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Jaw Discomfort & TMJ

700 million hours of work are lost yearly due to head and facial pain. Head, neck and facial pain, jaw dysfunction and ear problems affect a significant portion of the general population and masquerade as many other conditions. It is estimated that 700 million man hours of work are lost each year as a result. In addition, it is conservatively estimated that $500 million is spent on over-the- counter pain medications and $1.2 billion on prescription pain management medications annually in the “management” of this pain and discomfort.

With much frustration, patients often bounce from one medical doctor to another to find the source of their discomfort. Negative or inconclusive findings often lead to prolonged drug therapies, and often an ultimate and incorrect diagnosis of psychosomatic illness. Our dentists have the experience to diagnose and treat complex conditions of the TMJ and other areas of the head, face, and neck. Call 212-452-3344 or visit our website to arrange an evaluation with NYC Smile Design today.

What Is Neuromuscular Dysfunction?

Your “incurable” headache, ear and facial pain could be coming from jaw joints, your bite-how your teeth meet and/or spasms in your facial musculature. Our practice approaches treatment and management of problems of this nature as a team with your physician to provide the most comprehensive solutions. We are committed to the long term benefits of comprehensive neuromuscular treatment and enthusiastic about the options offered by the advanced technology that is part of the process.


TMJ stands for our left and right temporomandibular (jaw) joints. The acronym TMJ is very often incorrectly used to describe a disorder of these joints. However, the correct acronym of the disorder is TMD, meaning temperomandibular disorders and when we include the many symptoms of head, neck, facial and jaw pain it is recognized as “craniomandibular disorders.”

Long term studies now prove that the following symptoms are linked to the incorrect alignment of the upper (maxilla) and lower (mandibular) jaws and changes in the integrity of the TMJ. This produces physiologic stress, pain and dysfunction in the joints, supporting ligaments and associated muscles:

  • Headaches
  • Dizziness facial, neck, or back, pain
  • Pain or soreness of the jaw joints clicking, popping, or grating sounds as jaw joints are in motion
  • Congestion or stuffiness of the ears
  • Numbness of the arms and fingers, chipped, or cracked teeth
  • Pain in teeth that seems to move around
  • Loose teeth
  • Ear pain
  • Ear ringing/ buzzing sounds in ear
  • Loss of auditory acuity
  • Limitations of motion of jaw joins
  • Jaw locking upon opening or closing
  • Tired face/jaw
  • Snoring
  • Difficulty swallowing
  • Tingling fingers/hand numbness

Left untreated, the problems progress, getting worse over time and the stress and tension it produces can cause everything from mild discomfort to severe chronc pain throughout the body.

Craniomandibular disorders can also exacerbate:

  • Fibromyalgia
  • Tinnitis
  • Migraine


Causes of Neuromuscular Dysfunction

The Exact Cause of TMJ is Not Always Known. The factors responsible for craniomandibular disorders may be single or multifactorial. These include:

  • Developmental: A malrelationship of the maxilla and mandible produces symptoms that may emerge during childhood or may not occur until adulthood after years of day to day trauma.
  • Improper occlusion/bite: When teeth do not fit together properly it causes sustained microtrauma to the joints. Over time the body compensates by involving other muscles of the body
  • Direct trauma to jaw
  • Indirect trauma to jaw: A significant number of cervical whiplash injuries are accompanied with mandibular whiplash-a stretching or tearing of the ligaments of the jaw joints and cause damage within the supporting musculature.
  • Tooth loss: Losing teeth without adequate replacement results in a change in jaw position; improper restorations that change the jaw relationship or make an incorrect one worsen.
  • Poor sleep habits/position
  • Poor posture: Places unnecessary wear and tear on all joints, including jaw joints and resulting damage is similar to direct trauma
  • Bruxism/clenching of teeth: Some patients do this unconsciously and in some patients we are uncertain why this is occurring. This produces stress on jaw joints and muscles of face and neck
  • Sleep apnea: It is theorized that some patients clench and brux their teeth unconsciously to maintain the muscles of the throat and mouth in a patent open airway. This will help maintain an airway but will put stress on jaw joints and muscles of face.neck
  • Stress: Some patients unconsciously brux and or clench their teeth in response to increased stress


Craniomandibular disorders are classified as intracapsular or extracapsular. Intracapusular Disorders are characterized by structural alterations in the joint itself.


You Don’t Have to Live With Pain. The normal physiologic relationship between the part of the lower jaw called the condyle, the disc that moves between it and the part of the skull called the fossa have been altered and compromised. This interferes with form and function and frequently produces pain.

