Click here for Dr. Gottesman's credentials

NEW TREATMENTS FOR TMJ DISORDERS

Dr. Gottesman is proud to announce the initiation of NEW therapies in the treatment of temporomandibular disorders. These approaches are taken from advances in the neuroscience literature and are now being successfully applied to his TMD sufferers.

Dr. Gottesman has invented a new appliance called the G.A.S. appliance which is an abbreviation for the Gottesman Afferent Stimulator. This appliance is designed to strengthen and quicken signals into the reflex and central nervous systems in order to make the following improvements:

• Decrease pain in the jaw and neck muscles
  
• Decrease headache intensity and frequency
  
• Jaw mobility
  
• Muscular coordination

The appliance(s) does this with or without bite alteration, depending on the circumstances.

In addition, Dr. Gottesman has instituted:

• “Illusion Therapy” to diminish pain and improve motion and function.
  
• Cortical task strengthening exercises.
  
• “Re-patterning” to retrain the brain and reflexes.
  
• Low-threshold cyclical training to decrease degenerative events.

Dr. Gottesman, as the creator of these treatment modalities, may be the only dentist in the world utilizing these approaches to improve the quality of life for those patients suffering from TM Disorders. Dr. Gottesman hopes to present these novel treatment approaches in his upcoming lectures.

Dr. Gottesman looks forward to helping those patients suffering for TM Joint disorders.
Call today for an appointment!

---

More than fifteen percent of American adults suffer from chronic facial pain, typically in or around the ear and jaw. The pain is often accompanied by clicking or popping noises when opening the mouth, or headaches and neck aches.

The temporomandibular joint connects the lower jaw, called the mandible, to the temporal bone at the side of the head. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew, and yawn. Muscles attached to, and surrounding the jaw joint control its position and movement.

When we open our mouths, condyles, or the rounded ends of the lower jaw, glide effortlessly along the joint socket of the temporal bone. A soft disc lies between the condyle and the temporal bone to ensure smooth motion. This disc absorbs shocks to the TMJ from all movements.

Temporomandibular (jaw) disorders, also called "TMD" or "TMJ syndrome," are a general class of health problems associated with the jaw. TMD may occur when the jaw twists during opening, closing or side-motion movements. These movements affect the jaw joint and the muscles that control chewing.

TMD is not just one disorder, but a group of conditions that are often painful and that affect the jaw joint (temporomandibular joint, or TMJ) and the muscles that control chewing. Although researchers do not yet know how many people have TMD, the disorders appear to affect about twice as many women as men, according to The National Institute of Dental and Craniofacial Research.

A dental exam and X-rays may identify the source of the pain. In some cases, the pain may be linked to a sinus problem or toothache, or an early stage of periodontal disease.

Other reasons are not so easily diagnosed. The pain could be related to the facial muscles, the jaw or temporomandibular joint (TMJ) in the front of the ear. Treatments for this pain may include stress reducing exercises, muscle relaxants, or wearing a mouth protector to prevent teeth grinding.

The majority of TMJ cases can be treated by resting the joint, taking a pain reliever without aspirin and practicing stress management and relaxation techniques.

More severe cases may be treated with physical therapy, ice and hot packs, posture training, and splints.

Fortunately for most people, jaw joint or jaw muscle pain is usually not a sign of a more serious problem. Pain and discomfort from TMD is temporary and sporadic, and can come in waves or "cycles."

Only a small percentage of people with TMD pain develop significant, long-term symptoms, according to The National Institute of Dental and Craniofacial Research.

Temporomandibular disorders fall into three main categories:

• Myofascial pain, the most common form of TMD, which is discomfort, or pain in the muscles that control jaw function and the neck and shoulder muscles;
• Internal derangement of the joint, dislocated jaw or disc, or injury to the condyle; and
• Degenerative joint disease, such as osteoarthritis or rheumatoid arthritis in the jaw joint.

Severe injury to the jaw or TMJ can lead to problems. Arthritis in the jaw joint may also follow an injury. Orthodontic treatment, such as braces and the use of headgear, has also been blamed for some forms of TMD, but studies now show that this is unlikely according to The National Institute of Dental and Craniofacial Research.

As long as the displaced disc causes no pain or problems with jaw movement, no treatment is needed. People with TMD often clench or grind their teeth at night, which can tire the jaw muscles and lead to pain.

---

Grinding or clenching your teeth and the resulting abrasion can lead to a host of dental problems.

In many cases, teeth grinding occurs unintentionally during sleep. Teeth grinders, or "bruxers," often also bite their fingernails, pencils, and chew the inside of their cheeks.

About one in three people suffer from bruxism, which can easily be treated.

Teeth grinding over time can lead to hypersensitive teeth. Bruxers experience jaw pain, tense muscles, and headaches, as well as excessive wear on their teeth. Forceful biting when not eating may also cause the jaw to move out of proper balance.

Signs of bruxism

A few signs of bruxism include:

• Tips of the teeth appear flat. Teeth are worn down so much that the enamel is rubbed off, exposing the inside of the tooth (dentin)
• Pain in the temporomandibular joint (TMJ) or jaw, may manifest itself into a popping and clicking sound
• Tongue indentations

Anger, anxiety, pain, and frustration can trigger teeth grinding

If your dentist notices signs of bruxism, prescribed therapy may include behavior modification techniques to learn how to rest the tongue, teeth, and lips properly.

