Smiles and More

Claire Rath BDS MClinDent
021 429 7444
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What is TMD?

Temporomandibular joint disorder (TMD) is any disorder that affects the temporomandibular joint (TMJ). The TMJ is the articulation between the lower jaw (mandible) and the temporal bone of the cranium. It is one of two only joints in the body having the function of two types of synovial joint - hinge and sliding. Movement of the joint occurs in three dimensions and is a complex interaction of the elements of the joint and nueromuscular control of several muscles attached to the mandible and the joint. As the jaw opens the mandible rotates around an axis through the medial poles of the condyles until the disc between the (condyles of the) mandible and the (articular eminence of the) cranium reaches the end of travel permitted by the ligaments attaching it to the condyle. This occurs when the jaw has opened by about 20mm. Further opening of the jaw requires the condyles to slide (translate) down the eminence until full opening is reached. Normal opening of the jaw with healthy TMJs is in the range of 40 - 60mm.

What are the symptoms?

The most common symptom of TMD is pain in the jaw which may be accompanied by restricted movements of the jaw. There are many causes of pain that present as jaw pain and careful diagnosis is essential to differentiate between pain eminating from the TMJ and elsewhere. Apart from intra-capsular disorder of the joint, TMDs may also arise from masticatory muscle disorders or pain referred from elsewhere (such as cervical pain emanating from the neck). It is also the case that a patient may present with more than one of these conditions as one disorder can lead to another. Other symptoms of TMD include: - locking of the jaw - a load click, pop or grating sound when the jaw opens or closes - slow opening/closing of the jaw - deflection/deviation of the jaw when opening/closing - difficulty when chewing - tired or sore facial muscles

What is involved?

Our approach to investgating TMD begins with a detailed history in order to obtain a sound understanding of the patient's primary complaints and concerns, factors that may affect the condition and how it has manifested itself over a period of time.This is followed by clinical examination that includes observation of any signs of occlusal disease, palpation of the masticatory muscles, load testing of the TMJs, checking for occlusal interferences and an x-ray investigation. It is not uncommon for a person to experience one or more of the TMD symptoms for a period of time and for these to clear up without any treatment. The TMJ has a good capacity to adapt and to recover without intervention. Accordingly conservative treatment based on proper diagnosis is preferred before proceeding to irreversible procedures such as equilibration, orthodontics or surgery. It is possible to classify every type of TMJ disorder and to verify each classification by examination. Furthermore, improved understanding of the adaptive capacity of the components of the TMJ has improved our ability to identify problems not only within the joint but also in the connected tissues.

Biometric instruments are a very useful tool in clinical investigation of TMD as they can accurately measure key parameters of the TMJ in a manner that is both objective and repeatable.

The Piper classification of intra-capsular TMDs decribes the structural disorders that can be related to the symptoms routinely observed clinically. This classification specifies several stages of progressive deterioration as the TMJ progresses from full health to degenerative disease. In practice the degeneration may not occur sequentially but may involve passing back and forth between different stages. Furthermore, because of the joints ability to adapt the patient may experience painful episodes followed by painfree periods though the condition of the joint continues to deteriorate. It is therefore important to investigate TMD

What is the treatment?

The treatment regime will depend on the source of pain. For inflammation of the joint a diet of soft fruit and avoidance of the behaviours that may have caused the problem may be appropriate. This can be supplimented by non-steroidal anti-inflammatory drugs and hot/cold packs to relieve the pain and speed up recovery. Where premature tooth contact is confirmed by computerised bite analysis then equilibration (reduction) of the offending tooth may be appropriate. Where intracapsular disorders have been diagnosed the treatment plan will depend on the stage of degeneration of the joint. During the earlier stages muscle relaxation and counselling are often prescribed. In later stages recapturing the disc (which has slipped forward) may be done in conjunction with equilibration or supplimented by splint therapy.


Cerezen is a small custom-made device that is inserted in the ear canal that relieve TMJ pain during the day (as well as night) without interfering with eating and talking, and are barely visible. The device has a central hollow passageway so there is no interference with hearing.

How do they work?

The ear canal is located very close to the temporomandibular joint (TMJ). The shape of the ear canal changes somewhat when the jaw is opened or closed through movements such as chewing, smiling, and speaking. Cerezen™ inserts use this anatomical change to provide a unique near-field treatment for TMJD.

Cerezen™ inserts can be greater than 20% larger in their dynamic geometry than the ear canal when in a jaw-closed position. It is this change in ear canal space, as well as the inserts’ proximity to the TMJ and surrounding muscle and nerve tissue, that is believed to apply subtle pressure against the walls of the ear canal. This encourages the patient to return to the “open bite” position, thus minimizing the tendency to clench the jaw and surrounding muscle.

How are the Cerezen™ inserts created?

The process involves three simple steps.

1. Initial Consultation.
We will discuss your situation, diagnose your TMD and assess the suitability of the treatment for you.

2.  Take impressions of your ear canal.
We will take impressions of your ear canals to create the custom-made inserts.  This appoint normally takes 20 minutes.

3. Fit your Cerezen™ inserts.
Two weeks after the impressions have been taken, you will return to us where your custom-made devices are fitted

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