Degenerative osteoarthritis, rheumatoid arthritis and neoplasms are intracapsular disease. Trauma induced to the joint directly or indirectly can result in intracapsular disorder. A common problem is a slipped or dislocated disc of the jaw joint. Due to tearing or stretching of the disc and its attachments the disc assumes an abnormal position forward of the condyle instead of cushioning the condyle with the fossa.

Opening movements produce a clicking sound as the disc slips back into the proper position (a process called disc reduction) momentarily over the condyle. Frequently upon closing, as the disc assumes its abnormal position and slips off the condyle forward of it click can be heard again. These clicks may be audible, but frequently require a stethoscope or sophisticated instrumentation to hear it.

If this anterior disc displacement is left untreated, it may ultimately result in an “anterior disc displacement without reduction” meaning the disc never goes between the condyle and fossa. This causes limitations in movement laterally and opening and is called “closed lock” as the disc now acts a mechanical obstruction, getting in the way for normal condyle movement.

Long term worsening frequently results in degenerative osteoarthritis producing severe alterations in form and function. Most often internal/intracapsular problems/ derangements produce pain from the joint itself with or without referred pain to other areas of the head or muscle dysfunction such as spasm and myofascial trigger points.


Extracapsular disorders occur when the musculature of the TMJs have an altered acquired postural rest position. Over a prolonged period of time the muscles maintain themselves in an altered state of hyperfunction which the brain perceives as an accommodated “balanced position.”


This change from a physiologic rest position to an accommodated rest position occurs when the mandibular trajectory of closure is not coincident with the TMJ/neuromuscular trajectory of closure. This trajectory is directly affected by how the teeth meet-their “occlusal relationship” and how their proprioceptive input causes a change in jaw position forcing muscles to function at less than their optimal lengths.

This all results in the musculature and TMJs existing in a “stressed” condition. The subjective symtoms are similar to intacapsular problems including joint pain as well as muscle dysfunction such as spasm and myofascial trigger points. No joint noises are found with extracapsular disorders.

A strong and direct biomechanical relationship exists between all the muscles of the head and neck. As a result of reciprocal muscle function, dysfunction and pain in the head and face muscles, frequently results in dysfunction and pain in the cervical muscles-neck pain- that can eventually involve the whole upper back. Due to unbalanced posturing of muscles of the head neck and shoulders, these patients maintain what is called a forward head posture.

Neurologically there is a strong relationship between the head and neck muscles and the ear. Ear symptoms, including congestion, pain, buzzing, ringing and even loss of hearing are frequently found in craniomandibular disorders.

The best way to treat these symptoms is to establish their origin, by using the sophisticated diagnostic techniques of neuromuscular dentistry, evaluating the results to determine the best course of treatment. These can include orthotics, orthodontics, correction of existing restorations — all the way up to full-mouth rehabilitation where indicated for orthopedic and musculoskeletal stabilization. Finding the best treatment for them not only repairs the damage that has been done, but also prevents them from getting worse and stabilizes their physical condition at its optimal point.Neuromuscular Treatment

You are central to the process: The more accurately you describe your symptoms (and your goals), the more precisely we can test for and diagnose the best course for treating and attaining them. When a patient chooses the benefits of the diagnostic process, they can look forward to a thorough discussion of the test results in order to be able to select the options that seem most promising for long-range comfort. The process works like this:

  • At our initial consultation, we make detailed notes of all the chronic symptoms you experience.
  • Next, using the most sensitive cutting-edge technology, we record and interpret the sounds of both your left and right TMJs in motion with computerized electrosonography to objectively determine the pathologic nature and extent of joint sounds. In addition, we measure the pre and post relaxation status of muscles with highly sensitive electromyography (EMG) that records the electrical activity of your facial and neck muscles.
  • A computerized jaw scanner is used to track the spatial movement of your jaw as you open and close. TMJ X-rays show us any pathology that may or may not exist, changes to bone structure and the position the lower jaw is in with your skull. These measurements enable us to map out all your unique facial, bone, and muscle tissue functions.
  • By determining where you are presently, we can then move on to the next step- finding the most relaxed position of your jaw.

Finding that most relaxed position from which your muscles will act most efficiently and comfortably is accomplished through the use of a TENS machine. Once it has been confirmed, our goal for the first stage of the treatment will be the maintenance of this position. This position can be maintained through the use of occlusal guards and orthotics.

