What is TMJ Dysfunction (TMD)?

TMJ Dysfunction is a popular term to describe a disorder of the jaw joints or the muscles that control the joints. Various terms are used to describe this disorder, such as Craniomandibular Dysfunction, a dental term, which describes a collection of symptoms that result when the chewing muscles and jaw joints do not work together correctly. "TMJ" is a popular term commonly used to describe the same group of symptoms, which stands for Temporomandibuilar Joints.

  These are the two joints that connect the jaw to the skull.  


When these joints are out of place, they can cause symptoms that masquerade as a multitude of other problems like sinus headaches, migraines, neck and shoulder stiffness and earaches. Such symptoms may relate to your bite and how they can successfully be treated by Dr. Karbassi, who has special education in managing these disorders.


Muscle spasm goes hand-in-hand with displaced jaw joints. Because the nerves and muscles are so complex in this area, when these muscles spasm, the problems can be far-reaching. People suffer from symptoms they would never think to associate with their bite, such as:


• Clicking or popping of the jaw joints

• Pain in or around the jaw joints

• Locking or limited opening of your mouth

  • Headaches

• Pain behind the eyes

• Dizziness

• Earaches or ringing of the ears

• Clenching or grinding of the teeth

• Neck, shoulder, or back pain

• Numbness, or tingling of the fingers


The primary problem can be in the joints themselves, the muscles of the face and jaw, or a combination of these. The term Craniomandibular Dysfunction (cranio = head; mandibular = jaw) is a more descriptive term because it refers to problems involving both the jaw joints themselves and the muscles of the face and head. Because the symptoms masquerade as so many other conditions, many people travel from doctor to doctor in search of a cure. It is estimated that as many as 44 million Americans suffer from one or more of these symptoms. Many never think to seek a dentist for help.


The term “TMJ Dysfunction” describes an imbalance in the relationship of the jaw to the skull. This imbalance causes two problems for those that suffer from it. First, it leads to improper alignment of the Temporomandibular Joints (TMJs) which connect these two bones. Secondly, it creates disharmony in the muscles which attach to the bones. The cascade of painful symptoms that arise solely from these two problems is staggering to most people. Although most times the pain is not actually in the TMJs themselves, you can feel your own by pressing your fingers just in front of your ears and opening and closing your mouth.

How Does TMJ Cause Headaches
and Other Facial Pain?

Misalignment of the jaw and disorder in the joints causes the symptoms of TMD in two ways:


• The temporomandibular (TMJ) joint has nerves and blood vessels that lead to other areas of the head and neck. When the TMJs and jaw are misaligned, it creates excessive pressure on these nerves and blood vessels and pain is perceived as coming from where they eventually lead to (i.e. head, neck, shoulder, etc…) This is what confuses most of those that suffer because the problem isn't in the actual area of the pain. This is the same mechanism by which a problem in the joints of your spine can lead to numbness or pain in other regions of the body such as your hands or feet.


• TMD can cause these symptoms by disrupting the balance of the muscles associated with the jaw and skull. The jaw has a precise optimal position for creating balance and harmony in the muscles that attach to it. If this balance is disrupted, as is the case in TMD, these muscles become irritated and overly active eventually leading to muscle fatigue and spasms. Muscles that are excessively fatigued and spasming can be very painful and lead to the cascade of physiological problems and symptoms discussed earlier.

Muscle Spasm

Your upper and lower teeth must come together firmly each time you swallow. This happens over 2000 times each day and night! When your bite is unstable, your muscles must work ever harder.

This extra work makes them shortened and stiff. Eventually this strain makes them feel pained. A vicious cycle begins to increase tissue damage, muscle tenderness, and pain, causing you to feel tense and uptight. This worsens the muscle spasm, which in turn increases the pain.

A "Bad Bite"
What Causes Craniomandibular Dysfunction?


The structures that make is possible to open and close your mouth include the bones, joints, and muscles. These are very specialized and must work together whenever you chew, speak, or swallow. Your teeth are inserted in your jaw bone and at the other end of your jaw bone are the temporomandibular joints.

These joints attach your jaw to your skull. Muscles attach both the bones and joints and allow them to move. Any problem which prevents the complex system of muscles, bones, and joints from working together in harmony may result in Cranimandibular Dysfunction.

Jaw Joint Displacement

The position of your teeth can also affect the position of your jaw joints. Each jaw joint is a ball and socket joint. When functioning properly, the ball and socket do not actually touch because a thin disc of cartilage rides between them. The disc acts as a cushion and allows the joint to move smoothly. Each disc is held in place and guided by muscle. If your bite is not right, the joint is pulled out of alignment. Typically the disc is pulled forward. Since it no longer serves as a cushion, the joint itself now rubs against the boney socket and presses on pain fibers. Mild displacements cause a clicking or popping sound in the jaw joint; more severe displacements can be very painful and eventually can cause permanent joint damage.

An unstable bite can cause both jaw joint displacement and muscle strain and pain. Many seemingly unrelated symptoms result which are collectively known as Craniomandibular Dysfunction. When this condition is prolonged, the body begins to compensate and adapt by involving muscles in the neck, back, and even sometimes those of the arms, fingers, pelvis, legs, and feet.

