A Dental hygienist is often the first health care professional to notice that a patient has a TMJ problem.

          TMJ stands for Temporomandibular Joint. Every normal human has two TMJs, so everyone has TMJs. However, not everyone has TMJ Dysfunction or TMD.

          A patient with TMD may:

                     not be able to open wide enough to do a routine dental prophylaxis
                     have to take several breaks during her cleaning to rest her jaw
                     have flattened horse-like teeth on her bite-wing x-rays
                     have teeth that are sensitive to hot and cold
                     have a scalloped ( grooved ) tongue
                     have facial notches below several natural or artificial crowns
                     have mandibular torii (bone bumps),maxillary or mandibular exostoses, and/or a palatal torus
                     have six anterior lower teeth that are higher than all of her other posterior teeth

          TMD patients who also brux often have thickened lamina dura, which is the hard white looking bone coating the spongy bone around teeth.

          TMD patients do not always have to have popping and clicking joints.

          TMD patients complain most about the pain that comes from their jaw muscles.

          Many migraine patients are mis-diagnosed because physicians not longer touch their patients and can not tell the difference between pain inside the head ( migraine ) from pain outside the head ( TMD ). One of the muscles that often goes into spasm with TMD patients
( lateral pterygoid ) presses on the same artery ( middle meningeal ) that causes migraine pain. Every patient with a history of migraines should be screened for TMD.

          TMD patients often do not sleep well.

          The dental hygienist can do a very  quick screening  on every patient by palpating the masseter origin and the temporalis insertion.

          Normal healthy muscles should not hurt when palpated but TMD patients often feel like you are pushing too hard or cutting your nails into their muscles. This is not normal and should lead you to question the patient about whether she is having headaches on the sides of her head.

          You can place our hands on the anterior portions of the temporalii and ask the patient to bite hard. This will show you where this patient contracts her temporalii and shows the patient that pain in this area is due to a bad dental bite.

          With many TMD patients you can gently massage the masseters from outside and inside the mouth by kneeding the muscle between your forefinger and thumb with a gentle pinching circular motion. The patient may be able to open up better after you do this and will forever after request that you do this every time she comes for a cleaning.

          While inside the mouth, run your forefinger up onto the lateral portion of the jaw until you feel the coronoid process. The coronoid process is the place where the temporalis inserts into the jaw to pull the jaw closed. The temporalis and the masseter are both closing muscles and most TMD patients are too closed and can't relax these muscles.

          A TMJ patient can have a grooved (scalloped) tongue due to the TMJ patient pushing her tongue strongly into the sides of her teeth. With time, a TMJ patient's teeth may begin wearing so that wear facets that look like diamond cuts appear. At times there will be ringing in the ears, a fullness in the ears or even ear pain.

          TMJ patients commonly may have several other medical problems that seem to go along with the TMJ problem. These are:

                     Anterior open bites
                     Badly worn anterior teeth
                     Mitral Valve Prolapse
                     Decreased thyroid function
                     Nasal allergies
                     Hypoglycemia
                     Mineral and vitamin deficiencies
                     Forward Head Posture
                     Thoracic Outlet Syndrome

          TMD patients can sometimes get terrible headaches right after their dental procedures. If you know that a patient has a TMD problem, give the patient frequent breaks during the cleaning and polishing to allow for her muscles to relax. This rule goes for all dental procedures, even those done by the dentist. A TMD patient can not open wide for long without going into muscles spasm.

           If you wish to refer a patient for a TMJ Dysfunction consultation Dr. Padolsky would be pleased to assist you and your patient. Call 404-874-7428