TMD Treatment

'Temporo-mandibular Joint Dysfunction Syndrome’

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What is TMD? What treatments are available for Grinding and Clenching?

TMD stands for ‘Temporo-mandibular Joint Dysfunction Syndrome’ , and describes symptoms associated with jaw joint dysfunction.

Grinding and clenching of teeth is a common condition and often leads to tooth wear, stiff jaws, and jaw ache.

Both conditions can occur simultaneously or by themselves, and both are due to stress in either the jaw joint or jaw muscles.

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What are the symptoms of TMD?

Oral symptoms can include...

  • Jaw joint pain
  • Stiff jaw
  • Clicking / grating sounds coming from the joint
  • Limited mouth opening
  • Jaw moving to one side on opening the mouth
  • Grinding and clenching of teeth
Oral symptoms can include...

Other symptoms can include...

  • Pain around the ear
  • Headaches
  • Neck pain
  • Tinnitus (ringing in the ear)
  • Ear blockages
  • Ear pain on flying
Other symptoms can include...
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What are the treatments for TMD?

Soft diet

Jaw rest

Jaw exercises

Avoid opening jaw wide

Mouthguards

Are there any modern treatments for this condition?

One of our dentists, Dr Fareed Khan, based in our Putney branch, has been researching modern treatments for these conditions for about the last 5 years. He has successfully treated many patients with these conditions.

The treatment involves digital scanning of the teeth to produce a 3D virtual model of the dentition. Dr Khan then studies the virtual model and then designs appliances that are 3D printed from this model. The patient wears the appliances for a  few months until the bite is corrected such that the strain on the jaw joint and tension in the jaw muscles are permanently relieved.  Dr Khan is developing a course to teach other dentists and doctors about this new technique so they are aware of modern treatments available for these conditions.

If you suffer from either TMD and/or grinding or clenching of your teeth,  and would like a free consultation to see if your condition can be improved, please contact our Putney Branch.

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"The treatment has transformed me"

“When I first heard about Invisalign and how it can improve TMD I went to Perfect Smile to see if something could be done to improve the neck pain I was having every morning due to grinding my teeth when asleep.

After a few discussions with Dr. Khan, I decided to go ahead with the treatment.

18 months later my condition decreased, and to my surprise, even my constant chronic sinusitis disappeared. I now rarely have a blocked nose, even if I have the flu. My sense of smell has improved too.

The treatment has transformed more than the aesthetic of my smile – there are various non-cosmetic benefits too.

I was very impressed by Dr. Khan’s vast knowledge of the bite and jaw, which gave me lots of confidence in making the decision to take up the treatment and I am very pleased I did.”

"Invisalign treatment has been the most successful treatment that I received for my TMD"

I started to have pain in one of my upper left molar in Winter 2013. I saw several dentists, who tried (and failed) to treat this pain with root canal treatments. Eventually, I decided that I wanted this molar to be extracted. The pain did not disappear after the extraction and I was referred to a facial pain specialist, who treated me for neuralgia. This did not help either.

Another dentist that I saw after that suggested to remove the wisdom tooth in that area. That did not help either. For a few years, I managed my pain by wearing night guards and aligners, which helped with my grinding and clenching of my jaw, which in turn reduced the pain. In 2016, I saw another facial pain specialist, who suggested a combination of facial exercises and Botox treatment in the mandibular muscle areas every 3 to 6 months. I followed this programme for a year or so. Although it helped me manage the pain, it never completely went away. I didn’t think it was addressing the cause of the issue, but only the symptoms.

In October 2018, I heard about the Invisalign treatment and its potential to help with TMD. I had an appointment with Dr. Fareed, who suggested that if we correct my bite it would help my pain. In order to do that, I need to use Invisalign for up to 2 years and have an implant to replace my missing molar. Dr Fareed also found a cyst under one of my lower molars, which was extracted by another surgeon before I started my Invisalign treatment. Unfortunately, I lost my wisdom tooth and a molar during this operation. Since then until August 2019, I used Invisalign aligners over 20 hours a day and I got relief from my pain, mostly whilst wearing the aligners. In August 2019, we started the implant treatment to replace my missing molar, which will be completed around January/February 2020. In the meantime, I started to wear my last aligner only during night time and I realised that my pain and discomfort is minimal during day time even without the aligners.

I can say that, although it is not yet completed, the Invisalign treatment has been the most successful treatment that I received for my TMD. I believe that once I have my implant and last set of aligners, I will have dealt with my TMD. I would strongly recommend it to anyone who has TMD. It is a long treatment and requires some patience but ultimately, it is worth it.

