Complex Care
Orofacial Pain and Craniofacial Pain are significant life altering issues that can have a dramatic effect on the quality of life.
TMJ is a commune phrase understood by most in our community. TMJ actually is an abbreviation for a body part, the temporomandibular joint. Temporal, represents the temple area of the skull; mandibular represents the mandible, or lower jaw; the joint is where the head and jaw meet. Problems in this joint may be caused by a misalignment of the teeth, trauma, excessive muscle tension or a combination of all of the above.
Between these two bones, the base of the skull and the mandible, a disc acts as a buffer, and five muscles on each side are involved in the movement of the lower jaw.
Problems in this area can cause: • Headaches • Earaches • Trouble/soreness in opening and closing the mouth • Clicking or popping of the jaw • Pain in the jaw muscles • Soreness in the area, sometimes extending to the face
Treatment of temporomandibular joint disorders, or TMD, is done in phases in this practice. Phase I is the most imporatnt, which is the DIAGNOSIS of the pain problem. Successful treatment can not be obtained without a proper diagnosis first. We use High Tech diagnostics and xrays to help in that process.
Phase II is used to establish where the lower jaw wants to be in space so that the joint and the muscles are comfortable. This usually includes an appliance called an orthotic, which is used to stabilize the bite in a position that decreases the stress on the joint. This appliance is typically worn during the day, including when eating. During this phase, specific treatment options such as LLLT (low level laser therapy), iontophoresis, ultrasound, electrical stimulus (TENS and True Tesla therapy) and stretching of the muscles may be implemented. Nutritional supplementation is also utilized so that your body has the proper building blocks to do the repair process with.
Phase III takes one of two paths. Weaning off of the orthotic, or implementing a plan to allow the patient to be transitioned to be non-plastic dependent. The goal of Phase III is to restore the mouth to the position that eliminates the need to wear the orthotic during the day to keep the joint stable. Sometimes it is as simple as weaning off of the orthotic. Other options include fabrication of new dentures, crown, onlays, direct bonded restorations, or even orthodontics. There is no one solution that is right for all cases. If untreated and the condition progresses to extremes, surgery may be required to repair a badly damaged joint, but this is reserved as a last resort, not primary treatment.
Nutritional support during the treatment process, and after, is highly recommended, and your case success can be adversely effected by not addressing that component of the healing process. This practice is recommending the whole food supplement products of Standard Process for their supportive therapy. These supplements are made from whole foods, not chemically formulated, so that your body gets ALL the components it needs to process the vitamins and minerals most effectively. Additional therapuetic treatment modilities such as ultrasound, moist heat, spray and stretch and electrogalvanic stimulation can be used when indicated.
Phase IV, or the maintenance phase, is just as important as the treatment phases. This is critical to minimize the probablility of your system relapsing into the state of symptoms that brought your to the crisis state in the first place. You can maintain your relationship with your primary dental provider, if it is not Dr. Wiggins, but annual followups, at minimum, are recommended, as well as maintenance of the supplement program recommended for your systemic health maintenance.
Nighttime stability of the joint is usually maintained with the use of an appliance that is different from the day appliance. The appliance most often used for pure clenching and grinding is an anterior discluder such as a NTI-tss.
This treatment appliance is designed to minimize the damage to the teeth and joint that occurs during the night from the forces generated during nighttime clenching and grinding, also known as bruxism. It is a small appliance, about the size of your thumb’s first digit, that fits over your front teeth. Your opposing front teeth are fitted with a clear plastic shell, similar to an Invisalign aligner, that will contact a flat area on the appliance that allows the lower jaw to rest in a neutral position. It will allow you to move from side to side when you are sleeping, but it will not allow anything from the eye teeth back to touch.
If your diagnostic portion reveals a compromised airway, yout night appliance will address it as well. Patients who have a confirmed obstructive sleep apnea component to their health concerns can have an FDA approved appliance fabricated to both protect their joint position and health and open your airway. If OSA is suspected, a Home Sleep Test request will be sent to your primary care provider, or a Polysomnogram evaluation in the hospital if your health picture is more complicated.
If your diagnostic portion reveals a compromised airway, but it not severe enough to be considered obstructive sleep apnea, and appliance will be made to protect your joint and teeth from clenching and grinding, and also hold the chin in a more forward position, increasing the probability of helping to keep the airway open while you sleep. This is known as a long term anterior depgrommer with a lingual ramp, or Farrar appliance. It functions similar to the NTI, but also helps to keep your chin in a more forward position.
If you are interested in meeting with Dr. Wiggins to see if can potentially be helped, please complete the link below that completes a comprehensive medical history review form. SELECT THE FORM THAT BEST DESCRIBES YOU. That will get the process started. This information is loaded through a secure server to our office, which can then be reviewed by Dr. Wiggins. Once this hasa been completed, please contact our office for an appointment. Most people should choose the COMBINED form.
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