Treating TMJ / TMD Using Neuromuscular Dentistry

An article written with Dr. Sherry Tsai

Woman having TMJ Pain exam by neuromuscular dentist
Many people don't realize that dental care involves much more than just the teeth and gums. Because teeth are part of the body's musculoskeletal system, a comprehensive dental evaluation should also address issues that affect the face, head, jaw, neck and back. But because traditional dentistry tends to focus only on the teeth and gums, a more focused area of specialization called neuromuscular dentistry (NMD) has emerged. NMD works with the muscles in these areas, and can treat pain and symptoms that contribute to everything from migraine headaches, TMJ disorder and tooth sensitivity to misalignment of the cervical spine.

It is an extraordinary dedication to the art and science of dentistry that prompts dentists to advance their training to the level of a neuromuscular specialty, and Dr. Tsai is one of those rare doctors. Her training in NMD enables her to look beyond the obvious to the deeper causes of head and neck symptoms and effectively treat a variety of problems in these areas, including temporomandibular joint disorder (popularly known as TMJ or TMD). This is a common disorder in which the temporomandibular joint -- which connects the jaw to the skull -- is inflamed, damaged or strained. TMJ can also be called TMD (temporomandibular joint disorder) or MPD (myofascial pain dysfunction). But all of these terms mean basically the same thing; a collection of symptoms that includes but is not limited to the following:

Signs and Symptoms of TMD and TMJ Disorder

medical image example of headaches from tmj painmedical image example of neck aches from tmj painmedical image example of back aches from tmj pain

Clinching or grinding teeth
Limited mouth opening, jaw joint pain, jaw joint clicking
Back, neck or shoulder pain
Ear congestion
Dizziness or vertigo
Ringing in the ears
Loose teeth or sensitive teeth
Facial Pain
Tingling of fingertips
Imbalanced head or neck posture issues
Difficulty closing the mouth or chewing
Irregular bite
Difficulty swallowing

It is estimated that more than 10 million people in the United States have experienced TMJ problems. Even if you're not experiencing pain or other symptoms, neuromuscular dentistry plays an important role in aesthetic, cosmetic or reconstructive dentistry. It is also an essential element in orthodontic treatments and determining the correct occlusion for dentures.

How Are Neuromuscular or TMJ Issues Diagnosed?

medical scan of brain, neck, jaw to evaluate TMJ TMD pain
If you have any of the above-mentioned symptoms, your regular dentist or physician might recommend a NMD evaluation. In this exam, the first thing Dr. Tsai will examine is your bite, also known as "occlusion." If your top and bottom teeth don't fit together properly and your bite isn't aligned (malocclusion), your facial muscles will attempt to compensate for the problem, and as a result those muscles will become strained and stressed. The longer you wait to correct the problem, the more your facial muscles will adapt to the imbalance, and the more serious the symptoms can become. Without intervention you could experience a downward spiral effect that may include permanent tooth damage, postural abnormalities and chronic pain.

These symptoms are not always easy to diagnose because they're similar to symptoms that might suggest other disorders. Dr. Tsai will begin her evaluation by determining if your symptoms are chronic (constantly present) or acute (showing up suddenly with great intensity), or if they are the result of trauma, infection or other medical causes. Dr. Tsai uses state-of-the-art computer technologies to help her arrive at a diagnosis. Some of these technologies include a test that measures jaw and muscle movement using an electromyography device similar to the EKG that doctors use to diagnose heart problems. Other methods use ultrasound technology to detect any clicking or popping sounds made by the jaw, and magnetic jaw tracking to characterize the position of your jaw as it opens and closes. These methods help Dr. Tsai determine the severity of the problem and choose an appropriate treatment.

How is TMD or TMJ Pain Treated with Neuromuscular?

example of woman sitting upright wiht TENS machine to relax muscles
Once a diagnosis is made, Dr. Tsai uses a variety of techniques and technologies for relaxing the muscles and giving the jaw an opportunity to align in a more balanced and natural way. She will begin treatment by realigning the bite using a device known as a "myomonitor," which delivers painless electrical stimulation to selected muscles in the face, neck and back.

These electrical impulses increase blood flow to the target areas and promote muscle relaxation. After a short period of time your jaw, shoulder and neck muscles will be relaxed and ready for assessment.

example of neuromuscular orthotic for TMJ TMD pain relief
Once the muscles are relaxed, Dr. Tsai will create a mold of your teeth when your jaw is in its new relaxed position to help draw a comparison between the misaligned jaw position and the optimal one. This is your restorative goal position, and at this point, she may also recommend that you wear an orthotic device (also known as a "realignment appliance"). The orthotic is an intermediate step to show what the end result will be without going through irreversible treatment. Most patients will wear the orthotic for three to six months or until they are asymptomatic (pain free), and once symptoms are relieved, Dr. Tsai will determine if any further treatment is needed. In some cases, Dr. Tsai may recommend functional orthodontic or restorative procedures.

TMJ Pain & Neuromuscular Review Video

Here is a quick video that explains the neuromuscular approach to TMJ / TMD pain.

A More Natural Approach to TMJ TMD Pain Relief

Neuromuscular dentistry takes a holistic approach to dental care; Looking at bone and tooth position as well as skeletal muscle interaction. Dr. Tsai is one of a rare breed of dentists who has trained extensively to address TMJ / TMD pain via neuromuscular dentistry in her practice. With this specialized training, she is able to help patients find solutions to a wide range of cosmetic, reconstructive and routine dental care issues. Please feel free to call Dr. Tsai and her team to discuss your particular symptoms or questions at (650) 583-5880.

For more about Dr. Tsai’s training and experience, please click

Want to set up a TMJ evaluation?

E-mail or call to set up an appointment: 650-583-5880

Dr. Sherry Tsai is a leader in TMJ Pain Relief using Neuromuscular Dentistry, Orthotics and Non-invasive Therapies

88 Capuchino Dr.  
Millbrae CA 94030

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