The TMD Dilemma


The force of the human bite is so strong that it can wear through the strongest substance in the body: ENAMEL. Enamel is the outermost layer of a tooth. When the enamel encompassing each tooth is worn down, teeth appear smaller and spaced. Teeth can tell a story, with the muscles acting as the actors. Still, the temporomandibular joint (TMJ) ultimately authors the plot.

The temporomandibular disorder occurs when the internal articular disk assembly locks, pops, clicks, or is no longer positioned to function. The muscles surrounding the jaw become uncoordinated. How this occurs is patient-specific. The human body has a tremendous capacity to compensate for this imbalance. With some degree of discomfort, eating is still possible. In some instances no discomfort at all. The system can be thrown off due to a systemic problem unrelated to teeth. While in other cases, it may be directly related to broken teeth, new or failed restorations.

For instance, a patient presented with eight new crowns. Aside from the pain, the back teeth were unable to be combined. A digital analysis revealed only the front teeth could slightly be put together when the patient was asked to bite down. The muscles became so uncoordinated they went on strike – like actors in L.A. The muscles’ demand was maximum intercuspation, which is when the cusps of teeth come together in synchrony.

In this case, the muscles compensate to bring the teeth together. Even compensated muscles could not negotiate this deal. The patient was in excruciating pain.

The solution was a trial smile. This orthotic was placed over the existing teeth without any drilling. The pain subsided with a balanced bite. The final bite was transferred into a beautiful storybook ending.

Sometimes, there can be quick fixes in dentistry. Other times, unrealistic demands to fix many teeth in a single visit can compromise the outcome.

There are both short-term and long-term solutions to TMD.

Short-term options: Botox. While it provides temporary relief, it can become costly. This toxin allows the muscle to lose proprioception for a while, only to return to the same pathologic state after it wears off.

Another short-term option is night guards. The guard can provide some relief to the teeth; however, the muscles remain hyperactive, producing more compression on top of the plastic. The mandible is placed in a comfortable position, but then a deprogrammer gets your muscles back to their pathologic state. The smile remains unchanged. The bite remains problematic.

A local long-term solution is offered at Daydream Family Dentistry. The entire system is measured using electromyography, pressure mapping the bite, and creating the ideal occlusion for the worn teeth. Some term this type of practice physiologic dentistry or neuromuscular dentistry.

The difference, in theory, is compression versus decompression. It’s not new to the profession. It’s practiced worldwide and is now being offered in the RGV.

We are here to offer a solution.

Step 1: 3D CT scan of your entire gnathostomatic system. Interpretation by an oral radiologist.

Step 2: Electromyography studies of your muscles of mastication. Digital bite analysis.

Step 3: A trial smile in a physiologic position.

Step 4: The new bite in harmony with the musculature and, best of all, a brand new smile to complement the entire system.

We offer a warranty on our new smile design cases. Mention TMD and get $500 off your trial smile.

Contact us to get your consultation scheduled at 956-968-6561.

Dr. Rafael Carrales