Thomas F. Armstrong DDS
Creating Beautiful Smiles



Chronic recurrent headaches as well as facial and neck pain are a common occurrence in millions of Americans. In addition, people frequently suffer from ear symptoms including:

  • pain
  • ringing in the ear
  • buzzing noises
  • loss of hearing
  • clicking, popping, or "locking up" of the jaw
  • other symptoms related to a mis-aligned or off-centered bite condition of your teeth

These headache, neck and shoulder,  and ear conditions often come from problems with the TMJ jaw joint.  Frequently, physicians do not understand that a patient can have these pains that show up at a distance from the jaw joint itself.  These complicated symptoms can make chewing, speaking or moving the jaw painful or difficult.

Did you know that these symptoms, appearing unrelated, were frequently undiagnosed or misdiagnosed as migraine, tension headache, neuritis, neuralgia, or stress. When the usual medications and treatments prescribed by physicians or untrained dentists didn't help, patients were frequently labeled as hypochondriacs, "it's all in your head", or even neurotic.  Maybe this has happened to you or a family member in the past.

This is why many physicians, nurses, chiropractors, and even some dentists are fooled by TMJ situations.

 Now There is Hope for Patients with TMJ  Dental Problems

Today, it is well known by specifically trained dentists that these often unexplained, undiagnosed and therefore untreated symptoms are related to a group of problems called Temporomandibular Jaw Joint Disorders (commonly referred to as TMJ or TMD).  In many cases, these dental "miracle workers" are able to pin-point the cause of these symptoms and provide amazing relief of symptoms which may have been present for years!

 TMJ Problems Are More Common Than You Think

New research by the American Dental Association reports that as many as 20% of adults (and many teenagers, especially females) may have symptoms of a temporomandibular disorder. This includes many people here in Bakersfield and surrounding communities with this frustrating dental problem.  Although all of these individuals may not have conditions severe enough to warrant treatment, many sufferers have developed such debilitating pain so as to degrade the quality of their life making family, social and business interrelationships difficult if not impossible.

 How Are TMJ Conditions Diagnosed?

A comprehensive exam is needed to carefully evaluate someone who has possible TMJ problems.  A dental exam, which may require standard dental x-rays, is first done, to be sure a tooth condition is not causing some of the pain. If it turns out there is a tooth (or dental) issue, this may need to be treated before further evaluation for TMJ can be completed.

The TMJ part of an exam will include an analysis of someone's "bite", their jaw opening and closing, jaw noises when chewing, muscle spasm or cramping areas in the the jaw, neck, and shoulders, signs of teeth wearing down from intense clenching or grinding of the jaws and teeth while asleep ("bruxism"), and many other factors that go along with TMJ symptoms.

 Another portion of a proper TMJ evaluation, frequently overlooked, is investigating other medical conditions that can affect TMJ pain.  These include questions about fibromyalgia, chronic fatigue, and snoring or sleep apnea.  People with these issues are affected much more by pain, and their ability to heal is usually compromised.  You can see how important it is to find out about these conditions because they affect how successful TMJ treatment may be.

TMJ Treatment

There are several steps in treating TMJ problems.  In general, it is appropriate to start with easier, more conservative methods.  If they are not eliminating the symptoms then more complex therapy is needed.

 In the majority of patients, the first stage of TMJ relief starts with simple at-home physical therapy for sore head, neck, shoulder, and jaw muscles.  Almost always, a custom-made dental tmj appliance is recommended.  These may look similar to an orthodontic retainer, but do a lot more to support the jaw from intense biting pressures.

 It is important that these dental appliances (sometimes called a "nightguard") are not confused with inexpensive soft plastic mouthpieces purchased at the store.  When someone is using one of these soft pieces at night, whenever the jaw bites down into it, the brain thinks its something to eat and often bites down even more.

 In other words, these over-the-counter, one-size-fits-all plastic pieces can cause even more pain from TMJ.  They are usually bulky, fit poorly, make people drool while asleep, and can put abnormal pressure on teeth and gums.  A true, well-designed professional grade dental appliance is made from molds of the teeth so it fits accurately.  When correctly made, back teeth are kept slightly apart so our strongest masseter and temporalis jaw muscles are not closing our teeth together so hard.

Part of this type of treatment should include one or two follow up visits with one's dentist so the fit and comfort of the appliance can be properly checked.  A true dental TMJ appliance is very durable and can be repaired easily if it wears down or chips away.  Many patients have the same appliance for years with no problems.

 This first level of treatment can also involve working with a massage therapist, physical therapist, or chiropractor who understands the subtle nature of TMJ issues.

 It should be mentioned that if someone turns out to have sleep apnea, a particular dental appliance can be used to treat both the apnea and TMJ problem at the same time.  These Oral Appliances are another way to manage sleep apnea besides CPAP masks.

This is why its important to include questions about sleep and snoring (which is a major sign of sleep apnea) when examining a TMJ patient.

If the TMJ problems are not improving with conservative treatment, then more involved physical therapy, an additional daytime appliance, or even limited oral surgery may be necessary.  In the past, major surgery on the jaw joint was sometimes done.  However, the results were not predictable, most TMJ experts do not suggest this anymore except in very particular situations. 

Does My Insurance Pay for TMJ Treatment?

This is a common question.  And, unfortunately, our experience is that TMJ appliances are hardly ever covered by dental insurance.  Once in while, supportive treatment, such as physical therapy, can be prescribed by the patient's physician and be covered by some medical PPO insurances.