Daryl E. Malena DDS  Periodontics
10838 Old Mill Road
Omaha, Nebraska 68154
402 330 4100

TMD is the common abbreviation for Temporal Mandibular Dysfunction, and is also known as TMJ (Temporal Mandibular Joint) dysfunction. The relationship of the Teeth, Muscles and Joints of our jaws is very complex, and is mostly controlled by reflexes and thus out of our conscious control.  For example, teeth don't touch when we talk, and make surprisingly little contact when we eat.  Most of the normal contact our teeth make is when we swallow (Try swallowing without touching your teeth together--difficult, isn't it?).

The reflexes keep us from biting hard enough to break our teeth (Silver amalgam fillings break at about 10,000 lbs. per square inch, and folks break them every day!), and help us adjust to normal wear, but when confronted with signals outside of their range of control we experience them as pathology such as clenching or grinding (known as bruxing) our teeth.  This can lead to headaches, toothaches and joint pain.

Of course, stress alters the level at which these problems can be triggered, and each of us has a different threshold level of tolerance for stress. In addition, arthritis and joint degeneration and changes in the fit of our teeth also alter the threshold level for when we experience TMD problems.

The treatment can be as simple as touching up the fit of a new crown, or as complex as years of orthodontics, physical therapy or major joint surgery.  Treatment can involve any of a number of health care practitioners including dental specialists, physicians,  physical therapists, psychotherapists and maybe even a yoga instructor.

Fortunately, it is usually much simpler.  In most cases a plastic bite plate, known as an occlusal guard is constructed.  This device alters the fit of the teeth while it is worn and thus interrupts the reflexes that typically are causing the symptoms.  In some cases this is all the treatment that is necessary, and in other cases it is an adjunct to the diagnosis.  In any case, the diagnosis and treatment can be complex and it is necessary to consider many factors.  

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