"I cannot recommend Invisalign enough"

“I started using Invisalign in 2016 and finished my final course in December 2018. I absolutely love my smile now and it is the best thing I could have invested in.  I’ve been wanting to straighten my teeth since I was 17 but have always put it off due to not really wanting the “train track” type braces as an adult.  I’m really happy I waited and found Dr Khan and Invisalign in 2016.

I explained to Dr Khan that I was initially only interested in straightening my teeth and this was fixed in about 6-8 months, it was an amazing result and I found it really easy to get used to wearing Invisalign.  It didn’t irritate me, it all felt very hygienic and no one noticed that I was wearing braces and I only needed to visit Dr Khan every other month for a quick appointment, which meant it didn’t feel like a big task to be wearing Invisalign.

After my teeth was straightened Dr Khan explained that we could explore further what more we can do with Invisalign if I wanted to as I’ve mentioned to him before that I grind my teeth.

In 2008 my dentist pointed out to me that I am grinding my teeth and that I should consider getting a mouthguard to sleep with at night.  As it was quite expensive I did not consider this until 2011 when my grinding became so bad that I would wake myself up at night having chipped my front tooth. I was scared I was going to break my teeth if I did not seek help.  After visiting the dentist we ordered a mouthguard and he filled in the chip in my front tooth.  It took some time to get used to the mouthguard as it is quite thick and uncomfortable and I’ve never worn anything like it before.  The first initial months went okay wearing the mouthguard but then I started noticing that I would wake up at night and not be wearing it anymore.  I’ve obviously taken it out in my sleep as it was annoying me so I’d have to search for it and put it back in.  This routine would happen easily up to 5 times a night and I would always wake up in the morning having taken it out again.  I had to have the chip in my front tooth filled in quite a few times as it just kept chipping (due to me being unable to sleep with my mouthguard) and eventually the dentist said that it is best I don’t fill the chip in my tooth in anymore as I’ll just chip it out again.  Eventually I gave up using it and threw it away as it just did not work for me.  I used to get a really stiff jaw and neck, my gums were receding and I suffered from bad headaches all due to grinding during this period which was not ideal after not having had any sleep.

Dr Khan assessed my teeth and we kept experimenting with Invisalign until the grinding stopped.  It is a wonderful feeling as I’m not scared that I’ll wake up chipping my teeth anymore.  We’ve adapted some of my lower teeth to be more hygienic, my gums have stopped receding, we widened my smile and all of this means my teeth are less crowded and my jaw is more relaxed.  I don’t suffer from headaches anymore and all of this means I get a better night’s rest now and my teeth are much healthier – even my hygienist said that my teeth are the healthiest it’s ever been.

I cannot recommend Invisalign enough (and Dr Khan), all in all it was a great experience and one I would encourage you to consider if you had similar symptoms.”

"It will completely change their lives for the better."

“I used to suffer from big headaches and  jaw pain particularly in the last few years. I have visited different doctors and none of them gave me a solution for it apart from taking painkillers. In the end, I thought I had just to accept the condition and live with it. However everything changed when I met Dr Khan.

Around three years ago,  I was considering to get a dental implant, so I had an appointment with Dr Khan. During my first visit he found out that I was suffering from teeth grinding and jaw clenching. He also explained to me that my upper jaw was smaller than my lower one and that could be one of the reasons of having the headaches and pain in my jaw. He suggested that with Invisalign, he could expand my upper jaw as well as getting my teeth straighter, particularly the front ones, and hopefully the headaches and pain on my jaw will fade away.

When I left the surgery I was so excited – it was the first time that a doctor has told me a reason and a solution at the same time for my several pains, so of course, I agreed and I started with Invisalign.

It has been three years now and I don’t suffer anymore from headaches and any pain on my jaw, furthermore I used to suffer also from sinusitis and I have seen a huge improvement since wearing Invisalign, so I believe that it has helped a lot in that area as well.

Dr Khan is a very professional, kind, enthusiastic and supportive individual and he is always doing further research and studies on the holistic benefits of theInvisalign therapy. And I will strongly and highly recommend to anyone who might have similar symptoms as I had and haven’t found yet a solution to it, to book an appointment with Dr Khan and try Invisalign. It will completely change their lives for the better.”

"I'm now successfully treated where all others failed."

