Structure first
We study how the jaw is built before anything else.
TMJ Causes
Most TMJ begins with how the jaw is built and how the teeth meet. Stress can worsen it, but it is rarely the root.
Dr. Frey looks first at structure: the shape of the jaw, the alignment of the bite, and how the two developed over a lifetime. Early mouth breathing, injury, and imbalanced bites all leave their mark.
Even teeth that look straight can close incorrectly. Stress and grinding add strain, but the underlying imbalance is what we work to understand and correct.
How did I get TMJ?
TMJ disorder is not a sudden event, like injuring your knee. It can begin in childhood, and one early sign is mouth breathing, which often points to a misaligned jaw. When a child breathes through the mouth, the tongue has to sit lower, and that can change how the upper jaw develops, so that it grows into the shape of a V instead of its natural U shape.
Those are problems with the balance and alignment of the bite that begin early in life. TMJ can also follow a traumatic injury to the jaw or the jaw joints, and there also appears to be a genetic tendency. Stress and nightly clenching during sleep often bring symptoms on or make them worse, but as you will read below, Dr. Frey looks for the structural imbalance underneath.
Causes of TMJ.
An unbalanced bite, and the TMJ that follows it, can come from one cause or from several together. These are the ones Dr. Frey looks for.
Unbalanced bite.
A bad bite can cause soreness and is a common cause of TMJ. The obvious signs are an underbite or an overbite. An unbalanced bite can have one cause or a combination of them: allergies during childhood, thumb sucking, old dentistry that needs to be replaced, or teeth shifting after tooth loss can all lead to a bad bite.
Injury or trauma.
An injury to the jaw from an accident or any intense physical impact can damage the muscles or joints. Whenever your body absorbs a serious blow, the force travels through the rest of the body and changes how the muscles and joints of the head, neck and face work. The result is the discomfort and irritation of TMJ.
Skull deformation.
The shape of the skull and the bones of the face is set early in life. If the bones, muscles or ligaments develop out of alignment, the development of the jaw joint can change. It can also misalign the jaws and the bones of the skull, which leads to an unbalanced bite.
Genetics.
Your jaw structure, the position of your teeth and the whole makeup of your face are inherited. So is a sensitivity to your environment that can lead to allergies and congestion. If you inherited a small jaw, or teeth that are too large for your mouth, the result is a bad bite and a misaligned jaw.
Airway issues.
Airway issues can cause TMJ pain, an improperly formed jaw and bite problems. With an unbalanced bite, the tongue cannot sit where it should, and it can block air on its way to the lungs. Poor breathing can start with childhood allergies: when a child is constantly congested, the tongue drops down to let air pass over it. With the tongue out of balance, the growth of the upper jaw changes over time, and the result can be a compromised airway.
Unbalanced dentistry.
Even after orthodontic work to straighten your smile, there can be problems you cannot see. You can have a perfectly straight set of teeth and still have a misaligned bite and the symptoms of TMJ.
Finding which of these is at work in your case is where TMJ care at our Beverly Hills office begins, and it is what lets Dr. Frey plan conservative, non surgical treatment around the cause rather than the symptoms. If you are still working out whether your jaw is involved, our page on TMJ symptoms walks through the signs.
Is sleep apnea related to TMJ?
Often, yes. The same imbalance that crowds the tongue can narrow the airway, so at our Beverly Hills office we take full CT scans of the head and neck to see whether a patient has a compromised airway. The evaluation can include:
- Dental x-rays, for a closer look at your teeth and jaw
- A CT scan, for a closer look at the bones of the jaw joint
- An MRI when needed, to show any problems with the soft tissue or the disk inside the joint
If the scans point to a breathing problem during sleep, our page on sleep apnea treatment explains the next steps.
Common questions about TMJ causes.
Who is at risk for developing TMJ?
TMJ is more common in women than in men. Stress is a known risk factor: under a great deal of stress, a person may begin clenching their teeth during the day and grinding them at night, which sets off a chain of stressed muscles, damaged teeth and chronic pain. There also appears to be a genetic factor.
Can stress cause TMJ?
Stress can make TMJ worse, but Dr. Frey does not believe it causes it. Some doctors follow a psychosocial model, which holds that stress causes TMJ. Dr. Frey belongs to the structural and functional camp: he looks for a structural imbalance in the skull or the bones behind the TMJ. He evaluates the cause of your TMJ and works to bring those imbalances into harmony with the muscles of the jaw and neck, the jaw joint and the teeth.
Can TMJ cause tinnitus?
Yes. A ligament runs from the jaw joint into the ear, so TMJ disorder can cause tinnitus: when that shared ligament is very tight, it causes ringing in the ears. Ear pain, congestion and dizziness are covered on our TMJ symptoms page.
Can braces cause TMJ?
They can, because the original bad bite was already causing an imbalance in the joint. You may not have felt any pain before braces, but as the teeth shift, TMJ pain can increase while the imbalances in the jaw are being corrected.
Can someone with dentures get TMJ?
Yes, especially if the vertical dimension of the dentures is too low, meaning the jaw closes further than it should. That can push the jaw joint too far back in the head.
What causes some TMJ night guards not to work?
A night guard on its own may not be enough to treat TMJ, because it can upset the balance between the jaw joint and the muscles of the head and neck. If a night guard is not fitted properly, it will cause muscle tension. Dr. Frey’s approach to TMJ treatment without surgery looks at the bite, the muscles and the joint together.
What sets this treatment apart.
The details that turn a procedure into a result worth keeping.
Stress is secondary
It can inflame symptoms, but it rarely creates them.
History leaves clues
Growth, injury, and past dentistry all shape the bite.
Explore related treatments.
Care at Perfect White Smile is rarely a single procedure. These often work alongside tmj causes.
Ready to find the cause of your TMJ?
Sit with Dr. Frey for a private TMJ consultation and learn what is behind your symptoms, and how a conservative, non surgical approach could help.