There are various ways this system can be disrupted, such as accidents involving a blow to the face or a whiplash. Yet the most common cause of Craniomandibular Dysfunction relates to your teeth and your bite. If your bite isn't right, it can affect both the muscles and the joints.

So what does it mean to have a "bad bite?" The can be classified as the upper and lower teeth not joining together in a way that provides proper bracing support for the jaw against your skull. This can result from a missing tooth, misaligned teeth, or back teeth classified as too "short."


Since the teeth, jaw joints, and muscles can all be involved, treatment for this condition varies. Typically, treatment will involve several phases. The first goal is to relieve the muscle spasm and pain. Then, we must correct the way the teeth fit together. Often a temporary device (known as an orthotic, or "splint") is worn over the teeth until the bite is stabilized. Permanent correction may involve selective re-shaping of the teeth, building crowns on the teeth, orthodontics, or a permanent appliance to lay over the teeth.

If the jaw joint itself is damaged, it must be specificaly treated.

Though infrequent, surgery is sometimes required to correct a damaged joint.


Ultimately, we will stabilize your bite so that the teeth, muscles, and joints all work together without strain. The important aim of correcting your bite is to insure optimal long-term health. If you have any of the signs or symptoms mentioned, contact our office for a free TMJ consult. Your health is your most priceless possession. It is worth the investment!


Headaches and Relationship to your Teeth

One in eight Americans suffer from recurring headaches that are so severe they cannot carry out normal living! An estimated 80% of all headaches occur from muscle tension. Did you know that many tension headaches are related to your bite? .

Headaches are our number one pain problem in the United States. Approximately 40% of all "healthy" individuals suffer from chronic headaches. Head pain in not new. Early civilizations relied on magical potions and spells to cure headaches. In severe cases, holes were drilled in the skulls for headache sufferers so that the evil spirits which were believed to be the cause of the pain could escape. Over the years we have learned much about what causes headaches and how to treat them. Today, there is a growing realization that a common cause of tension headaches is a bad bite.

Tired Bite

The muscles which control your jaw and hold your head upright are very complex.

Many people do not realize that every time they swallow, their upper and lower teeth must come together in a firm way to brace the jaw against the skull. We swallow over 2000 times each day and night!

If your bite is unstable, as from poorly aligned teeth or even a missing tooth, the muscles must work harder to bring the teeth together. Most people take a vacation from work when they tire out-but your jaw muscles never get a break! The overworked muscles become strained. When muscles are under constant strain, they eventually become painful.

Muscle Imbalance

Other muscles may also become involved. Your head is delicately balanced on top of your spinal column by muscles in your jaw, neck, shoulders, and back. Your head weighs approximately 15 pounds the weight of an average bowling ball! 

Imagine your head as a baseball balanced on top of a pencil by a number of rubber bands. When muscles are tense, they shorten. Now imagine shortening just one of those rubber bands. Some rubber bands would stretch, some would shorten, and the baseball would be thrown off kilter! 

Similarly, when even a single jaw, neck, or shoulder muscle becomes shortened, all of the other muscles are forced to overwork to keep the head balanced on top of the spinal column. We see then that dental headaches originate from an unstable bite which cause the muscles of the jaw, head, and neck to overwork and become painful, Once the muscles become painful, a vicious cycle begins. The pain makes you feel tense and uptight. This worsens the muscle spasm, which in turn increases the pain.

Headaches from Dental Stress

How can your bite cause a headache? Tension headaches result from muscle strain, or contractions: when muscles are held tight for long periods of time, they begin to ache. Headaches from dental stress are a type of muscle tension headache. A tension headache may be on one or both sides of your head. Or, it may surround your head as if a steel band were wrapped around it. The pain feels like a dull, non-throbbing ache.

Tension headaches are usually relieved by asprin.


Specific signs which indicate that the headache may have a dental origin include:


• Pain behind the eyes

• Sore jaw muscles or "tired" muscles upon awakening

• Teeth grinding

• Clicking or popping jaw joints

• Head and/or scalp painful to the touch

Referred Pain

The pain may be felt in the cheeks or the jaw joints. Many times, however, the pain is "referred" to other areas of the head.  "Referred pain" is when a pain originates in a part of the body that differs from the area where it is felt. Even a single tooth can refer pain to the head.


Dental Treatment

If you suspect that your headaches might be caused by your bite, call for a TMJ Consult. We will examine your teeth, your muscles, and your jaw joints to determine if dental stress is the source of your headaches.

If so, treatment will involve correcting your bite so that the muscles can function without extra strain and tension.

In some cases it is helpful to receive other types of treatment, such as physical therapy, along with dental treatment to correct the postural relationship of your head, neck, and shoulders.

Counseling or relaxation training might also be helpful to teach you ways to relax the muscles and to identify sources of emotional stress. However, if the true source of the headache is an unstable bite, this must ultimately be corrected to relieve the headaches.

The important aim of correcting your bite is to insure optimal long-term health. If you have any of the symptoms mentioned, discuss them with us. Your health is your most priceless possession.

It is well worth the investment!

When Medical Help Is Needed

It is important to realize that headaches have many different causes and a wide range of severity.

Immediate medical help should be sought for any head pain that leads to:

weakness of an arm or leg, loss of vision, disorientation, loss of consciousness.

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