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For more information about neuromuscular dentistry, contact:


James R. Harold, DDS

700 Exposition Place, #151
Raleigh, NC 27615
Telephone: (919) 848-3636

Relieving the Anguish & Trauma of TMJD

“The pain was relentless and debilitating,” says Suzanne, a woman nearing 50 who prefers to use an assumed name for this article.

Images often provide Dr. Harold with
evidence of maladjustments.

“For years, I suffered with migraine headaches, jaw pain, clenching and grinding of my teeth, popping and clicking, and ear pain.

“My family dentist shared my frustration that his efforts, such as the use of night guards, simply brought no relief. He finally said, ‘If I had these issues, there’s only one person I’d seek out, and that’s Dr. James Harold in Raleigh. He’s a terrific neuromuscular dentist.’

“I took that advice, and within a matter of weeks I found the relief I’d been seeking for years!”

Common Problem

Millions of people in this country suffer from TMJD, Dr. Harold notes. “Typically, patients who come to me have seen four or five other doctors—chiropractors, ENT doctors, orthopedic surgeons, oral surgeons, other dentists. They have been diagnosed and misdiagnosed. They have one thing in common: they are desperate for relief.

“TMJD, caused by an improperly aligned jaw, contributes to a great array of problems. The basic goal of neuromuscular dentistry is to bring the jaw and teeth into harmony with the muscles. If the jaw is not in the proper position as it relates to the muscles, muscles become overstretched and place undue strain on surrounding bones, nerves and tissues, causing increasing amounts of pain. Over time, the pain can become intolerable.”

Most of us, observes Dr. Harold, have disharmony in our bodies—“whether it’s manifested in our jaw, hips, ears, or eyes. Very few of us are bilaterally symmetrical and perfect. So our bodies tend to accommodate our shortcomings, sometimes with signs, other times with signs and symptoms. The ones with symptoms seek us out.

“In fact, we get excellent results in treating a great variety of ailments that quite often defy traditional diagnoses: headaches, facial pain, worn, chipping, or cracked teeth, cracking or chipping of dental restorations, neck and shoulder pain, jaw pain, ear congestion, ringing in the ears, clicking or popping in the joints, clenching or bruxing, limited opening of the mouth, loose teeth, and even tingling in the fingers.”

Out of Balance

TMJD is not necessarily the root cause of these many problems, Dr. Harold points out, “but in many instances it contributes to the discomfort in a direct way. Basically, the problem is often a lack of harmony between the joint, muscles, and nerves, and it is thus ideally suited for neuromuscular treatment.

“In an initial evaluation, I often find an imbalance in the position of the jaw as it relates to the muscles in the joint, and in the closing pattern of the jaw as it relates to the teeth.

“The first goal is to find the position of the jaw where the muscles are relaxed and at rest—a three-dimensional position in space—and we rely on a series of neuromuscular scans to accomplish this.

“Once we determine the comfortable position of the lower jaw, the next critical task is to fabricate an acrylic orthotic that allows the jaw to close to this ideal position—where the muscles are at an ideal length and will not go into spasm. This allows muscles to heal, pain trigger points to subside, and joint capsules to heal. We leave this orthotic in place for three months, 24 hours a day.

“It is imperative that patients be pain-free for two to three months while wearing the orthotic before starting the next phase. Phase two may consist of either full mouth reconstruction, to permanently place the jaw and teeth into the new bite, or orthodontics, to move the teeth into the corrected bite. In some cases, a limited bite adjustment is all that patients need in order to correct the problems. Suzanne will move into this orthodontics phase in the near future.”

He adds, “Most of our patients—sometimes patients who have been in pain for 20 years—see an enormous improvement within 48 hours of initially placing the orthotic.  The vast majority of them are completely free of pain within two weeks—as was true with this patient.”

Dr. Harold notes, “For patients who have arthritis, a degenerating disk, or a bone-on-bone problem, neuromuscular dentistry is not going to resolve their pain. But we can determine the true cause of the pain very quickly, and move the patient to the most effective course of treatment.”

TMJD Often Begins in Childhood

“What I realize in a majority of TMJD cases,” says Dr. Harold, “is that this very painful and difficult condition could be averted in many instances with early detection in the childhood years. Many of these problems of having jaws out of alignment start at a very early age, and in most cases a major contributing factor is upper airways structure and obstruction.”

Dr. Harold advises parents to “occasionally observe your child during sleep. First and foremost, parents can look for chronic mouth breathing: is the child gulping and almost gasping for air, and breathing exclusively or almost so through their mouth? A child with an obstruction, perhaps due to enlarged tonsils and adenoids, can’t breathe through their nose. And check for inflamed tissue in their mouth. Mouth breathing dries out the mucosa.
“Children who are mouth breathers also often have ‘shiners’: dark circles under their eyes, which we have come to recognize as a symptom of a chronic breathing problem. Mouth breathers also tend to have a long face, with a very narrow upper arch and a very high palate.

“A majority of children who have an upper airway obstruction, and who become mouth breathers,” Dr. Harold explains, “end up with a lot of orthodontic problems as well as TMJD problems—misalignment of their jaws. And these conditions are detectable and more easily correctable early in life, before more significant problems set in.

“Often the TMJD problems will begin to manifest late in the teenage years, and by the mid- to late-twenties they will, for many patients, become sufficiently severe that they need professional help.”

As conditions tend to worsen for TMJD patients through their teenage years, says Dr. Harold, “they are increasingly likely to have frequent headaches. Clenching and grinding the teeth, which are TMJD symptoms, produce pain from the muscles in the head. Often these headaches are so frequent and severe that they are misdiagnosed and treated as migraine headaches.”