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in Manalapan, NJ

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TMJ Disorders

The term “TMJ disorders” (also referred to as TMD), as commonly used by patients, represents a broad array of jaw joint, occlusal, and musculoskeletal conditions of the head & neck. As the classification encompasses a wide range of conditions, there naturally are many signs and symptoms of TMD. Some of the more common ones include:

– pain in front of the ear

– tender or painful jaw muscles

– clicking, popping or crunching noises when opening or closing the jaw

– limited opening or locking of the jaw

- Headaches or general head / neck pain may also be associated with TMJ disorders.

    (See the section on headaches below.)

Such problems require comprehensive evaluation by a dentist with advanced training in this area. In evaluating a patient with symptoms of a potential TMJ disorder, our office combines the results of your medical history / questionnaire, x-rays, and a detailed examination of the head & neck to arrive at your diagnosis. Referral for imaging such as a CT scan, MRI, or iCAT may be indicated.

Due to the potentially complex nature of such disorders which often involve many contributing factors, our treatment approach is one of the whole person as a system to restore harmony and balance to your TM joint / head & neck functioning. Common therapeutic approaches may include the use of an oral appliance, occlusal equlibration (adjusting the “bite”), specific jaw exercises, and the use of moist heat.   We may also work with other medical specialists depending upon your individual needs, and may advise referrals for evaluating nutritional considerations, , general exercise, lifestyle, work habits and daily living changes, and stress reduction / relaxation suggestions.

We have had tremendous success with our integrative, conservative, non-surgical approach to the treatment of our TMD patients. In fact, this ability to provide such profound relief from chronic debilitating pain is one of the most rewarding aspects of our practice!


Headache is one of the most common medical complaints of the U.S. population today and actually accounts for millions of lost workdays each year.  Due to the wide range of apparent symptoms and presentations of head pain, the International Headache Society has developed a comprehensive classification in an attempt to categorize these disorders.

Our experience in treating these disorders has shown that the large majority of patients who complain of unilateral headache (pain on one side) often have a muscular / myofacial (MPDS) cause of their discomfort; and a large percentage of the time are associated with an actual TMJ (actual joint involvement) disorder.  The most common (although not the only) location for this type of headache is around or above one eye, travelling up from the neck on the same side.

If there is an associated TMJ disorder and/or bruxism (tooth grinding),  an oral appliance is usually essential to achieving relief.  Such headaches of muscular origin have been quite successfully treated at our office.  Coordinated referral to a physical therapist, occupational therapist, chiropractor, or a well trained massage therapist is often highly beneficial.

Dr. Ciuffreda has seen numerous patients who provide a history of “migraine.”   Frequently these patients have been placed on prescription migraine medication but have had only limited, if any relief.  However, upon examination Dr, Ciuffreda frequently finds that they really have a muscular / myofascial type headache often associated with a TMJ disorder and/or bruxism.  that can usually be alleviated without, or with minimal medications as discussed above.


Not all headaches are “just headaches”.  There are certain signs or symptoms that may indicate a serious underlying cause for headache symptoms.  If you experience any of the following it would be highly advisable for you to seek medical consultation promptly:

– abrupt onset of different or new type of severe headache

– “worst headache you have ever had”

– new onset of headache if over 50 years old

– worsening of a headache over a period of days or weeks

– headache worsened or precipitated by exertion

– presence of illness, fever, nausea, vomiting, stiff neck

– neurological symptoms (different from classic pre-migraine signs)

Teeth Grinding

It has been estimated that 30% of adults suffer from tooth grinding, or bruxism.  Although some people will grind & clench their teeth during the day as well, bruxism generally occurs during stage 2 of sleep.  Problems associated with clenching and grinding may include:

 - unsightly shortening and chipping of teeth

- disruption of naturally protective tooth architecture

- tooth sensitivity

- accelleration of periodontal bone loss in the presence of gum inflammation

- loosening of teeth

- headache

- TMJ disorders

The primary treatment for tooth grinding is to fabricate a custom "night guard" so that during the night you will grind on the oral appliance rather than on your teeth.  This will not only protect your teeth from wear and distribute biting 7 clenching forces, but it will also decompress your jaw joint promotog overall TMJ health.

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