TMJ Management/ Occlusal Analysis

TMJ and Occlusal Analysis

At Nuffield Dental, we believe in a rigorous and evidence-based approach to managing Temporomandibular Joint (TMJ) disorders. Our treatment methods are grounded in mainstream techniques that are widely recognised and published in reputable medical and dental literature, such as PubMed. This ensures that our patients receive the highest standard of care, supported by the latest research and clinical guidelines.

The Importance of Regular Reviews

For patients suffering from chronic TMJ pain, regular and consistent reviews are critical to achieving successful outcomes. Chronic TMJ issues require ongoing assessment and adjustment of treatment plans to ensure that they are effective and responsive to the patient's evolving needs. Our commitment to thorough follow-ups allows us to monitor progress closely, making necessary adjustments to improve patient comfort and function.

Multi-Specialty Collaborative Care

TMJ disorders often require a multi-faceted approach, which is why we routinely collaborate with a team of specialists, including physiotherapists, cognitive behavioural therapists, and other allied health professionals. This multi-specialty referral workflow is integral to our practice, as it allows us to address not just the physical symptoms but also the psychological and lifestyle factors that contribute to TMJ disorders. Research, such as the study by McNeely ML et al. (2006), highlights the benefits of a multidisciplinary approach in managing TMJ disorders, showing significant improvements in pain reduction and overall function when multiple therapeutic modalities are employed.

Realistic Expectations for Chronic Conditions

It is important to understand that none of the treatments we prescribe—whether splints, injections, or TENS—should be viewed as a quick fix. TMJ disorders, particularly those that have been affecting patients for years, require time, patience, and a comprehensive treatment plan to achieve meaningful relief. Our approach is designed to gradually improve your condition through sustained and targeted interventions, rather than offering temporary or superficial solutions.

At Nuffield Dental, our goal is to provide enduring relief and restore function through evidence-based, patient-centred care. We are committed to working with you every step of the way, ensuring that your treatment is tailored to your unique needs and is supported by a team dedicated to your well-being.

The T-Scan™ System

T-Scan™ is an objective assessment tool used to evaluate the occlusion of a patient. Unlike articulating paper, which can only determine location, T-Scan™ effectively identifies both force and timing - two of the essential variables to understand and measure occlusion.

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What is Dental Occlusion and How Do Dentists Measure it ?

T-Scan™ Novus™ is dentistry's only clinically recognized and research validated digital occlusion analysis system. T-Scan's state-of-the-art, innovative, digital technology helps me to identify in my patients: premature contacts, high forces, and interrelationship of occlusal surfaces. This important data cannot be captured by traditional, analog occlusal methods, like articulating paper.

Whether eliminating destructive forces on a new restoration, or performing an occlusal analysis and adjustment procedure, T-Scan helps me balance your biting (occlusion) and reduces costly repeat visits and remakes.

Rapid advancements in technology are shaping the face of digital dentistry. This is another valuable piece of digital technology in my practice,which will enhance your understanding how bite forces are important and the impact in your life. T-scan will allow me to give you a more confident, proactive approach to how I assess your bite.

T-Scan™ Data Provides Context to Understanding and Preventing Bite Discrepancies in Full Mouth Restoration Cases

Among the most complex procedures in dentistry, full mouth reconstructions require a treatment plan that revolves around teeth, periodontal tissues, temporomandibular joints and muscles, and aesthetics. T-Scan™ is a computerised occlusal analysis system that allows me to see when and how each tooth makes contact. This is critical to achieving a balanced, functional bite during and after a full mouth reconstruction.

Disclusion Joint Therapy in managing TMJ pain

Your Temporomandibular Joint (TMJ) connects your lower jaw to the temporal bone of your skull, which allows for all the movements of your jaw. The TMJ is surrounded by a intricate network of ligaments, muscles and nerves. A significant nerve is the trigeminal nerve - a cranial nerve responsible for most of the sensation throughout your head, face and neck and also controls some muscles.

When alignment and function are dysfunctional for any reason, the presenting symptoms are collectively referred to as TMJ/ TMD or temporo mandibular joint disorders. Some causes for this disorder include: trauma, toothgrinding (bruxism) and malocclusion (improper bite).

The symptoms of TMJ disorders typically include:

Clicking, popping, grinding noises in the jaw
Inability to open the jaw to its full range, sometimes complete lockjaw
Pain and/ or swelling around the jaw joint
Chronic Headaches
Chronic Neck Stiffness

Using computer-guided technology, called a T-Scan system, we can compile data on a TMJ/TMD patient’s timed and force bites inside the mouth. As back teeth touch each other while a patient chews, eats, or grinds their teeth, opposing teeth push each other in and out of their sockets. These socket compressions go on unknown to the patient and happen thousands of times throughout the day, all the while, excessively firing the jaw muscles of the patient into a state of severe pain.

