Neuromuscular / TMD / TMJ

What is “TMJ” or “TMD”

“TMJ” has become a catch-all term for a variety of pain/dysfunction conditions of the head and neck. It is derived from “Temporomandibular Joint” – your jaw joints – once thought to be the source of most of these ailments. We now know that there are many causes of head and neck problems that may or may not be related to the temporomandibular joint. For this reason, although it is not as widely familiar, most dentists use “TMD” – for temporomandibular disorders – to more accurately describe the condition. Could you be suffering from TMD?

Signs & Symproms of TMD

Pain or dysfunction of the head and neck is a very common condition and one that might be resolved very simply or might be very complex and frustrating to treat, depending on the circumstances. The bite can be a factor in many types of pain or functional problems because of the inter-relationship between the teeth, jaw joints, head and neck muscles, and head posture. A problem in any one of these areas may affect other areas. These can include painful clicking or popping of the jaw joint, various types of head and neck pain, swallowing problems, postural problems and excessive snoring or sleep apnea, to mention a few. If it is suspected that you suffer from this type of problem, the neuromuscular dentist may ask you if you have any of the symptoms shown below.

Do you suffer from any of these?

  • Headaches
  • Clenching or grinding
  • Jaw joint Pain
  • Facial pain
  • Jaw joint noise or clicking
  • Sensitive teeth
  • Limited mouth opening
  • Chewing Difficulties
  • Ear congestion
  • Neck pain
  • Dizziness
  • Postural problems
  • Ringing in the Ears
  • Tingling of the fingertips
  • Difficulty swallowing
  • Hot & cold sensitivity of teeth
  • Loose teeth
  • Nervousness or insomnia

In addition, the dentist will be looking for a number of signs in your posture, your existing bite, appearance and condition of your teeth that might aid in diagnosis. An imperfect bite often plays a significant role in these conditions and a dentist such as Dr. Marcela Kahane, experienced in treating them, may resolve the problem alone. However, diagnosing these problems can be very difficult at times and may require the collective efforts of your dentist and other health care professionals. These may include your physician, an ear, nose and throat specialist, physical therapist, chiropractor or massage therapist to name just a few.

The Dentist’s Diagnosis

Dr. Marcela Kahane, as a neuromuscular dentist, will consider all of the information gathered by taking your history and doing a physical examination of your teeth, head and neck. When indicated, she may conduct a series of tests using non-invasive electronic instruments. Data from these tests will indicate to your dentist whether your bite is a major contributing factor to your problem and will help rule in or rule out your bite as the cause of, or major component of, your condition. If these tests show that your habitual bite is a probable cause of your condition or pain, Dr Marcela will then identify a jaw position determined by the relaxed state of the muscles using a TENS machine (Transcutaneous Electrical Nerve Stimulator). TENS is a specialized therapy designed to treat the pain associated with TMD by directing mild electrical pulses to your facial and jaw muscles. These impulses increase blood flow to the muscles and help to relax the muscles so the dentist can determine the ideal jaw position for your bite. More information on the TENS machine can be found at This jaw position and the corresponding new bite is called neuromuscular occlusion.


If there are strong indications that the bite is a major factor in your problem, at the outset of treatment nothing is done to permanently alter your teeth or your bite.  You would typically wear a plastic, custom fabricated appliance, called an orthosis.  The orthosis can be worn over the teeth to maintain the neuormuscularly derived bite position.

The orthosis would be worn for a prescribed period of time to verify that this new jaw position solves or reduces the problem.  If it does, it has proven that the imperfect bite was the cause of the problem and you may elect to go on and have your natural teeth treated to permanently maintain that new bite position. If symptoms are not substantially alleviated, the bite position is most likely not the cause of the problem. Your natural bite has not been altered and other causes would then be explored.

Dr. Marcela Kahane understands your pain and your fears because of her years of experience working with other TMD patients. Dr. Marcela has received special training in neuromuscular dentistry at the world-renowned Las Vegas Institute for Aesthetic Studies (LVI). She offers the comfort, technology and convenience you need to make your dental experience memorable and enjoyable, without the pain you might be expecting.

Some issues can be treated using Botox injections as well.  Dr. Marcela Kahane has successfully treated patients suffering from TMJ and migraines as a result of neuromuscular problems.  Gone are the days that Botox is used just for cosmetic purposes.  This safe treatment can be used to treat TMJ, tension headaches, migraines and trigeminal neuralgia.

Using the TENS machine was easy – even relaxing – and my jaw and bite are now straightened and the cold sensitivity I was experiencing is completely gone!

Mike SFernie