• Temporomandibular Joint Therapy

  • Do you have frequent headaches, ear aches. tender jaw muscles, or a dull, aching facial pain? Does your jaw lock or stray to one side when you open your mouth? These aches and pains may be related to the jaw muscles and the jaw joint, called the temporomandibular joint or “TMJ”.  These painful condtions are often called “TMD” for temporomandibular disorders.


    Two joints and several jaw muscles help open and close the mouth.  The joints and muscles work together when you chew, talk and swallow.  These structures include muscles and ligaments, the jaw bone, and the mandible (lower jaw) with two joints the TMJ’s.  The temporomandibular joints are among the most complex joints in the body.

    These joints work together to make different movements, including a combination of rotating and gliding action used when we chew or talk. Several muscles help open and close the mouth.  They control the lower jaw (mandible) as it moves forward, backward, and sideways. Both TM joints are involved in these movements. Each TM joint has a disc between the ball and socket.  The disc cushions the load when the jaw opens widely or performs rotating and gliding movements. Any problem that prevents this complex system of muscles, ligaments, discs and bones from working together properly may result in pain.

    What Causes TMD?

    Several condtions contribute to TMD. These can be quite varied and often difficult to pinpoint and in some cases not possible to clearly determine the cause. The joints, ligaments, and muscles used for chewing and grinding food may all be involved.

    Some TM problems result from arthritis, dislocation or injury.  Muscles that move the joint are also subject to injury and disease. One of the most common causes is a disharmony or lack of stability in the way your teeth fit together –the bite–.

    Signs and Symptoms

    • Pain in or around the ear that may sometimes spread to the face.
    • Tender jaw muscles.
    • Clicking or popping noises when you open or close your mouth.
    • Difficulty opening your mouth.
    • Jaw joints that don’t feel quite right– a feeling as if they are “locked”, “stuck”, or they “go out”.
    • Pain when you chew, yawn or open your mouth wide.
    • Headaches or neckaches



    Some patients may experience symptoms and have no apparent loss of function. They can eat and speak without problems.  However, others slowly get worse and require treatment to relieve the pain and restore joint function.

    There are several ways TMD is treated.  Dr Alterman will do a careful evaluation of your joints and muscles.  This examination will include a complete medical history , x-rays and models or “casts” of your teeth to see how your bite fits together.

    Commmon recommendations include:

    • Modifying the pain with moist heat to painful areas
    • Taking medications including muscle relaxants, analgesics or anti-inflammatory drugs
    • Excercises to stretch the jaw muscles
    • A soft diet may be recommended for a short period of time.


    TMJ Exam

    • Thorough history
    • Palpate muscles of mastication (chewing muscles)
    • Palpate joint (check for clicking, popping, grating)
    • Joint Loading test
    • MRI

    A TMJ screening is done routinely with check-up exam. We perform the complete TMJ exam on patients who suffer from TMD symptoms.


    Treatment is decided upon on a case by case basis but may include one or more of the following:

    • Occlusal Splint
    • Occlusal equilibration (adjusting bite) after a thorough occlusal evaluation
    • Medications
    • Physical therapy
    • Surgery

    Practicing relaxation techniques

    Decreasing harmful clenching or bruxing ( grinding ) by wearing a special bite plate that prevents the teeth from touching.

    Selective grinding on some teeth to correct an uneven or improper bite

    Orthodontic treatment may also be needed to reduce problems caused by poorly aligned teeth.

    When all else fails jaw surgery may be an option.  It is usually reserved for advanced cases when no other treatment plan has worked and the patient still experiences pain. Dr. Alterman works with multiple oral surgeons that he will refer to in these advanced cases