It’s estimated that tens of millions of men, women, and children suffer from TMJ and TMD many of whom have no knowledge of their TMJ condition or how to seek TMJ treatments from a TMJ Doctor or Dentist. Headaches and pain are the most common complaints from those afflicted with TMJ. Around 80% of patients with a TMJ disorder complain of a debilitating headache, and over 40% report some kind of facial pain.
Your TMJ condition may unfortunately only worsen with time if you do not seek treatment from a TMJ specialist doctor or dentist. Without proper TMJ treatment, you will experience increasing joint damage or inflammation, and further wear and breakdown of your teeth, which typically leads to increases in muscle contraction and consequently increased head, neck and facial pain. If your jaw is not correctly aligned, you’ll add wear and tear every time you speak, chew, swallow, and yawn: even while you sleep.
The NYC / White Plains. New York TMJ specialist, Michael Gelb, DDS, MS has earned the prestigious award of Top Doc New York® multiple years in a row and is an NYC & White Plains top rated, best in class doctor on Vitals, HealthGrades, MakeMeHeal, Google, RateMDs, and other doctor’s services rating websites. Dr. Gelb has been featured as a TMJ specialist in The New York Times, The Chicago Tribune, Fox News, Fox Business News, CBS News, CNN, Women’s Day, Huffington Post, ABC News, Marie Claire, and other national and international newspaper and networks.
The Gelb Center of NYC and White Plains, New York is an internationally recognized best in class leaders (TMJ Dentists and TMJ Specialist Doctors) in treating and curing TMJ quickly. The Gelb Center’s team consists of top rated best in class dentist and doctors who specifically specialize in TMJ treatments – even the most difficult TMJ cases daily.
TMJ Symptoms: Below are a few symptoms that can help determine whether or not you suffer from TMJ:
- Headaches: sometimes of migraine proportions.
- Ear pain symptoms: ringing in the ears, hearing loss, “plugged” ears, ear pain, a feeling of being “underwater”
- Clicking: There is a pad or disc which ideally sits between the temporal bone and mandible in the TM Joint. This cushion, like a magic carpet, can slip out of place causing clicking when opening and closing. Clicking can lead to locking and grating or crepitus.
- Locking: When a disc is chronically displaced, it does not always click back into place. This leads to locking of the jaw joint with deflection of the jaw and limited range of motion.
- Popping: Some clicking can be staccato or popping by nature.
- Jaw Pain: Although it can originate from many sources, the most common reason for jaw pain is dental, then musculoskeletal. Most dentists can rule out dental decay, periodontal disease or root canal as the offending dental pathology. Muscles, tendons, ligaments and the temporomandibular joint can all cause jaw pain. Jaw pain can radiate from the neck.
TMJ Treatments: Below are a few possible treatment options that our TMJ specialist doctors and dentists offer; please note all TMJ Treatments offered by The Gelb Center of NYC and White Plains, New York are customized to your specific condition:
- TMJ Oral Appliances / Bite Guards: The Gelb™ TMJ appliance, Farrar™ TMJ appliance, Gelb TMJ NYU™ and MORA™ TMJ appliances all reposition the jaw to decrease clicking and decompress the auriculotemporal nerve. Stabilization appliances are also used for myofascial pain and cognitive behavioral habit control. Orthodontic appliances can also be used in the course of treatment.
- BOTOX™ Injections / Trigger Point Injections: Trigger point injection therapy involves the injection of a local anesthetic into tender points to eliminate pain and re-educate the muscles. BOTOX takes relief to a new level with 3-8 months of relief from TMJ.
- Sleep Appliances for TMJ: Breathing related sleep disorders are often diagnosed in conjunction with TMJ disorders. Oral sleep appliances can be prescribed in these cases. Dr. Gelb uses and offers 8 different sleep appliances.
