Thomas S. Jennings, DDS, talks Occlusion and TMJ –– LIVING WELL Magazine

Occlusion and TMJ…do you have them?

By Thomas S. Jennings, DDS, Colorado Springs LIVING WELL Magazine

If you have natural or replacement teeth (most of us), the answer is yes! The term “occlusion” refers to the relationship between upper and lower teeth when they are held together.  More commonly it could also be called a person’s “bite.”

Intuitively of course, there is a lot more to it than just teeth and how they come together. Each unique tooth is attached to an upper (maxillae) or lower (mandible) jaw bone and supported by the gums (gingiva). The bones are connected through a pair of joints, each called a temporomandibular joint, or TMJ (The mandible is connected indirectly to the maxillae through a temporal bone on each side). Among other structures, healthy TMJs are made up of a socket in the temporal bone, a ball on each end of the mandible, a cartilage disc that rests between the two bones, and a capsule. As the system is a dynamic one, there are a half dozen muscles on each side, and a network of blood vessels and nerves that allow for ongoing vitality and coordinated control of motion.

In the gnathological system (mouth, jaws and teeth), optimal function and health is dependent on each part performing its role and the proper amount of coordination existing among parts. Each structure has very specific functions that must complement other co-working and antagonistic structures. When the system is in balance, when all parts are able to respond appropriately to demands placed upon them and are performing their roles properly and in dynamic coordination with other parts, harmonious function and a state of health exists.

Also from an intuitive perspective, we know that total perfection rarely exists. In the gnathological system, the state of stability and health also exists as an ongoing summation of adequate compensatory actions on the part of some structures in response to insufficiency being exhibited by others. Balance is maintained due to the body’s ability to monitor and innately offset any deficiency with altered function somewhere else.  Occlusal health exists as a dynamic state, dependent on the system’s ability to adaptively compensate to ongoing and ever changing imperfections.

Unfortunately, our ability to compensate appropriately may be reduced during periods of our lifetime. Our resilience can be challenged from many perspectives including the lack of adequate exercise, nutrition, and rest, the presence of physiologic and psychological stress, an infective process, and just plain overexertion to name a few. In fact our systems are constantly challenged by several factors concurrently, and rarely just one. When the system is challenged past the ability of its members to adequately compensate, disease occurs in the form of breakdown in part or parts of the system.  Teeth become loose or fracture, muscles go into spasm, ligaments stretch and break, joints wear excessively. Compensating structures can then become overloaded due to the requirements placed on them. In some cases the resultant pain, dysfunction, and damage can become a self-perpetuating cycle of disease commonly known as “TMJ.” (A more appropriate term for this problem is “TMD,” or temporomandibular dysfunction. As explained above, TMJ is the name of an anatomical structure, not a pathological process.)

So what can be done if this problem occurs? In most cases only supportive treatment is necessary. As long as challenges to the system can be mitigated and over-exertion eliminated, the body’s healing capabilities alone are usually adequate enough to restore balance and health. This usually includes the avoidance of aggravating factors such as over usage, harmful sleeping posture, and the common chemical irritation of caffeine and refined sugar. Lifestyle modification to include adequate rest, nutrition, and treatment with moist heat and mild anti-inflammatory medications is usually also very helpful. In a large percentage of TMD cases, disharmony in the mechanics of the system due to teeth being in the incorrect position is a contributing factor. How teeth contact each other has a direct effect on the need for compensation by joints and muscle. The severity of the discrepancy and the particulars of these cases will usually dictate which is best, but several options are usually available for this including jaw surgery, orthodontics, equilibration (removal of non-harmonious tooth surfaces), orthotic treatment (use of a bite changing appliance to allow for proper joint/muscle function), restoration (replacing/adding to the working surfaces of teeth), and frequently a combination of several of the above.

All patients as well as their problems tend to be very unique. It is important that every suspected occlusal/TMJ problem receive individual attention by a qualified provider.

If you feel that yourself, a family member, or a friend may be having problems with their occlusion or jaw joint, please call your dental provider or Dr. Jennings at 719-590-7100.