“In 2013, I was having a drink and swallowed strangely, it felt like I’d pulled a muscle in my throat.  It really hurt, and almost immediately I noticed my left ear began to block up.  I was really alarmed at this, and thought it would surely heal, but it didn’t.  My ear seemed to block up on a whim, and it lasted for hours, and sometimes the whole day.  It hurt, I got a shooting pain and an aching pain from my ear to my mouth and it was irritating too because all I could hear was my heart beat.  Everyone said to blow my nose, yawn, etc etc, the usual, but it didn’t work.  The only thing which gave me a few seconds of relief was to tilt my head back.  This seemed to stretch some part of some tube or other and my ear would clear.  Or if I looked down, and bent my head downwards this sometimes worked.  But generally the only relief I got was a few moments of clearance.  As soon as my head went to it’s normal position, the ear blocked up again.  Sometimes it worked and cleared it for the rest of the day, most times it didn’t.  Sometimes my only relief was to lie down with my head tilted backwards.  I used to spend periods of time in tears because it was so unpleasant.  It was ruining my life.

I went to the doctors, who referred me to Benendon.  Here I had pressure tests, hearing tests, and cameras down my throat or nose.  But they never could find anything wrong.  They sent me away with a “you’ll just have to put up with it”.  I went back to the doctors and was referred to the NHS ENT specialists, same thing again, they couldn’t find anything wrong.

I saw a homeopath and visited a Chinese Herbalist, but the treatment didn’t work (acupuncture, teas, tinctures etc).

I also noticed that when I was under stress or pressure the symptoms came on and lasted all day.  Perhaps the way I held my jaw or something?

At the end of my tether, you find me in 2016.  One of the girls at work had just come back from seeing Dr Khan for a brace.  She told me he was a holistic dentist, he treated the whole face and jaw, not just the teeth…. I made the decision then and there that I’d see him, and made an appointment.

He asked me lots of questions about my general health, headaches (which I had daily), jaw ache, how my ears behaved when flying (agony), neck, shoulders etc etc.  He explained how he believed the treatment would help.   It would help to drain my sinuses, help to ease my headaches, and most importantly would re align my jaw so that it didn’t press against the tube in my ear which potentially was what was causing my blockages (he x-rayed and showed me how my jaw was resting).  I had absolutely every faith it would work and began treatment.

A year in, and my ear was still blocking up… my headaches had eased so that I barely noticed them, but my ear was still blocking up.  I was still under the NHS ENT specialists, and went again for more tests, and again they couldn’t find anything wrong.  But my ears were still blocking up…. and then I noticed they weren’t blocking up as much… and soon I realised that when I cleared them, it generally worked straight away and lasted… and my headaches had gone… Sometimes it got worse and I was miserable, and even said to Dr Khan “It isn’t working, is all this worth it?”! to which I’d get a lecture which made sense and I’d go away with positivity!

The NHS ENT specialists wanted to refer me to some other specialist to do with splints for jaws and stuff as a last resort, but Dr Khan forbade me!  And with good reason, and anyway, I wanted to carry on with the treatment, as long as it takes, even if it takes 5 years I didn’t care…

At intervals I had new photographs which showed how my teeth were changing, and of course my teeth were now nice and straight and everyone was commenting but it didn’t really mean that much to me because what I really wanted to change was my ear.  Mind you, now I could see positive changes and I loved them!  My lips were fuller, my jaw wasn’t so set back, and my teeth were straight!  The chips I had in them were repaired and they stayed repaired!

About a year ago I realised that my ear was hardly blocking up at all (before treatment it had been weekly, and in many cases, daily), and when it did block it was only for literally 5 seconds max.  And then about 3 months ago I realised that my ear wasn’t blocking up at ALL.  When I used to go to the gym the humidity of a workout made it block up, but it doesn’t seem to any more.  I couldn’t sleep on my left side before because it used to make my ear block up for the whole day, and now it doesn’t!  I can now sleep on my left side with no side effects whatsoever!  I’ve very recently suffered an unexpected bereavement, and my ear hasn’t blocked up once.  Not once.   On very rare occasions my ear goes as if to block up, it goes how it used to go before it blocked up and I sometimes think “oh no, oh no!” but it never (touch wood) actually does block up.

I’ve still got a little longer to go with the treatment, and I’m keen to continue with it, but if you’ve tried everything and everything’s failed, and you’re in pain and at your wits end, this mode of treatment will work.  I highly recommend it, and specifically Dr Khan.  Any old dentist can fit a brace and make your teeth straight, but it’s because of the forward thinking of Dr Khan and his research into how the jaw and teeth can be changed to treat other ailments that’s made the difference and made the treatment worthwhile.  I didn’t care about my teeth before, they were chipped and crooked and all sorts –  it was my ear and jaw that worried me, and as far as I’m concerned, I’m now successfully treated where all others failed.”