By using the T-Scan data collected, I can easily correct the time and force of occlusal problems. In most patients, many of the TMJ pain, headaches, and other head pain symptoms go away within the first week after treatment has begun!

In treating your condition, I may choose to employ any of the following treatment modalities, tailoring it, depending on the severity.

Patient Education

Physiotherapy

Pain Medication/ Adjuncts

Occlusal Adjustments

Occlusal Balancing

Occlusal Equilibriation

Occlusal Splints

CT 3D analysis

Nuffield Rehab is my choice for sending my TMJ patients for physiotherapy management.

For those who might be keen to look up the evidence base in the literature, please feel free to look up the following:

Masseteric Botulinum Toxin for TMJ Treatment:
- Thambar, S., Kulkarni, S., Armstrong, S. and Nikolorakos, D., 2020. Botulinum toxin in the management of temporomandibular disorders: A systematic review. British Journal of Oral and Maxillofacial Surgery, 58(5), pp.508-519.
- Machado, D., Martimbianco, A.L.C., Bussadori, S.K., Pacheco, R.L., Riera, R. and Santos, E.M., 2020. Botulinum toxin type A for painful temporomandibular disorders: Systematic review and meta-analysis. Journal of Pain, 21(3), pp.281-293.
Steroid Injection for TMJ Pain:
- Al-Jundi, M., John, M.T., Setz, J.M., Szentpétery, A. and Kullmer, K., 2020. Effectiveness of intra-articular corticosteroid injections for temporomandibular joint disorders: A systematic review and meta-analysis. Journal of Oral Rehabilitation, 47(2), pp. 173-183.
- Ferreira, D.M., De Oliveira, J.S., Teixeira, S., Peixoto, C.R., Sampaio, A.P. and Carvalho, F.H., 2017. Intra-articular injection with corticosteroids in the treatment of temporomandibular joint disorders: A systematic review. Journal of Cranio-Maxillofacial Surgery, 45(6), pp.902-909.
Hyaluronic Acid for TMJ Pain:
- Bjørnland, T., Gjaerum, A.A. and Møystad, A., 2020. Hyaluronic acid injection therapy in the temporomandibular joint: a systematic review and meta-analysis. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 130(5), pp.548-556.
- Al-Belasy, F.A., 2018. Comparison of intra-articular injection of hyaluronic acid, corticosteroid and ozone for the treatment of temporomandibular joint osteoarthritis. International Journal of Oral and Maxillofacial Surgery, 47(5), pp.658-662.
Use of Michigan Splint for TMJ Pain:
- Manfredini, D., Bucci, M.B., Montagnani, G., Guarda-Nardini, L., 2016. Temporomandibular joint disorders and occlusal splints: A systematic review of their effectiveness. Journal of Oral Rehabilitation, 43(9), pp.693-705.
- Altindis, S., Sen, E. and Hosgor, H., 2024. Comparison of the efficacy of occlusal splint and botulinum toxin therapies in patients with temporomandibular disorders with sleep bruxism. Journal of Orofacial Orthopedics, 85(Suppl 1), pp.102-108.
Use of TENS for TMJ Pain:
- Ferreira, C.L.P., Da Silva, M.A., De Felício, C.M., 2017. Efficacy of TENS and low-level laser therapy in the treatment of temporomandibular disorders: A systematic review and meta-analysis. Journal of Oral Rehabilitation, 44(5), pp.347-356.
- Al-Moraissi, E.A., Farea, R., Qasem, K.A., Al-Wabab, A., Al-Iryani, G. and Alkhutari, A.S., 2018. Effectiveness of transcutaneous electrical nerve stimulation (TENS) in the management of myogenous temporomandibular disorders: a meta-analysis. Journal of Oral Rehabilitation, 45(6), pp.475-483.
Multidisciplinary Team Management Approach for TMJ Pain:
- McNeely, M.L., Armijo Olivo, S., Magee, D.J., 2006. A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. Physical Therapy, 86(5), pp.710-725.
- Durham, J., Newton, A., Breckons, M., 2016. The effectiveness of cognitive-behavioral therapy for temporomandibular disorders: A systematic review. Journal of Oral & Facial Pain and Headache, 30(2), pp.124-136.