TMJ Treatment in Las Vegas

The temporomandibular joints sit just in front of each ear and connect your lower jaw to your skull. They move forward, back and sideways, which makes them among the most complicated joints in the body and among the easiest to overload. When they hurt, when they click, or when the muscles around them will not let go, the clinical name for it is TMD, temporomandibular disorder. Most people call it TMJ, and so does everybody here.

What does TMJ pain actually feel like?

It is often not felt in the joint at all, which is why it goes unrecognized for years and gets treated as something else.

• Pain in the jaw, the face, the neck or the ears
• Headaches that feel like migraines, often worst in the morning
• Pain or pressure behind the eyes
• Clicking or popping when opening and closing
• A jaw that feels out of joint, or muscles that are sore to touch
• Difficulty chewing, or a bite that feels like it has moved
• Teeth that are worn flat, chipped or sensitive from clenching

What causes TMJ pain?

Usually more than one thing at once, which is why a single treatment aimed at a single cause tends to disappoint. Clenching and grinding, stress carried in the jaw muscles, a bite that does not meet evenly, arthritis in the joint, an old injury and the shape of the airway have all been associated with TMD, and in many patients several of them are present together. Part of the point of an evaluation is working out which ones are driving your case.

Airway is worth naming here because it is easy to overstate. Breathing that is obstructed during sleep has been associated with clenching and grinding in a number of studies, and in some patients treating the airway appears to settle the jaw as well. That is an association rather than a rule, and it does not mean every person who grinds their teeth has an airway problem. Dr. Kevin screens for it because when it is there it changes the plan, and because ignoring it means treating the same symptom forever.

What happens at a TMJ evaluation?

Two hours are reserved for a new patient, and a jaw evaluation uses them. Dr. Kevin takes a history of the pain, examines the joints and the muscles by hand, measures how far and how evenly the jaw opens, checks how the teeth meet and where they are worn, and looks at the airway. A large view CBCT scan images the joints and the surrounding anatomy in three dimensions when the case calls for it. You are then shown what he found on your own images, and told what he thinks is driving it, before anything is recommended.

How is TMJ treated here?

Reversible first. Nothing that permanently changes teeth is a starting point for jaw pain.

• Custom orthotic: a night guard made from a digital scan, designed to take load off the joint and the muscles rather than simply cover the teeth.
• Nonsurgical jaw repositioning: gently realigning where the jaw sits, which can also open the airway.
• Laser therapy: used on the soft tissue, with a quick procedure and a quick recovery.
• Guided jaw massage: shown to you so you can release the muscles at home without provoking a flare up.
• Botox: targeted at muscles that are tight or in spasm, to relax them and interrupt the clenching cycle.
• MARPE expansion: where the upper jaw is narrow, widening it can change both the bite and the airway. This is a bigger intervention and it is not a first step.

How long does TMJ treatment take?

Muscle pain often eases within a few weeks of wearing an orthotic. Joint problems and long standing wear take longer, and cases where the bite or the airway is part of the picture are measured in months rather than weeks. Dr. Kevin reviews progress and adjusts the plan rather than leaving you with an appliance and a follow up in a year. If something is not working, that is information, and it changes what comes next.

Is jaw clicking on its own a problem?

Not necessarily. Plenty of joints click and never hurt, and a click with no pain, no locking and no limitation is often left alone and watched. A click that is new, that comes with pain, that changes how far the jaw opens, or that turns into locking is worth an evaluation.

What happens if TMJ pain is left alone?

Sometimes nothing. Plenty of jaws ache for a week after a long dental appointment or a stressful month and settle by themselves, and treating those is unnecessary. What does not tend to settle by itself is the wear. Clenching and grinding go on flattening cusps, chipping edges and thinning enamel whether or not the joint hurts that week, and that damage does not reverse: a tooth worn to the dentine is rebuilt, not healed. The other thing that changes with time is the joint itself, where a disc that has been displaced for years is harder to manage than one that has been displaced for months. So the reason to be evaluated is rarely the pain you have today. It is what the same pattern is quietly doing to your teeth.

What should I expect at my first appointment?

Two hours, and no treatment on the day unless something is urgent. You will be asked when the pain started, what makes it worse, whether it wakes you, whether anyone has told you that you grind, and how you sleep. Dr. Kevin then examines the joints and the muscles by hand, watches the jaw open and close and measures how far it travels, checks how the teeth meet and where they are worn, looks at the tongue and the airway, and takes the images your case calls for. You will see what he found on your own scans and photographs, and hear which parts of it he thinks are driving your symptoms. You leave with a plan and a written cost, not with an appliance you did not expect to be buying.

What does TMJ treatment cost?

It depends on what your jaw needs, and you are told the number before treatment starts rather than after. Some TMJ care is covered by dental insurance, some by medical insurance, and some by neither. The team will check your benefits and tell you what your part is in writing. Cosmetic and airway evaluations begin with a consultation fee, and what that includes is explained when you book.