- Physical Therapy for TMJ: Manual physical therapy can be used in myofascial release, mobilization of the TMJs, and deep muscle therapy. Postural correction, Feldenkrais, the Alexander technique, cold laser, ultrasound, stim, heat and cold are also used. Some therapists also find craniosacral therapy to be helpful.
- Chiropractic TMJ Treatments: Applied kinesiology, ART, SOT, atlas orthogonist, and cranial therapy are all used. Foot orthotics are prescribed when needed.
- Medications: Together with other nonsurgical treatments, medications that may help relieve the pain associated with TMJ disorders may include: muscle relaxants, Medrol, or Neuropathic medications. If nighttime teeth clenching is aggravating your pain, the doctor may prescribe a sedative.
Possible Causes of TMJ:
- Bruxism: A stereotyped movement disorder that occurs during sleep can overload the TMJ as a repetitive strain type injury and also exacerbate muscle pain.
- Estrogen: Adolescent girls can experience idiopathic or internal condylar resorption. Perimenopausal women also frequently complain of TMJ sensitivity and bite changes secondary to the presence of estrogen receptors in the TMJ.
- Autoimmune: Rheumatoid arthritis, psoriatic arthritis, Lupus, Sjogren’s, Reiters Syndrome, and seronegative arthritis can be responsible for jaw pain and bite changes
- Joint laxity: Elongated ligaments allow the disc to easily slip out of position.
- Trauma: Macro trauma, bad falls, blows to the chin, intubation and wisdom tooth extraction can all lead to joint strain or sprain.
- Sleep: Lack of stage 3 and 4 NREM sleep can lead to overall or widespread pain and fatigue. Healing occurs with 7-8 hours of deep restorative sleep.
- Arthritis: Arthritis can be localized as an osteo or traumatic arthritis, or systemic as an autoimmune disease. With this, you can also experience inflammation. Inflammation may be localized
Interesting to Note: There is an intimate connection between the jaw and the ear through the first branchial arch in human development. The temporomandibular joint (TMJ joint) and the petrotympanic suture connect the TMJ to the malleus and incus via Pinto’s ligament. Ear Pain may be located around the TMJ, but may be referred to the head, neck and ear. Ear pain that is located immediately in front of the tragus of the ear, projecting to the ear, temple, cheek and along the mandible, is highly diagnostic for TMJ due to trauma or compression and a sign of inflammatory arthritis. TMJ pain and dysfunction are often associated with neck and shoulder pain as well. This is why many TMJ patients that The Gelb Center treats complain of ear pain.
Ear Pain Symptoms Indicative of TMJ: Do you believe you are suffering from some kind of ear pain that is related to TMJ? Below is a list of symptoms:
Tinnitus: Tinnitus is usually described as a ringing noise in the ears or head. It has been described as a high pitched whining, electric, buzzing, hissing, screaming, humming or whistling sound. Tinnitus can come and go or it can be continuous. It is often the cause of great distress, but the intensity of tinnitus can be moderated by adjusting the position of the shoulder, head, tongue and jaw. Our TMJ specialists can discuss specific treatments for tinnitus with you during your consultation.
Earache: Once the NYC / White Plains TMJ doctors and dentists have ruled out ear pathology or infection, the head and neck muscles – as well as the temporomandibular joint itself – can be evaluated for referral to the ear. The auriculotemporal nerve is often compressed sending pain into the ear.
- Vertigo (spinning sensation)
- Floating or swimming sensation
- Loss of balance or feeling of unsteadiness
- Ear Sensitivity: Sensitivity can occur when the ear is overly sensitive to certain frequency ranges of sound. Thus people suffering from hyperacusis find it very difficult to adapt to seemingly loud, everyday sounds
Ear Pain Treatments at The Gelb Center of NYC and White Plains, New York:
- Chiropractic care for the temporomandibular joint (TMJ) can ease pain by correcting the misalignment between the spine and nervous system. Chiropractic can be effective at reducing the pain associated with TMJ, either when used alone or as a complement to other treatments. This is because, rather than change the diet or modify the teeth, it relaxes the muscles, adjusts the joint and uses specific trigger points to accurately re-position the jaw. When done successfully, this will not only relieve pain in the short run (as would medications or eating soft foods), but it will help prevent TMJ pain from returning.
