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Functional dentistry
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Headaches, locked vertebrae, tinnitus – when the jaw throws the body out of balance

He knows the causes of many physical symptoms: Dr. Paul Lee has dedicated himself to functional dentistry

Temporomandibular disorder, or “TMD” for short, is a somewhat unwieldy term employed by dentists to describe a widespread functional disorder in the jaw area. The “TM” stands for “temporomandibular”, referring to the joints connecting the jawbone to the skull, and the “D” stands for “disorder”. And precisely here, in the jaw not functioning properly, is where the problem lies.

In patients diagnosed with TMD, the temporomandibular joints (TMJ, jaw joints), the mastication (chewing) muscles and the teeth no longer function in harmony. The result is an imbalance for which the body attempts to compensate. Depending on the individual’s constitution, this may be successful for a time. However, if the strain becomes too great, symptoms develop.

A frequently overlooked health issue

Our body is a complex, sophisticated system. Like a system of cogs, everything is interlinked. The different areas of the body are closely connected to each other, but this miracle of nature also has its downsides. “If there is a problem in one area, it often also has consequences for others. This can result in a variety of health issues,” said Dr. Paul Lee, dentist for functional dentistry at INTEGRA in Luxembourg. These can include headaches or joint pain, a drop in performance, tinnitus, vertebral blockages and intestinal issues. Dr. Lee continued: “Many patients have a veritable odyssey of appointments with specialists behind them before they find out about TMD and make their way to a dentist with real expertise in functional dentistry.”

The linchpin: how important is our jaw?

The temporomandibular joint (TMJ) is responsible for opening and closing the mouth as well as chewing and speech. We only pay closer attention to it when problems develop. If the joint is not functioning correctly, it can lead to a wide range of unpleasant symptoms extending far beyond the jaw/mouth region. The term temporomandibular disorder refers to a group of disorders affecting the TMJ and surrounding muscles. However, symptoms may also present throughout the body. It is estimated that around 80% of the population are affected, approximately half of whom to a degree which would require treatment (Source: ZMK – Zahnheilkunde Management Kultur).

Causes of TMD

The exact causes of TMD are often complex and very specific to the individual. No two cases are the same. A detailed medical history is essential for a reliable diagnosis and thus successful treatment. So how does TMD actually develop?

Some possible factors which can contribute to TMD are:

  1. Malocclusion: Misalignment of the teeth that affects the bite and can overload the TMJ, caused, for example, by missing teeth or bridges, crowns, inlays, etc., which are too high/low.
  2. Stress: Long-term or recurrent episodes of stress can cause someone to clench or grind their unconsciously, which overloads the jaw muscles.
  3. Injuries: Injury to the jaw region or TMJ can result in TMD.
  4. Traumatic changes to the TMJ or spine, resulting, for example, from accidents (including in childhood), difficult births, birth trauma, KISS syndrome (Kinetic Imbalance due to Suboccipital Stress) and subsequent untreatable spinal misalignments in infants.
  5. Poor posture or malformations during development: Poor posture, especially in the neck and shoulder area, can affect the TMJ.

How do I recognise TMD?

“Do I really suffer from TMD?” That’s not an easy question to answer. The symptoms of TMD can vary significantly and range from mild to severe. Common symptoms include:

  1. Pain: Pain in the TMJ or teeth; facial pain, neck pain or headaches can occur.
  2. Restricted jaw mobility: For example, difficulty opening the mouth wide.
  3. TMJ noises: Cracking/grating in the jaw joint when moving the mouth can be an indication of TMD.
  4. Discomfort in the ear region: Earaches or the sensation of pressure in the ear is often associated with TMD.
  5. Changes in nasal breathing, secretion disorders in the nose and mouth: TMD can have negative consequences for neighbouring areas of the face.
  6. Teeth grinding: Unconscious grinding or clenching of the teeth, especially at night, is a common sign of TMD.
  7. Tinnitus: Ringing in the ears with no explainable cause can be regulated with TMD treatment.
  8. Balance issues: If the complete system is disrupted, there can also be consequences for balance and the risk of falls increases, especially in older people.
  9. Nervous stomach: TMD can also affect digestion. The consequences range from a nervous stomach to acid reflux.
  10. Vertebral blockages: Patients with TMD often complain of blockages in the cervical and/or thoracic spine.
  11. Pelvic misalignment: The imbalance in the jaw region can produce pelvic misalignments and, consequently, leg length discrepancies.
  12. Difficulty swallowing/clearing throat.
  13. Headaches, especially originating from the nape.

INTEGRA focuses on the interdisciplinary treatment of TMD

TMD treatment aims to relieve symptoms and restore the function of the TMJ. The TMJ is a joint which can be regenerated. The following approach presents an optimal interdisciplinary treatment plan as employed at INTEGRA:

  1. Basic examination by the dentist: functional medical history and brief functional examination.
  2. Basic examination by the physiotherapist/chiropractor.
  3. Manual functional analysis and measurements of the TMJ in relation to the skull:
  • Manual structural analysis of the TMJ, the skull, the cervical vertebrae, muscles, nerves and ligaments.
  • 3D measuring of TMJ function in relation to the skull (optoelectronic measurement).
  1.  Centric relation bite registration: Treatment by physiotherapist/chiropractor, followed by (approx. 30–90 minutes after treatment) centric relation bite registration to visualise the TMJ position on the teeth.
  2.  Model evaluation (following axiography and centric relation bite registration) with reference to the functional analysis and the physiotherapeutic/chiropractic examination.
  3. Insertion of the bite splint: physiotherapeutic/chiropractic treatment, then (30–90 minutes later) grinding of the splint by the dentist. This requires the diagnostic problem to be therapeutically adapted to the splint.
  4. Therapy with physiotherapist/chiropractor after approximately two weeks, followed by grinding of the splint 30–90 minutes later.
  5. Additional combination treatment at 2–4 week intervals depending on diagnosis.

The end of treatment is reached once no more changes to the splint are identified without therapy by the physiotherapist/chiropractor, the patient has even support on the splint and their symptoms have decreased significantly.

TMD – a small joint with a big sphere of influence

Temporomandibular disorder may appear to be an inconspicuous health issue at first glance, but it can have considerable consequences on the patient’s quality of life. Individuals suffering from symptoms such as jaw pain, headaches or restricted jaw mobility should consult an interdisciplinary dentist with expertise in functional dentistry in order to obtain an accurate diagnosis and suitable treatment options. Proper care of the TMJ can contribute to relieving symptoms and preventing long-term health problems.