TMJ Specialist Serving Los Angeles and Beverly Hills

Like a Richter scale showing an earthquake, EMG data allows us to assess how unhappy the muscles are. It also guides us into a bite position where we know the muscles are more relaxed. Getting the EMG muscle data as low as possible is the key to getting you out of pain! Low EMGs tells us that you are relaxed and in a healthy position. Using a TENS machine and other techniques to decompress the jaw joint will also help get these muscles as calm as possible.

Transcutaneous electrical nerve stimulation ( TENS or TNS ) is a device that will send an electrical impulse to the nerve that innervates all the muscles of the TMJ. We use this machine to relax the jaw muscles (low earthquakes on the Richter scale). We use the TENS to buzz all the tension out of the muscles before we capture your physiological correct bite position. We say the muscles of the jaw is like a puppet on strings. Many times these strings are tangled and need unwinding. The TENS machine helps us relax these muscles.

The Anterior Reposition Appliance is a Phase 2 option for TMJ patients. This appliance allows for the lower jaw to re-nestle itself in a larger upper jaw. With this appliance, we are now able to help patients with sleep apnea, poor posture, and can allow the lower jawbones to accommodate all the teeth in a place that is in harmony with jaw joints, vertebrae, and muscles of the head and neck. This is the essence of Face-forward Orthodontics or Jaw Development orthodontics or Orthopedic Orthodontics which allows the lower jaw to come down and forward creating happier muscles and more room in the joint space.

Chronic pain is the main component of TMJ - pain in your jaws, mouth, teeth, ears, neck, shoulders, and head. Chronic pain leads to depression, alcoholism, addiction to pain medication, and diminished daily existence. Many TMJ sufferers grind their teeth while they sleep, a condition known as bruxism. Left unattended, this leads to cracked and damaged teeth and usually is accompanied by insomnia. Ear problems such as tinnitus are another result of TMJ, as can be inner ear problems leading to problems with vertigo. The continued pressure on your misaligned jaw can lead to permanent jaw damage, including possible jaw locking or jaw dislocation due to damaged cartilage.

Locking of the jaw can occur in an open or closed position. This can be caused by jaw muscles that are stiff and may actually spasm which we call Trismus. Another reason for a locked jaw occurs when the soft cushion/disc between the bone of the skull and the jaw joint can move into a position that precludes normal jaw joint function, limiting the movement. The good news is, techniques are available to get the jaw moving normally! We can start your TMJ treatment in Los Angeles right away!

TMJ can be caused by a number of issues. Some of these include:

• Unbalanced, misaligned bites like deep bites or over-jet bites, crossbite, and many others.
• Airway issues relating to poor sleep
• Unhappy tense jaw muscles
• A compressed jaw joint that does not allow for the disc to ride on the joint properly. This may cause popping and clicking.
• Injury or trauma
• poor posture

We recommend that you see a TMJ Specialist in our Beverly Hills office right away. There is no substitute for a professional evaluation with a dentist who uses a 3D CT scan along with an evaluation of your head and neck and your bite and condition of your teeth! There are a few tests you can try at home to get a sense of possible TMJ. If you suffer from facial pain, migraine headaches, or other symptoms - these tests can point to TMJ

• Opening your jaws - Open your mouth while looking in the mirror. If your lower jaw doesn't move straight downward, subtly moving to one side instead
• Clicking or popping - Your jaw should open and close silently. If you hear a clicking or popping sound, these are signs the joint is not functioning properly. (if it used to pop and stopped, it could be an advanced stage)
• Inability to fully open your mouth - When your mouth is fully open, most people are able to vertically insert three stacked fingers between the teeth. If you are not able to do that, your jaw muscles have unnatural pressure caused by TMJ.
• You are always trying to rest your lower jaw somewhere to relieve tension.

Los Angeles TMJ specialist Dr. Frey is a leading expert in Neuromuscular dentistry and has treated thousands of patients with persistent pain from TMJ disorder. Neuromuscular dentistry emphasizes the importance of the position of the jaw, teeth, and surrounding tissues.

