Temporomandibular Joint Disorder (TMJD) - Migraines, Pain and Movement Disorders Interview

- Dr. Anthony B. Sims, DDS.

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Dr. Anthony Sims has been practicing dentistry for over 30 years. In the last 15 years he's specialized in dental sleep disorders, TMJ dysfunction and its connection to the various movement disorders.

In this interview Dr. Sims discusses TMJ disorder/dysfunction. The causes including micro/macro trauma, symptoms and possible misdiagnosis as well as other disorders associated with TMJD. He talks about why X-rays should not solely be used to diagnose TMJD, his thoughts on home remedies, treatment options and much more!

Interview Transcript

Tye: Hello. I want to thank everyone for tuning in today. My name is Tye Binuyo with the Top Rated Dentist Podcast. We are the show that introduces you to excellent dentists and dental professionals from around the country as well as the services they offer. Today I have a very special guest joining me, Dr. Anthony Sims.

Tye: Dr. Sims is the owner of the Maryland Center for craniofacial TMJ and dental sleep disorders located in Columbia, Maryland. He is here today to discuss TMJ disorder.

Dr. Sims has lectured on TMJ dysfunction, the treatment and its connection to the various movement disorders. He's lectured across the United States and internationally on the modern advances in TMJ treatment. Thank you for joining us Dr. Sims.

Thank you. Thank you for having me.

Tye: To get started could you give us some background information about your practice as well as your journey in dentistry?

Dr. Sims: I've been practicing for over 30 years. I've been here in Columbia for about 30 years. It's been a nice journey. At first, I started out in general dentistry but about 15 years ago I started learning more about problems that my patients had and things that I did inadvertently and solved them. So, I decided to dig deeper and investigate more of what was possible.

Tye: Could you tell us what exactly is TMJ?

Dr. Sims: TMJ means temporomandibular joint, everyone has one. It is a joint right before the ear canals and it is the joint that articulates the lower jaw or mandible with the cranium or skull.

It consists of muscles, bone, nerves and it affects so many different aspects of your body. It's what they've called the master joint. It's different in that it doesn't just rotate but it also hinges, so you can open very wide to accommodate specific foods.

Tye: What constitutes TMJ disorder or dysfunction?

Dr. Sims: Well one of the factors is that people have muscle disorders. That's usually the case in probably 80 percent of TMJ disorders. There's a muscle problem. People grind their teeth, people clench their teeth, and this makes the muscles sore.

Sometimes this can be alleviated by certain things such as putting a splint between their teeth, preventing them from grinding or clenching their teeth. Some people just need muscle relaxers, some people just need a little heat pad on those muscles to allow healing to begin into those muscles. So TMJ disorder means that the joint itself has damage.

Now that doesn't mean that there cannot be even more disorder or damage. Greater damage can occur.

Tye: Would you say the damage comes from physical trauma or just something that you are born with? what brings it about?

Dr. Sims: You hit him right on the head both times. Some people have a genetic disorder and their growth pattern is not correct. That's why you grow to your height, I grow to my height, my wife grows to her height, someone’s young daughter grows to their height.

Everybody has a different height. Some people grow to a specific height and some areas don't grow as fast as others so that can constitute a genetic factor.

The other factor is what you just mentioned, traumatic. There is both macro trauma and micro trauma. Macro trauma is caused when you're in an auto accident. It can be caused by whiplash which can tear the TMJ because the head snaps back and the jaw does not snap back as fast and so you get damage into the temporomandibular joint.

You can have micro trauma; micro trauma is what we talked about earlier. Bruxism or clenching and grinding of your teeth, so the grinding and clenching causes other problems to occur. That’s part of it.

Another area is airway. If you cannot breathe, you hear people snoring, they cannot breathe which can cause a trauma to the joint by the jaw having to constantly find the best area so that it can absorb as much air as possible during sleep time. There are multiple possible causes of the TMJD.

Tye: Wow that's very interesting. I would never think something as simple as snoring would then relate to TMJ disorder.

Dr. Sims: Oh yes.

Tye: Now would you say it’s often hard to diagnose? or maybe even mistaken for other problems because of the different ways that it can come about?

Dr. Sims: Oh yes, very much so. As I stated earlier it's called the master joint. This joint has what is called the trigeminal nerve number five. That's what I tell everyone, nerve number five. Nerve number five is the one that has sensory into your brain.

What that does is all these different nerves from nerve number five can cause you to cough, can make you sneeze, can make other symptoms worse than what you originally have, and no one predicts that this is from that sensory nerve number five.

When you are basically being formed in the uterus, the nerve cells that come from the embryo form the whole dental complex so that the major nerves that all your neurologists use also form your facial structure.

Tye: I'm not a Dentist but just from the sound of things I would never think there's that much association between the dental cavity and then you start talking about nerves and moving up into the head.

Dr. Sims: Yeah, a lot of nerves and nerve fibers that are connected from the dental apparatus to what we call them brain stem. The brainstem is the area that makes you move automatically, your heart, your breathing, your blinking all those types of things are connected to your dental structures.

Tye: So what other disorders would you say are associated with TMJD? It sounds like from the connection there are other disorders that are possible, are there any specific ones that you would want to mention?

