2210 North Broadway
Rochester, MN 55906

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TMJ Dentistry in Rochester, MN

Gentling Dental Care provides TMJ treatment, night guards, and NIT appliances in Rochester

What is TMJ?

TMJ is actually stands for temporal mandibular joint. Some people have been told or they think they have TMJ. What they really have is TMD, temporal mandibular disorder.

How do I know if I have TMD?

The best way to find out if you have TMD would be to go to a qualified TMJ dentist and have a complete examination done. Together you can sit down and talk about symptoms and what is going on and then talk about treatment options and there might be further information gathering needed. That would be the best way to get a start on discovering on what type of TMD you have and what is the best possible treatment that could be done.

What treatment works best for TMD?

In our practice one of the easiest ways that we have found to treat TMD is to start with splint therapy (also called night guards or mouth guards). There is a wide variety of kinds of splints, mouth guards and night guards. The first type of splint that people can be familiar with or something you could buy from Target or Wal-Mart over the counter store, you get from your local drug store. It looks like a little boil and make your own athletic mouth guard. These can be okay and sometimes we do offer those to our patients but we have found that patients can start chewing on them a lot more at night time and actually aggravate a lot of the TMD symptoms that they might have.

Are all mouth guards / night guards the same?

No, all mouth guards / night guards are not the same. We have patients that come to us and they said that they had a night guard before with the dentist and it did not work. There are so many different kinds of night guards. Every night guard should be defined by what it is doing and how it is affecting again we are going to assume clenching and or grinding our teeth at night time. Night guards are actually very different and what they can do for a patient is quite a bit different as well.

The most common type of night guard or mouth guard that patients will get from their dentists is made of hard acrylic. They are sent to a laboratory so the patient would have models made of your teeth and most of these splints are made without looking at the system. Most of them are made without looking at how the jaw joint functions. Most of them look at just the tooth contact so they would make a splint to cover just one arch that could be the upper arch or the lower arch and they would then put them together. Fabricate the splint so it would be made in between jaw joints and it is just a protective covering against any occlusion, occluding that goes on with your teeth.

The problem with that is they are not taken in consideration the system as far as where the jaw joint is so these can also be fabricated on a machine called an articulator that mimics the jaw pattern so it has the jaw joints both sides. The dentist would then get records, the bite records to make sure that it is made in the correct position. So this splint could be made that way so if you are going to your dentist and you are having a splint made, you may want to ask how they are fabricating it. Do they use instrumentation or they just leave it up to the lab technician to make it with their hands.

One mouth guard is called the MAGO, the Maxillary Anterior Guided Orthotic which is a fancy name for this splint. The place we were learned to do this is called OBI, Orognathic Bioesthetic International and they just believe in making upper orthotics and the way that they treat their TMDs, you wear this 24 hours a day and you come back to the dental office to be seen many, many times and slowly adjust this in to the proper bite so they are looking at getting stable jaw joints and stable muscles on the occlusal plane of the splint, on how the splint hits.

Another type of night guard that you will only find in certain study clubs and organizations so less and less dentists are educated in how to make these, these are called the Tanner splints or the anatomical splints, these getting to be the key word there. And they are made somewhat like the MAGO but a little bit smaller, sleeker design, they are made with the idea of maybe replicating or discovering slowly together over time how your teeth hit together and what feels better in your mouth. As you slide your teeth to cross or hit on it, little tiny adjustments are made to correlate to make the teeth grinding symptoms disappear or obviously get better would be the goal.

What is a NTI Appliance?

Another night guard, mouth guard is the NTI appliance and this is unbelievably genius of an appliance. It is a small piece of plastic. By the way you can check this appliance online. The website is headachehope.com or you can just Google NTI and Google and NTI will bring up so much information that you would be busy for hours. This is just a very simple appliance that just fits right on the edge of your front teeth and what’s the difference between this little appliance and all the other appliances that we have is that there is no posterior contact, there is no hitting ability of the back teeth to touch together and what’s great about that is it does not allow the masseter muscles and the temporalis muscles to allow teeth clenching.

The NTI appliance does not allow the masseter muscles or temporalis muscles here to clench it for maximum ability. You can actually take a pencil, between your teeth and then clench as hard as you can, you can’t feel the intensity levels, the ability of the muscle that clench the maximum is not there. So this little appliance takes advantage of that. You have to be careful when you fabricate these.

You want to go to a TMJ dentist that does several NTI appliances a year. There are a lot of parameters that need to be solid in place before you go home with an appliance like this, as you can understand and then there should be a follow up with these as well for retention and of course checking symptoms so that is the big way that most dentists that treat TMD, the best way to start there is also a physical therapy we refer to a physical therapist, of course medication is possibly a route that we will take but usually from the start this solves most of the TMD problems associated with teeth grinding and teeth clenching.

I had an orthodontic treatment in the past, is it possible for me to have TMD now?

That is a tough question and it gets into a lot of philosophical discussions with dentists and orthodontists. What we find in our office, we have a variety of orthodontists in town, some take special attention on how the jaw joint seat in the fossa, how the jaw stays there. There is a lot of research that out there that goes out across the board on whether this is important or not.

What we find in our practice is that the orthodontics that is finished with anterior guidance. That means the orthodontics that finishes the case with a stable joint position, or a repeatable position, something that is pretty repeatable. But then also has some sort of anterior control over their front teeth touch in the anterior, we find those over time to be the most stable occlusions, we find those over time to be patients that do not report to us with TMD problems. We see that the patients that do not have multiple fractures in their teeth, have less pain symptoms, could be tooth pain, tooth sensitivities, they have less dentistry in general, which is very interesting.

Whereas if we find patients that maybe were finished with an orthodontics with an anterior open bite or an over jet in excess, we find over time in our practice, we find that those patients will have multiple needs for crowns in the back teeth, they may end up having root canals done. They may have teeth missing. This is again, this is in our practice. So I am not saying in general. So just because you had orthodontics, does not mean that the system is in a balance, so again if a bite is made and the jaw joint is not seated right, you can find pivoting in places off and with all this, we are assuming that there is teeth clenching and teeth grinding going on.

Who is qualified to treat TMD?

Any dental professional is qualified to treat TMD. There is not a Board certification in treating temporal mandibular disorders at this time. What you should look for in your TMJ dentist would be if they have a special interest in it. You should ask a lot of questions. Ask if they have taken extra courses to study the temporal mandibular disorders, study anatomy, study pain associated with the trigeminal neuralgia. The bottom line is that anybody can treat TMD but you should be very curious as to what extra continuing education your TMJ dentist has taken.

View Our Patient Education Video: TMJ, NTI Appliance Part 1

View Our Patient Education Video: TMJ, NTI Appliance Part 2

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