Your dentist may also provide a plastic mouth appliance, such as a night guard that is worn to absorb the force of biting. This appliance can prevent future damage to the teeth and while the patient`s destructive behavior changes.

Biofeedback is sometimes used to measure muscle activity and teach patients how to reduce muscle activity when the biting force becomes too great.

---

Temporomandibular Joint Problems

Disease or dysfunction of the temporomandibular joint (TMJ) is one common source of headache and facial pain. The TMJ is a "ball and socket" joint that allows the lower jaw to move and function and is located in front of the ear where the skull and lower jaw meet. TMJ disorders have a variety of symptoms. Individuals may complain of earaches, headaches and limited ability to open the mouth. They may also complain of clicking or grating sounds in the joint and painful opening and closing of the mouth. Arthritis is a known culprit in TMJ disorders. TMJ also can be caused by a sudden injury, or years of teeth grinding.

Displacement or dislocation of the disc that is located between the jawbone and the socket also can lead to TMJ. Injury or rheumatoid arthritis can cause parts of the joint to become degenerative, preventing jaw movement altogether. Stress can trigger pain in the jaw muscles that is very similar to that caused by TMJ problems. Arthroscopic joint surgery is minimally invasive and has proven effective in resolving advanced TMJ disorders.

---

Pain can be the result of problems in the root structures of your teeth, your gums, palate, or soft mouth tissues. Common causes for pain include deep cavities that have exposed nerves beneath your teeth or in your gums; impacted wisdom teeth; and gum disease.

In other cases, pain can be caused by clinical problems involving the chewing (masticatory) muscles or temporomandibular joint. These kinds of pains are called orofacial pain.

Problems can include temporomandibular joint discomfort, muscle spasms in the head, neck and jaw, migraines, cluster or frequent headaches, pain with the teeth, face or jaw, or anxiety or depression.

You swallow approximately 2,000 times per day, which causes the upper and lower teeth to come together and push against the skull. People who have an unstable bite, missing teeth, or poorly aligned teeth can have trouble because the muscles work harder to bring the teeth together, causing strain.

Pain also can be caused by clenching or grinding teeth, trauma to the head and neck, or poor ergonomics. Some may experience pain in the ears, eyes, sinuses, cheeks, or side of the head, while others experience clicking when moving the jaw or even locking if the jaw is opened or closed.

Here are some common types of orofacial pain:

• Temporomandibular disorders (TMD) - The National Institutes of Health estimates that more than 10 million Americans have TMD, or problems affecting the jaw joint and muscles. Your temporomandibular joints are located where the skull connects to your lower jaw. To feel these joints, place your fingers in front of both ears and open your mouth. The muscles on the sides of your head and face control the joints` movements. Researchers believe women between 20 and 40 are most likely to suffer from TMD because of the added estrogen in their bodies.
• Headaches - One in eight Americans suffers from headaches. Experts estimate that 80 percent of all headaches are caused by muscle tension, which may be related to the bite. Headaches also can be caused by clenching jaw muscles for long periods of time. Signs that may indicate a headache from a dental origin include:
  • Pain behind the eyes
  • Sore jaw muscles or "tired" muscles upon awaking
  • Teeth grinding
  • Clicking or popping jaw joints
  • Head and/or scalp is painful to the touch
  • Earaches or ringing
  • Neck, shoulder or back pain
  • Dizziness
• Sleep disorders - If you have gone through treatment and still experience orofacial pain, you may have a sleep disorder, such as bruxism, or a sleep-related breathing disorder, such as snoring or sleep apnea. Bruxism is the technical term for grinding and clenching. Snoring that goes undiagnosed may lead to an increased tendency for the airway to collapse, leading to sleep apnea. Sleep apnea is a condition when the tissues and muscles in the back of the throat collapse the airway. This can cause a person to wake up multiple times in the middle of the night, sometimes without knowing it.

Some orofacial symptoms can be relieved by an orthotic, or splint, that is worn over the teeth until your bite can be stabilized. Permanent correction may require reshaping teeth, building crowns, orthodontics, or a permanent appliance for the mouth. Your dentist might also recommend physical therapy, counseling, relaxation training or massage therapy.

You can help avoid or alleviate orofacial pain by:

• Placing an ice pack on the painful area for 10 minutes, three or four times daily.
• Eating softer foods and avoid chewing gum or ice.
• Cutting your food into smaller pieces.
• Keeping your upper and lower teeth slightly apart except when chewing or swallowing.
• Keeping your tongue between your teeth may help with this.
• Sleeping on your back.
• Not resting your hand on your chin.
• Not resting the receiver on your shoulder when talking on the phone.

Pain management

Pain is probably the number one cause of anxiety in most people when it comes to thinking about visiting a dentist. Unfortunately, some people avoid regular checkups, or even needed treatment to correct a serious problem because they want to avoid pain.

Today, advances in medications and pain management mitigate most of the discomfort from having treatments performed on your teeth and gums. Following is a look at some of the common types of pain management tools available:

• Anesthetics
• Analgesics
• Sedatives
  • Conscious sedation
  • Deep sedation and general anesthesia