Edi Guidi, DDS
Sacramento Cosmetic Dentist Dr. Edi Guidi
916-483-3204
4350 Marconi Ave., #300
Sacramento, CA 95821

Topics of Interest

TMJ and TMD Symptoms and Treatment Overview

Do you ever experience a clicking or popping sound when opening or closing your mouth? Have you been suffering from headaches or migraines and no one seems to be able to help you? Have you been taking pain medicine for years and would like to get off of it? Do you feel any clogging or congestion in one or both of your ears? These are just a few of many symptoms that might be associated with TMD, or Temporomandibular Dysfunction, a common condition affecting the jaw joint or Temporomandibular Joint (TMJ).

TMJ dysfunction, often referred to as TMD, is a disharmony between the way the jaw joint works in an unstrained position and the way the teeth and bite work during those movements. Possible causes of this disharmony include tooth loss, accidents (like whiplash), mal-positioned and/or underdeveloped cranial or jawbones, and perhaps habits like clenching or teeth grinding. Many people go through life suffering from headaches and a variety of facial and neck pains without knowing the ultimate cause, which in many cases is TMJ disorder.

Define TMJ and TMD

TMJ or The Temporomandibular Joint

They are the two joints which connect the lower jaw to the temporal bone at the side of the head. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of the head. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. When the TMJ is not functioning normally and it is not within its physiological limits, it creates a condition called TMD, or Temporomandibular Dysfunction.

TMD is a group of conditions resulting from not having a normal function or "comfortable" positioning of the TMJ, and will present as a cycle of pain, muscle spasms and jaw problems. When teeth are missing, out of alignment, crowded or misshaped, chewing and biting cannot be achieved in a balanced way, so the TMJ and the muscles of chewing try to compensate for this unbalanced movement which results in symptoms that will confirm the presence of TMD.

Temporomandibular Joint Disorder (TMD) is not just a disorder, but a group of conditions, often painful, that affect the jaw joint or Temporomandibular Joint (TMJ) and the muscles that control chewing.

TMD falls into three main categories:
  1. Myofascial pain, the most common form of TMD, which is discomfort or pain in the muscles that control jaw functions and the neck and shoulder muscles.
  2. Internal derangement of the joint meaning a dislocated or displaced disc or injury to the condyle (the rounded part at the end of the jaw bone).
  3. Degenerative joint disease such as Osteoarthritis or Rheumatoid Arthritis in the jaw joint. Causes of TMJ/TMD
There are many causes for TMD such as:
  1. Unbalanced occlusion or "Bad Bite"
  2. Stress (emotional or work/school related)
  3. Injury or trauma (this could have been an injury as obvious as a blow to the jaw with a fist or something as subtle as a whiplash injury with direct trauma to the head or jaw.
  4. Teeth grinding or Bruxism
A "Bad Bite" could be caused by any of the following:
  1. Missing teeth
  2. Crowded or "crooked" teeth
  3. Worn down teeth
  4. Old crowns and bridges
  5. Unbalanced dentures

When teeth are missing, or out of alignment, it causes the jaw to shift positions and the muscles to work harder to chew, swallow, bite...etc and eventually will cause: muscle spasms, tension and pain.

Muscle tension and misplaced TMJ could cause the TMJ disc to be pulled out of place which will result in pain, clicking and popping in the TMJ.

If the disc is displaced for a long time, the bones will start rubbing against each other and some damage will happen to the bone, this is called Osteoorthrosis.

If there is inflammation in other joints or bones of the body, it is called Osteoarthritis (Arthritis) which may involve the jaw bone and the TMJ. Some damage to the bone may be evident on the x-rays.

TMD Symptoms
  1. Headaches, Migraines or tension headaches
  2. Worn or loose teeth
  3. Painful muscles in the neck and shoulders (muscle spasms)
  4. Pain behind the eyes.
  5. Clicking and popping of the jaw joint (TMJ)
  6. Locked jaw or restriction in opening or closing the mouth
  7. Earaches or a clogging feeling in the ears
  8. Tingling or numbness in the hands and the fingertips

TMJ Diagnosis

While recognizing TMJ problems is within the ability of most physicians and dentists, not all practitioners are qualified to diagnose it properly and treat it right. It is imperative that a trained practitioner in Craniofacial pain or Neuromuscular Dentistry give the final and definitive diagnosis, and suggest the most suitable treatment plan.

