Return to the TMJA Home Page
Return to the TMJA Home PageTMJA Member LoginTMJA Member RegistrationPlease Donate to the TMJA Now!

Join the TMJA Community

Who Owns YOUR TMJ Implant?

Especially during this past year, it’s been brought to our attention by a number of TMJ implant patients having their implants removed that...

Social Security Disability Benefits and Temporomandibular Disorders

Those who suffer from Temporomandibular Disorders also referred to as TMJ or TMD, may find it impossible to maintain the responsibilities...

Pain Sensitivity and Genetic Factors: Act Two of the OPPERA Study

This month we present the last set of findings from “Act Two” of the Oral Pain: Prospective Evaluation and Risk Assessment (OPPERA)...

Symptoms, Sociodemographics, & Psychological Profile: Act Two of the OPPERA Study

Last month we began our report on findings in OPPERA's Act Two," the second series of analyses of data from the Orofacial Pain Prospective...

Temporomandibular Disorders and Sexual Intimacy

A recent posting on the TMJA website included the following request: "I wonder if you could include something in a future newsletter about...

OCCLUSAL (BITE) ADJUSTMENT

Jan 16, 2014

According to the National Institutes of Health brochure on TMJ Disorders irreversible treatments that have not been proven to be effective — and may make the problem worse include:

  • orthodontics to change the bite.
  • crown and bridge work to balance the bite.
  • grinding down teeth to bring the bite into balance (occlusal adjustment).
  •  mandibular repositioning splints (MORA) which permanently alter the jaw position and bite.

The 1996 National Institutes of Health Technology Assessment Conference Statement booklet states that “evidence is insufficient to warrant prophylactic modalities of therapy. Additionally, available data are not persuasive that orthodontic treatment prevents, predisposes to or causes TMD. Therapies that permanently alter the patient’s occlusion cannot be recommended on the basis of current data.”

Bioesthetic Dentistry

Bioesthetic dentistry is another name for bite modification. It is based on the idea that such diverse signs and symptoms as worn or cracked teeth, gum recession, a history of multiple root canal treatments, headache, TMJ problems, ringing in the ears, equilibrium problems, fibromyalgia, etc. — are all related to a disharmony between the way the teeth meet and the correct position of the temporomandibular joint. The bioesthetic dentist has patients wear a bite appliance called a MAGO (Maxillary Anterior Guided Orthotic) for six to twelve weeks, which is supposed to get the bite to match the correct jaw position. This position is then maintained by tooth grinding, bonding, crowns or braces. There is no scientific evidence to support the claims made by the bioesthetic dentists, and patients should be wary of having such irreversible changes made to their teeth and bite without such evidence.

Neuromuscular Dentistry

Neuromuscular dentistry is a dental treatment philosophy intended to correct a “malalignment”of the jaw at the temporomandibular joint and produce a balanced bite. The neuromuscular dentist uses several computerized instruments to measure your jaw movements and jaw muscle activity to determine the extent of your problem and to establish a “physiologic rest position” for the jaw. Here are some of the measurement techniques and procedures used.

  • Sonography. This measures vibrations from the joint when you open and close your mouth to identify joint derangements.
  • Electromyography (EMG). This involves placing surface electrodes over the jaw muscles that pick up electrical impulses and send them to the recording instrument. It is used to measure the activity in the muscles during various movements.
  • Jaw Tracking (Electrognathograph, Kinesiography). This analyzes mandibular movements three dimensionally. A headset is placed on the patient, and a magnet is attached to the lower front teeth. Recording of the lower jaw movement is then made.
  • Transcutaneous Electrical Nerve Stimulation (TENS). This ultra-low frequency electrical stimulation of the muscles, relieves muscle spasms and pain and helps establish a “physiologic” jaw position.

Once the rest position of the jaw is determined, the patient undergoes extensive restorative dental procedures or orthodontics to maintain this new position.

Neuromuscular dentistry can cost from $3,500 to $25,000+ for 4-6 months to one year or more of treatment.  Insurance companies typically do not cover the TMJ- related costs due to the lack of  a scientific evidence base for such treatment.

According to the American Association For Dental Research’s March 3, 2010 Policy Statement on Temporomandibular Disorders (TMD),  "...the consensus of recent scientific literature about currently available technological diagnostic devices for TMDs is that except for various imaging modalities, none of them shows the sensitivity and specificity required to separate normal subjects from TMD patients or to distinguish among TMD subgroups." In other words, those who practice neuromuscular dentistry have their own standards for what are normal and abnormal readings which may lead to a “false positive” — meaning people may be told they have a TMJ problem when they really don’t, leading to unnecessary treatments.

Neuromuscular dentistry is NOT a specialty recognized by the American Dental Association.  Although a variety of health care providers advertise themselves as TMJ specialists, treatments available today are based largely on beliefs, not on scientific evidence.

The Latest In Science

  • Orthodontics for treating temporomandibular joint (TMJ) disorders
    "
    There is no evidence about the effects of different types of orthodontic braces for problems associated with the joint between the lower jaw and skull. When the joint between the lower jaw and the base of the skull is not working well (temporomandibular disorders (TMD)), it can lead to abnormal jaw movement or locking, noises (clicking or grating), muscle spasms, tenderness or pain. TMD is very common, and it is believed by some that it may be caused by the occlusion (the way the teeth bite), trauma or psychological stress. There is also a belief that the pain associated with TMD is similar, in that respect, to low back pain and may be related to variations of a person's individual pain perception. Changes in the way the teeth meet can be produced by the use of active orthodontic appliances. This review found that there is no evidence from trials to show that active orthodontic treatment can prevent or relieve temporomandibular disorders adding support to teeth not being part of its cause. It is suspected that we do not know the real cause of TMD at present."
  • Occlusal adjustment for treating and preventing temporomandibular joint disorders
    "No strong evidence of benefit from occlusal adjustment (adjusting the teeth's biting surfaces) for problems associated with the joint between the lower jaw and skull.
    When the joint between the lower jaw and the base of the skull is not working well (temporomandibular disorders (TMD)), it can lead to abnormal jaw movement or locking, noises (clicking or grating), muscle spasms, tenderness or pain. TMD is very common, and might be caused by occlusion (the way the teeth bite), trauma or stress. Treatments include occlusal adjustment, splints, physiotherapy and surgery. Occlusal adjustment involves adjusting the biting surface of teeth by grinding the enamel (outer layer of the tooth). The review found there is no evidence from trials to show that occlusal adjustment can prevent or relieve temporomandibular disorders."

This page was reviewed for accuracy by Dr. Daniel Laskin, the TMJA's clinical consultant.

 

Site operated by The TMJ Association, Ltd. (TMJA) is a nonprofit, 501(c)(3) tax-exempt organization. ©2009-2014 The TMJ Association, Ltd. All rights reserved.

The TMJ Association, Ltd., P.O. Box 26770, Milwaukee WI 53226. Email: info@tmj.org.

This website is for general informational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. This website is not a substitute for such advice, diagnosis, or treatment. You should always consult your doctor if you have questions about your health condition or before starting any treatment. The TMJA is unable to provide doctor referrals and does not endorse any particular health care professional or organization. Reliance on any information provided by the TMJA, TMJA employees, other personss appearing on the website at the invitation of the TMJA, or other visitors to the website is solely at your own risk.

Site Designed and Developed by 11th Hour Solutions, LLC