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Middletown, NY 10940
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TMJ/TMD Therapy - Middletown, NY

Erase Jaw Soreness with Ease

Chart explaining the parts of the skull and bite "TMD (Temporomandibular Joint Dysfunction) affects 5 to 12 percent of the entire population (NIH 2014)." Dr. Udoff’s question to the NIH is what parameters were used to assess the TMD because by the time a person experiences pain in the TMJ region, the dysfunction has existed for many years. TMD is a chronic progressive disease leading to the complete derangement of the Temporomandibular Joint (TMJ). This derangement advances the unraveling of the homeostasis of the entire musculoskeletal system. The question is which dysfunction came first: TMD or Musculoskeletal disharmony. Studies have proven that the symptoms of TMD and musculosketal disharmony are a descending phenomenon. This means the symptoms of musculoskeletal dysfunction develop from TMD to cervical vertebrae and descend down the body. If you would like to learn more, please keep reading:


Temporomandibular Disorder (TMD)

Jawbone model

To understand TMD, we first want to help patients understand the anatomy and function of the TMJ and joint space.

The lower jaw articulates in a space of skull called the mandibular fossa (temporal bone of the skull). The lower jaw, called the mandible, has a vertical (green in picture below) and horizontal (grey in picture below) component. The horizontal component houses the teeth and vertical component is what articulates in the mandibular fossa. The end of the vertical component has an oval shape to it that’s longer left to right then up to down. This is called the condyle (marked with arrow).

The condyle is covered with a thin layer of hard connective tissue. Housed between the condyle and mandibular (temporal) fossa is the articular disc. A fibrous tissue that resembles a donut, it allows the condyle 360 degrees of support due to the thinness in the middle with a thick, fibrous connective tissue ring.

The temporomandibular joint is encapsulated in a connective tissue sling that’s completely sealed so synovial fluid can lubricate the moving parts. The articular disc is attached from behind by inelastic connective tissue (retro-discal tissue) and in front by a muscle (the lateral pterygoid muscle).

As the jaw moves, the lateral pterygoid muscle must contract in order to keep the disc on top of the condyle. When the Lateral Pterygoid releases and the mandible closes, the inelastic connective tissue (that is attached from behind) is tight, allowing the disc to stay on top of the condyle as the jaw closes. 

The masticatory system is composed of four compensating parts. All four on dependent on each other.  They are:

  • Teeth
  • Periodontium (gums and bone)
  • Temporomandibular joint
  • Neuromuscular system

The teeth are the only part of the masticatory system that will not accommodate. For the system to work in physiologic harmony, the gears of the teeth must line up when the TMJ and neuromuscular system are in physiologic equilibrium.

The neuromuscular system is an intricate network of nerves and muscles controlled by neural feedback loops. There are 26 muscles attached to the mandible (lower jaw). They have a proprioceptive control mechanism where their action is controlled mainly by the arrangement of the gearing of the teeth. When the gearing of the teeth causes shifting of the mandible, neuromuscular system responds rapidly by accommodating to the needs of the teeth, allowing them to “line up.” Any small accommodating shifts will begin the process of joint derangement.

The signs and symptoms of TMD can be divided into three categories: muscle, non-muscle and musculoskeletal.

Muscle pain is cause by a sustained accommodating muscle contraction, leading to constricted blood flow followed by depleted oxygen to the muscles.

Musculoskeletal Health

Animations of musculoskeletal systems

The head postures sit atop of the atlas and ondontoid process. The atlas and ondontoid process are the first two cervical vertebrae. The head rotates in all dimensions atop the atlas. 42 muscles are attached to the skull – short ones from the cervical vertebrae to the base of the skull and long ones from the sacrum up to the base of the skull.

This intricate system can contribute to the onset of TMD because of fatigue, injury, or general dysfunction. Thankfully, Dr. Udoff can serve as a personal guide for his patients, helping them understand the intricacies of their musculoskeletal health and how their symptoms relate to the presence of TMD. Effective therapy options will not be far behind once we’ve pinpointed the severity and cause of your condition.

Common muscle symptoms of TMD include:

  • Temporal headaches (also called migraines)
  • Occipital pain/headaches (base of skull)
  • Neck pain, either down the back neck or along the side of the neck
  • Limited mobility of the neck up and down or side to side
  • Retro orbital pain (pain behind the eyes)
  • Lower back pain (just above waist line)
  • Jaw is tired/sore/stiff at waking
  • Pain in the jaw when chewing, yawning, and occasionally when swallowing
  • Pain at corner of lower jaw
  • Pain in ear
  • Pain on palpation of the TMJ
  • Limited painless opening

Common non-muscle symptoms include:

  • Popping or clicking of the TM joint
  • Can’t find bite
  • Deviation on opening
  • Ringing in the ears
  • Vertigo
  • Clenching
  • Toothache
  • Abfractions (teeth chipping off at the gum region)
  • Bone loss around roots of teeth
  • Mouth Breathing
  • Dry Mouth

Common musculoskeletal symptoms include:

  • Facial asymmetry
  • Head pointed upwards
  • Head postured forward
  • Left and right shoulder sloping
  • Pelvis imbalance (pelvic tilt)
  • Protonation (inward roll of the foot)
  • Changes in curvature of the spine

Total Body Dentistry

Model of tooth

There are four ways in which dentistry is crucial to the body:

  • The presence of TMD (headaches, facial pain, ill-functioning airway, etc)
  • Musculoskeletal concerns (the unravelling of the musculoskeletal system due to improper head posture)
  • Holistic dentistry (Preserving the natural dental structures whenever possible)
  • Mercury-Free Dentistry (Protecting the patient’s overall health)