The second stage of the treatment begins once your symptoms are diminished, and we are assured that our goal of establishing the most comfortable position has been accomplished. The goal of this stage is also to create a bite that will preserve the corrected alignment of the jaw so that jaw, muscles, and teeth can work together in harmony. Completion of the second stage will include decisions about future use of any guards, orthotics and/or orthodontics as well as the benefits of full-mouth rehabilitation.

After choosing the direction of the treatment, we begin by creating a jaw position for the remainder of treatment. This can be accomplished in several ways: with a removable orthotic or a fixed orthotic, or can be achieved by moving the teeth through orthodontic treatment. Once the position has been stabilized we move to the second stage of treatment previously agreed upon.

Don’t live with pain a day longer than you have to. Find out how our experienced neuromuscular dentists can help by calling 212-452-3344 or visit our website.

If you have chronic pain in your head, face, or neck you may not realize that the pain is originating from a disorder in the temporomandibular joints (TMJ) of your jaw. Often, symptoms relating to this disorder can persist or go undiagnosed for years because they are similar to the symptoms of many other ailments. Because of this, general physicians outside of the dental field may have difficultly pinpointing the underlying issue and often have a hard time seeing the relationship between the pain you are suffering and the alignment of your jaw joint. This is where a TMJ specialists, also known as a neuromuscular dentist, becomes essential.

Our Manhattan TMJ Specialists Can Detect Even the Slightest Jaw Irregularities.

Both Dr. Elisa Mello and Dr. Ramin Tabib have trained in neuromuscular dentistry, enabling them to properly diagnose and treat temporomandibular joint disorders (TMD). Utilizing the latest in technology and diagnostic tools, our Manhattan TMJ specialists can detect even the slightest jaw irregularities and provide swift treatment to help ease symptoms while retraining muscles to allow for long-lasting relief.

The Temporomandibular Joints (TMJ)

The temporomandibular joints, which sit between the lower jaw and the skull on each side of the face, are highly complex joints that are under constant pressure. These joints are responsible for proper movement of the jaw and creating a balanced muscular workload on each side of your face. But when these joints become misaligned or disjointed because of stress, overuse, or trauma, they may cause a myriad of painful symptoms that can negatively affect your life.

Running through your TMJ is the trigeminal nerve, the largest of the cranial nerves. The trigeminal nerve has three main branches:

  • Ophthalmic, which supplies sensation to the upper eyelids, eyebrows, forehead, and scalp
  • Maxillary, which supplies sensation to the lower eyelids, cheeks, sinuses, nasal cavity, and palate
  • Mandibular, which supplies sensation to the area in and around the jaw. The mandibular branch of the trigeminal nerve also controls the muscles of mastication

The muscles of mastication surround the TMJ. When there is tension in these muscles, pressure is placed on the mandibular branch of the trigeminal nerve, which can result in instant jaw pain. Pain in one branch can create pain sensations in the others as well, producing symptoms that may seem to be completely unrelated to the jaw joint.

The TMJ specialists at NYC Smile Design understand the complexities of the jaw joint, trigeminal nerve, and surrounding muscles, and can customize a treatment plan that addresses these things to produce lasting comfort.



TMJ Symptoms

The discomfort caused by TMJ disorders may radiate from your jaw to your cheeks, neck, shoulders, and back. Pain like that can be distracting and a major hindrance on the quality of your daily life. TMJ disorders may cause a variety of uncomfortable, even painful symptoms, such as:

  • Headaches
  • Facial pain and/or soreness
  • Jaw pain and/or soreness
  • Ringing, pressure, or pain in your ears
  • Pain behind the eyes
  • Sinus pain and pressure
  • Neck and/or upper shoulder pain
  • Sore teeth
  • Loose teeth or teeth that feel loose
  • Jaw locking when you open and close your mouth
  • Numbness in the fingers and/or hands

When TMD is left untreated, these symptoms can persist indefinitely. They may also lead to changes in the posture which can, in turn, impact digestive function and cause chronic low-back pain.

If you have experienced any of the symptoms of TMD, especially if you have experienced more than one for a period of longer than two weeks, it is important that you call our Manhattan office to schedule a neuromuscular evaluation. We can detect TMJ disorders and provide swift treatment to restore alignment and produce lasting comfort.



TMJ Treatment

Experienced TMJ specialists Dr. Ramin Tabib and Dr. Elisa Mello understand how intrusive these symptoms can be on your life. With extensive training and experience in their field, they have honed their neuromuscular dentistry skills, enabling them to treat our patients with the latest advanced technology and techniques.