There is a lot of skepticism about TMJ treatment in the medical society, and that is simply due to the fact that physicians didn't receive the dental training and didn't acquire the knowledge required for such complicated diagnosis and treatment. Furthermore, many dentists rush into treating TMJ thinking that they can cure these problems, only to find that they lack the skill and experience to get the job done.

We have training and experience in the treatment of these problems with outstanding success rates. With highly advanced equipment and a high level of knowledge, we address your concerns and provide the best diagnosis for the optimal treatment.

Undiagnosed TMJ/TMD

Many patients who suffer from TMD symptoms were never told that it is related to their TMJ problem and were not aware that treating their TMJ could easily relieve their suffering. To explain this further...

Headaches and Migraines

If you suffer from headaches or migraines, TMJ dysfunction, could be the major and most likely cause of your suffering. Your doctors, including neurologists, have simply not received the dental training required to relate your migraine or headache pain to your TMJ problems. Once you rule out any brain tumors or aneurysms, TMJ should be checked and TMD should be treated to relieve the headaches and migraines.

Ear congestion

Due to the proximity of TMJ to the ears, it is very common for the ears to feel congestion, or to have ringing in the ears when the TMJ bones move or dislocate from their place. In this case, ENT's (ear doctors) won't find anything wrong with the ears, yet the patients keep complaining about their ears. Once the TMJ is put back into its natural position, the pressure put on the ears will be relieved and the congestion disappears.

Tingling or Numbness in the Fingers

When the TMJ is not in a balanced position, it affects the general posture of the body. When the posture is not straight and upright, the nerves coming out from the spine could be irritated, which could cause the numbness or tingling feeling in the fingertips.

Jaw Tracking

We use a state-of-the-art jaw tracking system that helps diagnose TMJ Dysfunction (TMD) by tracking the jaw movement. Research shows that there are certain jaw movements which show very specific types of TMJ dysfunction. For example, limited opening and closing or locking, jaw opening deviations and deflections, and restricted side-to-side jaw movements. All of these indications are widely accepted and published criteria for diagnosing TMD.

Joint Vibration Analysis (JVA)

The Joint Vibration Analysis (or JVA) has been accepted by the American Dental Association to help provide a fast, non-invasive method to accurately diagnose TMJ function and demonstrate the severity level of the problem.

Electromyographic Analysis (EMG)

We use an Electromyographic Analysis (or EMG) to measure muscle activity on head and neck muscles both at rest and in function. This is done by placing computerized sensors on the skin allowing us to accurately monitor muscle activity. Hyperactive muscles are common for patients experiencing pain symptoms associated with TMJ problems. Imbalances between right and left sides of the same sets of muscles are also typical. The EMG system is a safe and comfortable method do help detect such issues and getting to the root of a TMJ issue.

Neuromuscular TMJ Treatment

TMJ/TMD is treatable most of the time. Simple cases of TMJ can be treated with anti-inflammatory medications and a hot/moist compress.

Treatment for more complex cases usually consist of two phases:

Treatment of complex TMJ - Phase One:

Generally speaking, it includes the fabrication of an orthotic. An orthotic is an acrylic device that is worn on the lower teeth 24 hours a day. The orthotic is designed to reposition the jaw to the correct neuromuscular position. We analyze the bite, decide which muscles are causing the pain, and where the current position of the bone is and the disc. All this is done with the aid of advanced equipment like the TENS unit, K7 jaw tracking, Sonography, EMG's and advanced x-rays like Tomography, CT Scans and MRI's of the TMJ. This will help us determine the best and most comfortable position of the TMJ and the muscles. Once that position is determined, we place the orthotic on the lower teeth to keep the TMJ in that position. Orthotics usually are worn for 4-6 months or until most of the symptoms are relieved. Once an orthotic is in use, the symptoms start gradually disappearing until we reach a point that both the doctor and the patient are satisfied with. This concludes Phase I of the treatment.

Treatment of Complex TMJ - Phase Two:

After 4-6 months of relief and when the patient is no longer suffering from any TMD symptoms, Phase II will be considered. Phase II includes any of the following:

  1. Wearing a long term removable orthotic, full time or part time.
  2. Replace missing teeth.
  3. Orthodontic treatment (Braces).
  4. Restore all the lower and/or upper teeth with crowns and veneers to preserve the optimal occlusion (bite) that was achieved with the orthotic in phase I.

Most of the time, any of the above could be considered and chosen, depending on the patients' preferences and financial capability. If you are currently suffering from TMD, it is too early to think of phase II at this time, since it is important to get you out of your pain and symptoms.