Dr. Sims: Well the number one thing that most people associate TMJ disorder with is pain and that is true to a degree. But you have more than one type of sensory nerve, you have the pain nerve, true.

You also have a temperature nerve, you also have a proprioception nerve, which means knowing where your face or your body is in space. Those nerves run through your TMJ also. You have a balance nerve, you have a vibrational nerve, you have a chemical nerve, you have a vestibular nerve.

All these nerves running through the temporomandibular joint. But no one thinks of the other nerves, but they only focus in on the pain nerve. So other disorders can be associated with that.

There are cases such as people who have what they call Complex Regional Pain Syndrome. If you lightly touch them, they have severe pain.

There are patients who have a balance disorder, when you correct the disorder within the TMJ, their balance returns to normal. There are people who have what is called dystonia or their head is stuck in one position either forward, backward, laterally or rotationally and they can't move their head.

That too is also connected to the TMJ through the connection with the cervical nerve. You have people who have Tourette's Syndrome. Tourette's Syndrome is people have what they call ticks.

Ticks are involuntary motor movements and those movements can be regulated and helped by correcting the temporomandibular joint. So, you can correct multiple disorders... and that's just a small number of disorders that are associated with the temporomandibular joint.

Tye: Wow, sounds really interesting. I was able to check out some of the videos on your website. What I saw was amazing. What was going on with some of those ailments that you just mentioned, as you were able to improve the lives of some of those people was amazing.

Dr. Sims: That's part of the job. I want most especially young people to understand that knowledge is good. Knowledge only makes you a good scholar. Understanding what that knowledge means makes you a good teacher. But wisdom is what makes you a great practitioner. You must know what to do and act on the knowledge and understanding that you have to be able to make that person or that patient have a better quality of life.

Tye: Now moving on would you say TMJD is more common in maybe kids, teens or adults. Do you see one population more than the other?

Dr. Sims: I see them all… like we stated earlier, a lot of the kids are because there is a genetic unproportioned growth, so we can help those kids correct the problem. That's why some cases kids need braces. You have two growth spurts, one when your little one when you're a teen.

So, you have a secondary growth spurt which also needs to be addressed. Now adults usually have finished growing. We talked earlier about trauma, there may have been some type of accident, they can't breathe or maybe they've been through multiple surgeries. We don't know what the case may be until they come in and tell us. But I get to see the whole gamut of patients.

Tye: Good stuff. Now the other thing you mentioned was pain. We talked about pain nerves balance, chemical, when we go back to the pain part of things, is there a specific part of the body where they experience pain?

Dr. Sims: Nerve five can cause damage into the area that is called the brain stem. When that happens, some patients have pain from other portions of their body which now becomes exemplified.

And so even though that pain is in your arm or your leg, it now has more access to the brain. So, it tells the brain that you have a severe pain in your arm or your leg. This is also caused or can be caused by the nerve five firing against the brain stem.

People who have migraines, migraines are mainly a pain within the muscles of the head. Therefore, patients are given muscle relaxers. But if you put in a specific type of device that prevents those muscles from tightening up, the muscles don't tighten up.

Therefore, the blood vessels are released, the pain fibers within the muscles are released. The migraines dissipate. So, you can decrease migraines by using something dentally.

Tye: Got it. In other words, we're going to the source of the pain and not just treating the symptoms?

 Dr. Sims: There you go, you're getting good knowledge.

Tye: Good stuff. Now what about diagnosing TMJD? Is it just with the basic X-ray or what's involved?

Dr. Sims: If you are being diagnosed with TMJD just by an x-ray, you've only gotten half or less than half of the deal. You are not made just of bone and teeth. X-rays only take pictures of hard tissue, which is bone and teeth.

You are made up of soft tissue also. You must have an MRI. The MRI is the gold standard that we have at this point in time, but the MRI shows us soft tissue. You cannot diagnose somebody who has a TMJ problem, dysfunction or disorder without both an x-ray and MRI.

Tye: Now I've also seen home remedies online for TMJ. What are your thoughts on these home remedies that you see across the internet?

Dr. Sims: Well some of them are good, and others not so good. If you're having a problem with your TMJ go to someone who knows about TMJ. Some of these home remedies make me cringe at what I know that they're doing.

Tye: Sounds like they are doing more harm than good?

Dr. Sims: That's right. That's exactly right. Knowledge is the key. Understanding is what you need, then you need to know what to do to correct the problem with the knowledge.

Tye: Interesting. Now you also mentioned the device used for TMJD. How effective is it? What kind of standard of life can one expect after treatment? Is it totally gone?

Dr. Sims: That is correct, each individual. That's what I do. It's not just one device, sometimes there are other things that must be done to help that nerve to calm down.

You treat the cause not the symptoms. If you treat the cause the symptoms go away, if you treat the symptoms the cause is always there so you must keep coming back again and again. Treat the cause and the symptoms go away.

Tye: Right. Dr. Sims this has been amazing. It's been very informative and helpful. I've learned a lot and I'm sure our listeners will also get a lot out of this. A lot of value. Now what's the best way for people to contact you to schedule a consultation or if they have any TMJ Symptoms or Questions?

Dr. Sims: Yes my best contact number is 410-872-0872 and my email is [email protected]

Tye: Thank you again for coming on the show

Dr. Sims: You’re welcome.

Practice Details & Contact Information