TMJ treatment restores a harmonious relationship between your bite and the surrounding muscles, blood vessels and nerves, thereby alleviating problematic symptoms and pain.

Depending on the cause of your condition, treating TMJ disorders may require:

TMD treatment is designed to restore proper alignment while addressing underlying bite issues that may be contributing to your condition. In some cases, lifestyle changes may need to be implemented as well. Bruxism (teeth grinding), stress, and even some bite disorders can contribute to or exacerbate TMD symptoms. Stress reduction, jaw exercises, and other lifestyle modifications may be needed to truly address TMJ disorders when these factors are playing a role in your discomfort.

During your neuromuscular evaluation at our Manhattan office, we will work to uncover the underlying cause of your condition, enabling our TMJ specialists to provide treatments that are tailored to your exact needs.

Using BOTOX® Cosmetic for TMD Treatment

A Single BOTOX® Treatment Can Relieve TMJ Pain for Up to Four Months.

Renowned as a way to restore smoother skin and create a more youthful look, BOTOX® Cosmetic can also be used as a neuromuscular dentistry application. If you suffer from a TMJ disorder, BOTOX® Cosmetic injections may help you find relief from chronic jaw and facial pain related to clenching and grinding of the jaw.

Dr. Elisa Mello is passionate about offering you the most effective and beneficial treatments and technologies. Dr. Mello received training to provide BOTOX® Cosmetic therapy for TMJ at the prestigious American Academy of Facial Esthetics where she saw first-hand the tremendous benefit this treatment could have for people suffering with TMJ pain. Other advantages of this treatment include:

  • Provides rapid relief from TMJ discomfort
  • May relieve chronic headaches caused by clenching and grinding
  • Only a quick, single appointment is required to administer the injections
  • No hospital stay or surgery is needed
  • Return to work and other activities right away
  • Lasts 3 to 4 months
  • Re-treatment sessions will restore the effect

The first step is to determine if you are a candidate for this type of treatment, which Dr. Mello will conclude in your consultation. Dr. Mello will then gently administer a series of injections into the targeted muscles, in order to bring about a relaxation effect.

BOTOX® Cosmetic reduces the number of fibers in the muscle that is injected, safely and effectively reducing the ability of those muscles to contract, relaxing the affected area. This effect will be isolated to the specific areas of treatment. After the injections, the clenching power of the chewing muscles will be reduced, so your involuntary habit of clenching and grinding will be reduced, thereby treating the pain that comes from the habit.



Financing TMJ Treatment

Insurance May Pay for Your TMD Treatment.

Many dental insurance carriers will cover the cost of TMJ therapy, even when it completed with BOTOX® Cosmetic. However, it is always a good idea to check with your carrier to ensure coverage before assuming treatment will be paid in full. If you need assistance financing your treatment, whether for lack of insurance coverage or for any other reason, we would be happy to discuss your options during your initial consultation.

We work with CareCredit®, a trusted healthcare financing company that offers plans including 0% APR and low, fixed APR for periods of three to four years. During your initial consultation we will review all TMD treatment financing options to help ensure you are able to receive the full treatment you need without breaking the bank.

TMJ disorders may take some time to correct, particularly when their cause is unknown or complex. We will work with you every step of the way to help ensure the swiftest resolution for your particular needs.

Why Choose our NYC TMJ Specialists?

Dr. Tabib and Dr. Mello use their knowledge and experience to give our patients comfort from the painful and limiting symptoms of TMD – and use the latest in advanced methods and technologies to do so. They will work with you every step of the way to ensure that they find the right treatment to help you live a happy, healthy life free of pain.

Committed and highly-trained, our TMJ specialists take time to understand the complete needs of each patient before beginning a treatment plan. This enables us to ensure the services being offered are safe, effective, and long-lasting. During your first appointment, we can discuss these things in greater detail to ensure you are educated and empowered as we plan your treatment.

Schedule a TMJ Treatment Consult Today!

If you think you may be suffering from TMD symptoms and are ready to start on the path toward long-term relief, please call the experienced neuromuscular dentists at NYC Smile Design at 212-452-3344 or visit our website today to schedule your consultation. You can also fill out the appointment request form in out contact page, and our talented team will help you set up your meeting. Our TMJ specialists proudly serve those who live in Manhattan, throughout New York City, and in all surrounding areas of NY, NJ, and CT.

Send us a message or give us a call

(212) 452-3344