Marmorstein

Expand the scope of
your practice by
becoming the local
chiropractic TMJ expert
ffering temporomandibular joint (TMJ) services can ex- When the jaw functions properly, the right and left jaw joints pand your patient base and increase awareness of chiro- move as one unit. If this coordination of movement is upset, the jaw O practic treatment. Working with TMJ patients can be a may exhibit one-sided open-and-close movements leading to further creative and rewarding part of a holistic-based practice. joint and muscle stress and eventual breakdown. As in spinal situa- Chiropractors, not just maxillofacial surgeons or dentists, can help tions, it is typical to find the patient caught in a cycle of localized relieve the suffering of most TMJ patients. stress and pain, muscle imbalance, and joint imbalance, all feeding Chiropractors are already treating patients with TMJ problems— ICwhiplash injuries in auto accidents, after dental procedures where the There are two major reasons why chiropractors can treat patients mouth is forced open for long periods of time, minor head injuries from contact sports, patients who clench their teeth or grind them 1. We deal with functional disturbances originating from struc- Ttogether (brux) at night, and patients who are anxious or tense with tural (neuromusculoskeletal) aberrations. Our philosophy and tight upper trapezius or sternocleidomastoid muscles carrying this analytic and therapeutic methods may contribute greatly toward 2. The TMJ cannot be isolated from the rest of the body/mind CVís-a-Vís
system. Ignoring the TMJ will compromise resolving or man- The TMJ is located between the temporal bone of the skull and the aging neck, back, shoulder, and other structural and physi- lower jaw (mandible). The condyle is the part of the joint at the head of the mandible. Between the condyle and the temporal bone, there is a Ameniscus or disk. Like any other joint in the body, the TMJ is prone to DC and DDS?
insult, injury, chronic disorders, and serious degenerative changes— There is no standard or uniform protocol for evaluating TMJ Rosteoarthritis, rheumatoid arthritis, or cancer. function or dysfunction. Sometimes there is obvious malocclusion The most common type of these disorders that chiropractors will (bad bite), which may need dental intervention. Dentists will often encounter is myofascial pain disorder, characterized by discomfort make a custom acrylic splint for the patient. The patient will rarely or pain in the jaw muscles and accompanied by neck and shoulder require surgery. Other than that, the dentist will probably use chemical muscle tension. Also, we will see patients with some internal de- agents to relax muscles and lower inflammation, or use some sort of rangement of the joint itself. They may have a displaced disk within physical therapy to relax the muscles or lower inflammation. the joint capsule, or some type of injury to the condyle. Occasionally, You can offer treatment by bringing the rest of the body into better structural balance. If you decide to use homeopathic, herbal, or Often, patients will exhibit elements of all of these disturbance. nutritional products to lower inflammation and help the patient relax, Symptomatically, they may experience any or all of the following: you will also spare them the toxic side effects of pharmaceutical jaw pain while the jaw is opening or closing or sometimes when still; substances. Find dental professionals with whom you can establish a Rjaw noise (clicking, popping, or grating) during motion; discomfort good rapport. IRduring biting, chewing, or yawning; deviations from normal jaw As a practical matter, I do not use diagnostic codes on my chiro- motion; and headaches. Sometimes there is also a feeling of stiffness practic receipts that would indicate that the primary problem is TMJ. CH in the facial muscles. If someone is bruxing, they may also develop Sometimes I will give a diagnosis of “Cervical Strain 847.0, with H wear facets on the teeth and fatigue in the muscles of mastication. One of the first things I learned is that chiropractors should patients that I am trying to find out what their body seems to be avoid causing TMJ problems. I was injured by a colleague when he performed a cervical adjustment on me while grasping my mandible. It is critical to relax the local muscles. If you have studied With one strong thrust, my TMJ was severely traumatized. The BEST (Bio-Energetic Synchronization Technique), the Double joint became so hypermobile that if I shifted my body position while Crown technique is good after bringing the body back into better S sleeping, the mandible would often move enough to irritate the balance. This technique is noninvasive and uses the polarity of the doctor’s fingers to ease some of the soft tissues in the man- Some of the dental procedures designed to improve my plight dibular area. Herbal compounds containing Valerian can be used S had the opposite effect. I do not recommend equilibration to on a short-term basis (when there are no contraindications) to anyone. This method of finding high spots on the teeth using relax muscles. Alternating heat and cold applications can reduce local congestion. Enzyme formulations can also be used to reduce joint inflammation. Ignoring the TMJ will
compromise resolving or
Hear Ye, Hear Ye
an all-too-brief period of adaptation. The managing neck, back, shoulder,
with ear acupuncture points corresponding and other structural and
with anatomical structures) can afford re- physiological dysfunctions.