- Orthotic therapy requires you to wear an unobtrusive oral device. It is shaped to look like your natural teeth. When in place, it achieves your ideal bite. An Orthotic will halt any further wear of your teeth. It will prevent the progression of other bite-related concerns and over time it will minimize TMJ symptoms and eliminate ear pain. Some people find that their symptoms resolve instantly and others find it may take months before their symptoms resolve. Every person responds differently to Orthotic Therapy, however, the vast majority will experience an improvement in their TMJ symptoms and ear pain symptoms. To complete the treatment long term, a full orthodontic treatment such as Invisalign invisible braces can be used to permanently correct your bite.
TMJ Imaging: The Gelb Center of NYC and White Plains, New York utilizes the latest in maxillofacial imaging, Our Cone Beam CT (CBCT) allows 3 dimensional (3D) visualization of the temporomandibular joint and skull. The New Tom VG CBCT gives crystal clear images of the TMJs in sagittal, coronal and axial views.
The Gelb Center of NYC and White Plains, New York offers advanced treatment of ear pain. The ear has three main parts, the outer ear, middle ear, and inner ear. Sound waves travel through the outer ear, reach the middle ear and finally, vibrations travel to inner ear. A variety of conditions affect your hearing and ear infections are the most common. An ear infection is most commonly an inflammation and infection of the middle ear.
Frequently Asked Questions
What is TMJ exactly? The temporomandibular joints (TMJ Joints) are the hinges located on either side of the face that connect the lower jaw to the skull. Each temporomandibular joint has two sections that permit the hinge and gliding actions needed to open the mouth widely. The joints work together with the facial bones and five pairs of muscles to allow opening and closing of the mouth and forward, backward, and side-to-side movements of the lower jaw. Any disturbance of this facial symphony can trigger TMJ dysfunctions: muscles and joints not working together correctly, causing muscle spasm, resulting in pain, muscle tenderness, and tissue damage. With these disturbances, arthritic changes can accelerate, muscles can tighten and the bite can feel off. Simply having a dentist adjust the teeth usually makes TMJ symptoms worse and can throw the jaw further off line and create even more pain; this is why it is imperative to see a TMJ specialist.
What causes TMJ? Interesting fact: 80% of TMJ patients are women so estrogen plays a big role in setting the stage for the effects of micro and macro trauma. There are estrogen receptors in the TMJ so women of childbearing age are sensitized to feel increased pain in the TMJ. Clenching, grinding and bruxism produce micro trauma and repetitive strain injury which can cause degenerative changes and inflammation in the joint. 4 Bicuspid extractions in orthodontic therapy with over retraction of the maxilla are a very common contributing factor in our practice. Any headgear which retracts the maxilla can also contribute to TMJ disorders. Systemic joint laxity or hypermobility syndrome in women make the TMJ more susceptible to injury, clicking, popping and locking.
TMJ has many causative factors the more common of which are malocclusion or problems in the way the teeth fit together, a blow to the jaw or head, clenching or grinding of the teeth, arthritis of the jaw, poorly fitting dentures, yawning for prolonged periods with the mouth open too wide, recent dental work, accidents that damage facial bones or the jaw, extraction of teeth or missing back teeth, birth trauma due to delivery complications, and traction involving the head, jaws, and neck.
The most common TMJ dysfunction originates in the jaw muscles and is called myofascial pain dysfunction (MPD). MPD strikes four times as many women as men – usually those between 13 and 60 years old – and results from a tendency to deal with tension and stress by clenching or grinding the teeth. These habits can tire the muscles and trigger spasms, producing pain, more spasms, and eventually, a TMJ dysfunction. MPD sufferers may or may not have problems with their bite.
