Temporomandibular Joint (TMJ) Dysfunction

TMJ Dysfunction is now designated as Craniomandibular Dysfunction (CD). This malady is known as the “Great Imposter” due its far reaching effects on the rest of the body and the difficulty in properly diagnosing it.

Craniomandibular dysfunction is responsible for such ailments as headaches, fatigue, migraines, and neck, shoulder, and back pain. There are two separate components to the ailment. The first has to do with the joint itself. If there are painful clicking, noises while opening or closing, or an aberration in the movement of the lower jaw, there is disc involvement. The head of the mandible (condyle) is separated from touching the temporal bone by a cartilaginous disc, as in all joints. Spasms in the muscles surrounding the TMJ can cause the disc to move out of position. If you look in a mirror, slowly open your mouth wide, and see the tip of your chin move from side to side, then you have a disc that’s out of position. Your body is trying to slowly manipulate it back into place with the back and forth motion you’re observing.


The second component is known as myofascial pain dysfunction. The teeth are attached to the jaw bone by ligaments which contain stretch receptors. Each individual tooth can be called a joint because all joints in the body are basically two bony structures connected by ligaments (with stretch receptors). These are designed to protect the joint from injury. If a stretch receptor sends a signal, the body responds by causing muscle spasms surrounding the joint in question. It’s the body’s joint defense mechanism. Every back tooth can take an unlimited amount of pressure along its long axis. But, if the tooth is torqued off axis, the stretch receptors start sending the muscles surrounding the TMJ messages to go into spasm. This in turn creates pressure of the head of the mandible against the temporal bone. This may move the disc out of position or merely cause discomfort.


My TMJ therapy involves a multiple approach. First, the cause the problem (the stretch receptors in the ligaments surrounding the teeth being triggered) must be eliminated. Second, the muscles around the joint which develop a “spasm memory” must be encouraged to relax. The OCRA (Orthopedic Condylar Repositioning Appliance) accomplishes this goal. It is a two piece appliance that fits over the upper back teeth. There is a single pad stage (which allows for rotation of the lower jaw in the saggital plane) and a full pad stage. The patient remains in the single pad stage for approximately five weeks. Weekly adjustments are required to reorient the pads to the new stage of relaxation. Once symptoms are relieved and the rotation of the lower jaw is accomplished, acrylic is added in front and back of the single pads to establish the full pad phase.


The OCRA is worn all the time except when eating. This wear pattern continues for approximately two months. The patient is then slowly weaned from day time wear (the appliance must be worn during sleep indefinitely). A consultation with me will help determine if you are a good candidate for this program.

TMJ Form