lief—gently, safely, and without needles. portunity to learn how the chiropractors around the earlobes. You can also stimulate the Shen Men point, and dentists worked with TMJ cases. I have continued to pursue and cervical spine and muscle points. Adhesive tabs containing this area of study through reading, postgraduate classes, and re- small smooth metal balls can be used by the patient to stimulate these points after they have left your office. Portable handheld Problem Identification
units can be purchased for under $200 with electronic point find- B You can identify patients with TMJ disorder primarily through ers. B history. Pay close attention to details about emotional stress, recent For patients who brux, I use a soft, adjustable mouth splint. This dental work, and recent facial or head trauma (including biting hard splint fits over dental and orthodontic appliances, and gives feedback on tough food or objects). Certain medications, including common to the muscles by pushing back when the patient grinds. This retrains C antidepressants such as Zoloft, have bruxism as a side effect. Also, the muscles to let go of the bruxing habit. patients will complain about a tight jaw for as long as they can If you suspect that emotional stress is a major contributor to TMJ disorder syndrome, stress reduction approaches and substances, in- Watch patients open and close their mouth from head-on. If the cluding Bach flower remedies or other flower essences, self-help books, T jaw swings to one side as they open, or if they can’t open the mouth yoga, meditation, or counseling, are recommended. at least as wide as their three middle knuckles placed next to each More receptive TMJ patients can also benefit from an evaluation of their dietary and exercise habits—both of which influence the health C Some minor clicking of the jaw can occur in relatively normal of the joints and muscles, as well as the tendency to accumulate rather patients. The clicking noise is a result of the disc slipping out of place, sticking, or malfunctioning. Reassure the patient that most With a stronger kinesiology background, you can work directly A clicking sounds are quite common and are seldom significant unless with the muscles of mastication. Spindle cell and Golgi tendon appara- A accompanied by pain or major grating noises. tus stimulation (by hand) can help the masseter, temporalis, medial, and In general, the body will make better adaptations to any- lateral pterygoid muscles to relax, frequently bringing about a dramatic R thing if structural stress is reduced. Use current adjusting meth- improvement. ods to ensure that the patient is free from spinal subluxations. A Fitting the patient for custom orthotics can help the TMJ if it careful analysis of what C2 is doing is a major key to reducing contributes to structural stability. Kinesiology, in general, helps over- P TMJ stress. Look carefully for any combination of vectors of all structural balance through balancing the body’s muscles, and of- misalignment in C2, including lateral sideslip, posterior body, fers the practitioner a good lens through which to view the interrelated and posterior rotation of the segment, and adjust to correct all of events taking place in the body/mind system. For the best results, it is imperative to consider the cranium. If I am comfortable using applied kinesiology to challenge the the shape of the cranium is distorted, the condyles of the mandible do vertebrae for adjusting vectors. If you prefer to use static palpation, not have a good place to sit. In addition, dural tension originating R motion palpation, or leg checks to find a specific subluxation list- within the skull will pull on the upper cervical area, the sacral area, and I prefer muscle testing here so the patient can receive unmis- takably clear sensory feedback that you have found a specific problem. Seeing a stronger indicator muscle group on a post- Stu
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e managing director of Universal adjustment challenge can build confidence in recovery and in you Some chiropractors claim that kinesiology is not reproduc- Neutralization Technique. Location: Houston, TX. C ible in double-blind studies, and is therefore not objective. I con- sider this approach to be part of the art of chiropractic, and tell

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