Because this dysfunction mimics so many other conditions, diagnosis may be complicated. Many people may spend a great deal of time and money searching for the source of their symptoms. If your physician cannot find any underlying conditions, he could consider the possibility of TMJ dysfunction and recommend that you consult a dentist with a special interest in the diagnosis and treatment of TMJ dysfunctions.
What does TMJ mean? TMJ stands for “temporomandibular joint”, the joint which connects the mandible to the temporal bone. The mandible is the moving component.
What is TMD? TMD refers to “temporomandibular disorders” which are joint, muscle, tendon and ligament disorders of the jaws. Pain and inflammation as well as limited opening, clicking and locking are included in this broad category. TMD is in the same medical class as TMJ.
How do I use my TMJ appliances? Daytime symptoms typically call for daytime appliance therapy for at least 6-8 weeks along with cognitive behavioral attention. Nighttime treatment depends on the diagnosis. A locking, clicking, misaligned jaw may require a Farrar anti retrusion appliance. Breathing related sleep disorders may call for an appliance that maintains an open airway. There are a variety of appliances for sleep bruxism and clenching and grinding. Long term, certain appliances are used for sports, working out and lifting heavy objects as well as travel. Many of our patients use their lower appliances while playing musical instruments, working on computers or painting.
How do I clean my appliances? Hard acrylic appliances are best cleaned with denture cleaners. Our staff will use a special solution in the ultrasonic during your visits.
Should I do Physical Therapy for TMJ? Dr. Michael Gelb will often recommend physical therapy during appliance therapy. It is important to do appliance therapy and physical therapy concomitantly. Physical therapy is recommended for both myofascial pain as well as to increase range of motion. The joint is mobilized during manual therapy in order to establish normal translation and lateral movements with at least 36-54 mm opening.
Who gets chiropractic treatment? Many of our TMJ patients are referred for applied kinesiology which recognizes the importance of the jaws and feet, neck, back and face pain. Cranial treatment has been added to the AK protocol. Some patients will do better with chiropractic than physical therapy. Lately, atlas orthogonal therapy has been getting good reviews. SOT combined with craniosacral is also very effective.
What do you think about Craniosacral Therapy? For patients who have had trauma and who haven’t, this can be a most effective treatment. Dr. Michael Gelb works with the top cranial practitioners in the area. CT is a gentle nonforce technique that goes deep to solve layers of problems.
Do I get my teeth fixed before I see you for TMJ and Sleep Disorders? We only recommend emergency dental treatment prior to TMJ therapy and Oral appliance therapy for snoring and sleep apnea. One of the goals of TMD treatment is to find a jaw position where all chief complaints have been alleviated. We work with the top cosmetic and restorative dentists to find the ideal correct bite prior to starting dental treatment. Oral appliance therapy for sleep apnea can change the bite. We want to alleviate all airway complaints and achieve a bite that is harmonious with an open airway.
What are your criteria for picking an orthodontist? I think the best orthodontists in the world treat to an open airway, that is they move the upper and lower jaws to a position that allows the tongue and palate to move forward. This produces the best looking smiles in the world. These orthodontists like Bill Hang and John Mew achieve greater horizontal growth and intervene earlier than others.
Will I need braces after TMJ treatment? Only 5-10% of our patients need orthodontics after TMJ treatment. Most children under age 13 will need orthodontics after their TMJ treatment. Some children come to me in braces, mid orthodontic treatment due to clicking or locking. We work with the child to alleviate symptoms and allow the orthodontics to be completed.
If you currently experiencing painful TMJ or TMD or are unsure if your headaches or facial pain is related to TMJ please feel contact the best in class, top rated TMJ specialist, Dr. Michael Gelb, at his NYC or White Plains, New York Gelb Center office today.
The Gelb Center of NYC
635 Madison Avenue, 19th Floor
New York, NY 10022
P: (212) 752-1662
The Gelb Center of White Plains
12 Old Mamaroneck Road, Suite 1C
White Plains, NY 10605
P: (914) 686-4528