Treating TMJ/TMD Caused by Dentures:

Many patients complain that when they received dentures, they noticed pain in the jaw, headaches, ear problems and other symptoms. Sometimes taking the dentures out will relieve those symptoms. If your dentures are not made to the correct bite, or vertical dimension, it will most likely cause these symptoms. Simple adjustments could get rid of these symptoms, but sometimes a whole new set of dentures need to be made according to the neuromuscular principles, to rid you of your headaches or jaw pain.

Orthotics or Bite Splints

An orthotic is an acrylic device that is worn on the lower teeth 24 hours a day. It is designed to reposition the jaw to the correct neuromuscular position.

An orthotic, sometimes called a Bite Splint, is a very effective method in relieving TMD symptoms. It provides an acrylic platform to bite against, sometimes moving the mandible to a new position that is more comfortable.

Obstructive Sleep Apnea is very common and if left untreated can cause individuals to stop breathing during their sleep for a minute or more. Each time this happens the brain will wake a person up for a moment in order to get them breathing again, which results in sleep being interrupted frequently and leaving the individual tired throughout the day.

Obstructive Sleep Apnea
If your bed partner notices that you snore or gasp for air regularly while sleeping, you may have Obstructive Sleep Apnea (OSA). Not everyone who snores has OSA, however everyone who has OSA does snore. OSA is a condition in which people stop breathing for short periods, several times if not hundreds of times per night. Sleep apnea effects 13-17% of all adult Americans. Undetected sleep apnea is serious and can lead to obesity, diabetes, high blood pressure, heart attack, stroke and even death. Severe Obstructive Sleep Apnea can take 10 to 15 years off one's life.

Obstructive Sleep Apnea Causes
Obstructive Sleep Apnea is caused by a blockage of the upper airway. It may be related to the tongue being too small, muscle weakness around the throat, or fat around the airway caused by excessive weight gain which leads to the collapse of the airway during sleep. Waking up activates the body's fight-or flight response causing increased heart rate, heart stress and high blood pressure.

Obstructive Sleep Apnea Symptoms
- If you are told by your bed partner that you snore or gasp for air during your sleep.
- If you are tired and un-rested after sleep and need to take frequent naps.
- If you have hard-to-treat blood pressure.
- If you are obese and/or have a collar size larger than 16 inches for women or 17 inches for men.
- If you wake up with a dry or sore throat.
- If you are irritable in the morning or have morning headaches.
- If your legs feel twitchy at night.

Obstructive Sleep Apnea Diagnosis
OSA can only be properly diagnosed by a board-certified M.D. in sleep medicine. This is done either through spending a night in a sleep lab connected to wires and monitors or by a home sleep test. In our office, we have home sleep testing monitors which you can wear to bed in your own home. When you bring the testing unit back to our office, we will upload the data stored in the unit to a board-certified sleep physician who will diagnose if you have sleep apnea. The physician will also determine how severe the sleep apnea is and prescribe what treatment options would be appropriate. Treatment options include dental, medical or surgical.

Obstructive Sleep Apnea Treatment Alternatives
Until recently, the recommended solution was to pump air into the blocked passage by the use of a Continuous Positive Airway Pressure (CPAP) machine. It's appearance has been described like being a bulky jet pilots mask to something resembling a Darth Vader's mask. It's cumbersome, noisy and uncomfortable, but it will keep you alive. The problem is that most people use the mask on an inconsistent basis, which provides only limited value and still puts the patient at risk. Recent advancement in a specialized custom dental fabricated mouth guard provides a more comfortable solution. This small mouthpiece that rests inside the sleeper's mouth moves the jaw forward creating suction to open the throats airway. Research hasn't yet proven that treatment can reverse Obstructive Sleep Apnea, but does decrease or eliminate many of the bad outcomes.

Bad Breath

What you eat affects the air you exhale. Certain foods, such as garlic and onions, contribute to objectionable breath odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is expelled. The odors will continue until the body eliminates the food. People who diet may develop unpleasant breath from infrequent eating.


If you don't brush and floss daily, particles of food remain in the mouth, collecting bacteria, which can cause bad breath. Food that collects between the teeth, on the tongue and around the gums can rot, leaving an unpleasant odor.


Dry mouth occurs when the flow of saliva decreases. Saliva is necessary to cleanse the mouth and remove particles that may cause odor. Dry mouth may be caused by various medications, salivary gland problems or continuously breathing through the mouth.