In our Beverly Hills office, TMJ treatment is divided into two phases: Phase 1 is stopping the symptoms or severely diminishing the symptoms of the TMJ disorder, and Phase 2 is preserving the results of the treatment. This can be accommplished many different ways. For example, holding the corrective bite position with porcelain crowns and veneers, or with an orthodontic procedure thus moving the teeth into the corrective bite position found in Phase 1. . Phase 2 can also involve permanent splint therapy, bite adjustments, and doing nothing.

• PHASE ONE: In phase one, a TENS machine (see below) is used to get the muscles of your jaw into a relaxed natural position. We call this the "physiological resting position." This machine will relax overworked jaw muscles with tiny, relaxing electrical impulses. We can also de-compress the joint using manual decompression techniques and other devices. We prove that the jaw muscles are relaxed by evaluating EMG (electromyography data - see below) which is like looking at a Richter Scale measuring an earthquake. We then capture this position with a dental play-doh molding material. Once we have the location of the corrective bite position, we can then realign your bite into the optimal, relaxed, position. We actually work backward. We first relax the muscles of the jaw and then decompress the jaw joint. Once the muscles are relaxed and the jaw is decompressed, you look to see where the jaw is exactly and capture that position.

You will then wear a custom-shaped orthotic (basically a re-aligned bite) to rehabilitate the jaw muscles. These "trial" bites can be fixed or removable. The fixed orthotic is bonded to the top of your existing teeth and looks and feels perfectly natural. It will not alter your speech, and no one will notice you're wearing it. The process takes a month or less for your muscles to acclimate to the new bite position, and many patients report headaches, back and neck pain, ringing in the ears, vertigo, and many other symptoms associated with TMJ dissipating or completely vanishing.

• PHASE TWO: Phase two of the treatment begins once you're comfortable with your new bite and your TMJ symptoms are doing better. In order to sustain the results of your Phase 1 TMJ treatment, we may recommend a restorative solution like a full-mouth rehabilitation plan or orthodontics solution depending on your personal situation. There are many options to choose from once your TMJ symptoms have vanished, including just wearing a splint or doing nothing.

Our philosophy is to avoid jaw surgery wherever possible. Surgery should be the last resort when all other non-surgical methods are exhausted. We understand that surgery may be the best approach for certain scenarios but in our experience, the majority of TMJ patients can resolve their symptoms without surgery. We do everything in our power to treat TMJ organically without surgery. We do this by finding a bite position that is in harmony with the muscles of the head and neck, and the jaw joint. We find this zone of comfort position for patients in a material that is completely reversible. We call this Phase 1. It's a test to see if we can resolve the TMJ. Once the bite position is resolved, we recommend permanent solutions to keep it from coming back.

The three components of your bite - the way your teeth come together, the muscles of mastication, and the temporomandibular joint - all three must work together for correct function. Many times, when the three are not working together, patients report experiencing symptoms like headaches, jaw pain, facial pain, ear pain, dizziness, tinnitus, neck, back, and shoulder pain.

The pain is due to the continued chronic, the stress of the misaligned jaw trying to find alignment with the muscles and the jaw joint or vice versa. Considering we use our bite, muscles, and the temporomandibular joint every day, the pain can be debilitating and feels like the body cannot heal it on its own.

Sometimes, it's like a straw that breaks the camel’s back. " I just had a dental crown when it started". The body does everything it can to keep your body in equilbrium. When something disrupts this equilibrium, pain can start.

Jaw pain, facial pain, ear pain, headaches, migraines, neck, shoulder, and back pain, dizziness, tinnitus, numbness in the arms, hands, and fingers, clicking, popping, or locking of the jaw.

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If you are experiencing any of these symptoms, contact Dr. Frey–the best TMJ dentist in the Los Angeles area–today to find out if you have TMJ

These three acronyms all point to the same thing - temporomandibular joint disorder. Sometimes TMJ is used to solely describe the joint. Sometimes TMD is used to describe a patient who is experiencing symptoms and has an imbalance in the muscles of the head and neck, the jaw joint, and the bite. TMJD is rarely used, and simply adds the D for “disorder”. TMJ is a syndrome that can involve painful symptoms like jaw pain and headaches which are most common.

How Can our Los Angeles TMJ Specialist team Help