to allow the body to heal.Dr. J

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