Tobacco products cause bad breath, so if you use tobacco, ask your dentist for tips on kicking the habit.


Bad breath may also be the sign of a medical disorder, such as a local infection in the respiratory tract, chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment.

Bruxism, commonly known as 'tooth grinding,' is the process of clenching together and the grinding of the upper and lower teeth. During sleep, the biting force of clenched jaws can be up to six times greater than during waking hours.

Bruxism can cause complications over the years:
- Wear down tooth enamel
- Break fillings or other dental work
- Worsening of TMJ dysfunction
- Jaw pain, toothaches, headaches, or earaches
- Tooth sensitivity
- Tooth mobility
- Chipped teeth
- Erodes gums and supporting bones contributing to gum disease

The most common procedure to help to alleviate pain and discomfort is a Nightguard.

Dry Mouth

Saliva flow is important other than appearance and comfort. It keeps the mouth moist and aids in chewing, swallowing, digestion and speech. Dry mouth is a condition from the lack normal saliva flow.


Causes of dry mouth:
- Dehydration
- Emotional Stress
- Anemia
- Related to surgery
- Medical Conditions
- Medication
- Allergy
- Anti-depressant
- Blood pressure
- Some mouth washes high in alcohol content


Dry mouth symptoms:
- Mouth feels sticky
- Lips cracked and dry
- Tongue may have burning sensation


People who experience dry mouth are at high risk for developing:
- Cavities
- Gum disease
- Bad breath


Helping dry mouth:
- Chewing gum / lozenges
- Humidifier at night
- Maintaining good oral hygiene

Oral Piercing

Oral piercings can be bad for your health. Because your mouth contains millions of bacteria, infection is a common complication of oral piercing. Pain and swelling are other side effects of piercing. Your tongue (a popular piercing site in the mouth) could swell large enough to close off your airway. Piercings can also cause uncontrollable bleeding or nerve damage. The jewelry itself also presents some hazards. You can choke on any studs, barbells or hoops that come loose in your mouth, and contact with the jewelry can chip or crack your teeth.

Pregnancy

We ask that our female patients who are pregnant or think they possibly could be to inform us prior to your x-ray examination and dental treatment.

You are probably familiar with the links between tobacco use and lung disease, cancer and cardiovascular disease.

Current studies have also established that tobacco smoking not only causes direct damage to your mouth but also makes periodontal diseases more damaging and harder to treat.

There is a greater incidence of calculus formation on teeth, deeper pockets between gums and teeth, more gum recession and more loss of the bone that hold teeth in your mouth. In addition, smokeless tobacco greatly increases your chance of developing oral cancer. Any tobacco usage can complicate the placement of dental implants.

Besides smokeless tobacco, cigarette smoking negatively impacts the health of the gums. The healing capacity of the mouth is significantly altered. The healing time from any procedure is always increased. Needless to say smoking creates more tartar, more stain, bad breath and an increased potential for mouth cancer.

Other chemicals impair the function of your white blood cells which are your first line of defense against infection. The tars contain carcinogens which over time induce cell mutations and cancers.

Quitting tobacco use will lower the risk of your developing cancer and improve the health of your teeth and gums, as well as your heart and lungs.

Smokeless tobacco poses very serious problems including:
- Causes tooth decay
- Eats away your gums
- Leads to tooth loss
- Bad breath
- Stains your teeth
- Causes oral sensitivity to hot and cold
- Decreases sense of taste and smell

If oral cancer is left untreated long enough, it may even cause death.

Tooth Fractures

There are many types of cracked teeth. The treatment and outcome for your tooth depends on the type, location and severity of the crack.

Unlike a broken bone, a fracture in a cracked tooth will never heal. Early diagnosis is important, even with high magnification and special lighting, it is sometimes difficult to determine the extent of a crack.

A crown will bind and protect the cracked tooth. When a crack reaches the tooth root, root canal treatment is frequently needed to treat the injured pulp. A cracked tooth that is not treated will progressively worsen, eventually resulting in the loss of the tooth.

Traumatic Ulcer

It is not uncommon for children to inadvertently "bite" on their lips or cheeks, particularly following a dental visit where local anesthetic was used. The main reason why this occurs is the natural curiosity that a child has about the area of the mouth that is "numb". We try our best to explain to children that local anesthesia is temporary and we give them (and their parents) instructions on how to prevent "lip biting". In the event that this occurs, please notify our office so we can determine if your son/daughter will require treatment (i.e., antibiotics or pain medicine).

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