There is no disease called "TMJ", but common confusion has left us with this misnomer. Every person starts life with two of these joints. We are calling TMJ the disease when it is usually not an actual disease of chemistry in our body, but it is a disease of structure? There are many ways to describe this disease, but the beginning way of understanding, is to imagine your jaw was part of your automobile. The structural disease of TMJ is like the poor alignment of the front wheels on your automobile—you initially feel it as excess vibration, but left unbalanced it causes you to wear out your tires and front end joints. The human analogy to tires and joints is to have chronic head, neck and jaw pain. The ultimate problems are many and can be blown discs in the low back, kyphosis (anterior-posterior excess curvature in the forward plane of the spine), chronic hearing problems, locked jaw, or Tinnitus (ear ringing). Many chronic human ailments can result from simple TMJ misalignment.

TMJ disorders can result from birth trauma and this is the most common cause. There are also causes related to trauma which are quickly reversible if this is the only cause. This reversibility will occur quickly when the trauma is the only cause. The long involved Physical Therapy, Chiropractic, or other manual therapies will not be necessary when the cause is only trauma, assuming these therapies are prudently applied. The most common case is where a birth cause is underlying, but the person has had many years to adapt and live with the disease of structure. Then along comes an automobile accident and the follow-through treatment takes many months and still does not give complete comfort and relief. These patients have underlying birth-related misalignment and, without a multidisciplinary approach, the problem may never be adequately repaired.

The way I prefer to discuss these misalignments is to use a larger picture of the TMJ problem called CCMD. This acronym stands for Cranial Cervical Mandibular Dysfunction [CCMD], which also helps visualize the problem. The misalignment involves the skull or cranium, the cervical spine, and the mandible or lower jaw. If we understand the three-dimensional aspect of misalignment of the cranium we can better understand why headaches may be a direct symptom. If we understand misalignment of the cervical spine we can better appreciate the restrictions in moving the head, shoulder pain, and, of course, neck pain. If we understand misalignment of the mandible, we can appreciate ear pain, tooth wear, and maybe even sinus problems.

We have been trained to think of the cranium as being fixed and not subject to the misalignment problems, when in actuality the bones that make up the skull are quite movable and changeable. This is quite easy in young children, and becomes much more difficult in adults. The practitioners who specialize in these disorders are called Cranial Osteopaths. They have medical degrees, and could just as easily become prescription writing practitioners. The extra training and dedication of these dedicated practitioners is very unique in healthcare. They can also help with cervical spine problems, and do give relief of the mandibular aspect of the CCMD. The final practitioner is obviously a dentist with extra training to more permanently realign the way the mandible relates to the cranium and cervical spine.

The main interface the Dental Specialist has to work with is the way the mandible or lower jaw relates to the maxilla or upper jaw. The confusion for most of us is because the teeth touch, how can this be changed? The reality is there is a shim placed between the teeth to temporarily relieve the symptoms. This shim must then be continually modified as the structure of the body is realigned. This in our health care system requires different practitioners to interface regularly as the bodies changes occur through the Chiropractic or Osteopathic changes. These changes can be worked through with other body therapies, when the practitioners work closely together. The key then is to find a team of practitioners who have learned how to work together. I will make other attempts to help patients appreciate this complex side of health care.