Temporomandibular Joint (Jaw Joint)
Dr. Woodruff has spent the last 10 years of his 25+ years in dentistry studying with the recognized experts in TMJ/TMD in this country. He has traveled to conferences, attended special training seminars, spent time in the offices of these recognized experts, learning at the feet of the masters best how to diagnose and treat this serious problem. He has taken courses from men like Dr. Peter Dawson, Dr. Mark Piper, Dr. Henry Gremillon, Dr. Terry Tanaka, Dr. Jeff Okeson, Dr. Parker Mahan, and others. Drs. Dawson and Okeson both have authored their own textbooks on this subject, that are considered standard references on TMD diagnosis and treatment.

He is a member of the American Equilibration Society, an academic organization that is dedicated to the study and advancement of treatment for TMD problems and the interrelationship of occlusion and the temporomandibular joint.

He feels that in order for dentistry to be complete we must not only consider how healthy are the teeth and the gum tissue, but how the entire system of the oral structures works in coordination with each other. We can not just look at teeth, and then gum tissue if the jaw joint that moves the lower jaw is not healthy as well.

Dr. Woodruff's treatment philosophy is that most TMD problems can be treated in a non-surgical manner, but the cornerstone is a complete diagnosis of the problem. TMD is not just one problem, but it is collection of disorders that must be separated from each other. Just as heart disease is not one problem, but many, many different problems, the success of the treatment depends upon a proper diagnosis.

TMJ/TMD denotes a disorder associated with the temporomandibular joint, (your jaw joint,) as well as the muscles, tendons, ligaments, and other structures that help you move your lower jaw. It is not a singular disorder, but could be only one of several different problems common to the jaw joint. These problems are characterized by one or more of the following symptoms:

• Pain in and around the jaw joint, immediately in front of the ear
• Limited opening of the jaw
• Headaches on the side of the head or the back of the head
• Ringing in the ears or other hearing changes
• Episodes of the jaw becoming "stuck open or closed"
• A changing bite
• Facial pain on the side(s) of the face near the chewing muscles

The most important factor in treating these problems, which can become very debilitating for some, is a proper diagnosis. There are many stages to TMD, and an understanding of the severity of the problems dictates the type of treatment necessary. There is good news -- in most cases, treatment is not complicated if the condition is detected early.

Diagnosis includes:

• Complete and thorough history of the problem(s)
• Complete dental examination
• Range of motion study (how wide can you open)
• Muscle testing
• Listening to the jaw joint with Doppler ultrasound
• Analysis of mounted study casts
• Radiographic (x-ray) studies
• Possible MRI studies

With the exception of the MRI, which is seldom necessary, all of the above diagnoses can be accomplished in our office.

TMD problems can be caused by any of the following:

• Abnormal bite relationship, or how your teeth come together
• Trauma, auto accidents, sports injuries, physical abuse, etc.
• Inherited problems causing malformations of the jaw
• Clenching and grinding of the teeth
• Missing teeth and no replacement of the same, causing the teeth to change position
• Abnormal growths or tumors in the joint

These factors create a disruption in the way the jaw muscles move the lower jaw, and can cause the muscle to go into spasm or long term contraction. When the muscles are tense for a long period of time, they will become painful. This pain is felt in the areas where the muscle are located around the jaw joint or the side of the head. If muscle contractions have occurred for a very long time, they can cause the internal portion of the joint to change and break down. If the internal joint deterioration is longstanding, surgical treatment may be necessary. However,, if the problem is detected early and proper diagnosis made, the treatment will be less complicated, less expensive, and most likely to produce a favorable outcome. Treatment methods could include:

• Use of bite appliances (similar to an orthodontic retainer) for short periods of time, 2-3 months
• Pain medication along with anti-inflammatory agents
• Physical therapy modalities
• Reshaping of the teeth to correct bite discrepancies
• Proper dentistry to replace missing teeth
• Jaw exercises
• Orthodontics or tooth movement to correct large bite problems