All posts by Dr. Glenn Clark

About Dr. Glenn Clark

Glenn Clark, DDS, MS is an expert on sleep apnea, orofacial pain and oral medicine, and Temporomandibular Joint Disorder (TMJ). Dr. Clark serves as the Director for the Advanced Program in Orofacial Pain and Oral Medicine at the Herman Ostrow School of Dentistry of USC.

Woman grabbing her jaw with both hands because of TMJ pain from a mandibular mobility disorder.

4 Mandibular Mobility Disorders

Woman grabbing her jaw with both hands because of TMJ pain from a mandibular mobility disorder.

1. Muscle Contracture

Muscle contractures are abnormal reductions in the extensibility of the jaw muscles (usually the closers). Contractures can result from a trauma induced scar, a spontaneous slowly developing shortening of the muscles without enlargement, or a muscle hypertrophy condition. The latter two problems should present as a long standing progressive loss of motion.

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Dentists Hand Holding a Needle for a TMJ Injection Treatment Such as Lidocaine, Steroids, Botox, or Hyaluronate

TMJ Injection Treatments: Lidocaine, Steroids, Hyaluronate & Botox

Dentists Hand Holding a Needle for a TMJ Injection Treatment Such as Lidocaine, Steroids, Botox, or Hyaluronate

Lidocaine Trigger Point Injections

When myofascial pain is a component of the pain problem, a trigger point injection is helpful in treatment, but only after the patient demonstrates ability and compliance with the home stretching protocol.

These injections are used to treat extremely painful areas of muscle that do not respond to stretching.  A trigger point is a knot or tight, ropy band of muscle that forms when a muscle fails to relax.  The knot often can be felt under the skin. Continue reading TMJ Injection Treatments: Lidocaine, Steroids, Hyaluronate & Botox

Woman placing her occlusal appliance on her teeth

Appliance-Based and Occlusion-Based Treatments for TMJ

Woman placing her occlusal appliance on her teeth

Occlusal Appliances

Occlusal guards have several purposes.  The guards can protect the teeth from wear such as attrition, interrupt oral habits such as clenching, redistribute forces of sore and sensitized teeth, and establish a comfortable occlusal position in a patient who has substantial complaints of bite discomfort.

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Man Holding His Temporomandibular Joint (TMJ) Before Applying a Manipulation and Mobilization Treatment

TMJ Manipulation & Mobilization Treatments

Man Holding His Temporomandibular Joint (TMJ) Before Applying a Manipulation and Mobilization Treatment

Open Locking TMJ Manipulation

This procedure is done to reduce open locking or open dislocation of the TMJ, and it can be done in one of two ways.

One method includes grasping the jaw with both hands and placing the molars on the posterior molar teeth and the fingers of the hands more anteriorly under the inferior border of the jaw.  By applying downward pressure on the molars and upward pressure on the inferior border of the jaw, this would distract the condyle down so it can move back over the eminence and allow it to return to the fossa. Continue reading TMJ Manipulation & Mobilization Treatments

Woman in pain at home due to TMJ disorder

Home-Based Physical Therapy Treatments for the TM Joint

Woman in pain at home due to TMJ disorder

The Myalgia or Myofascial pain protocol (MFP) is a self-directed home-based (and sometimes office-based) treatment approach, which includes several elements such as identifying and avoiding activities that are potentially harmful to the jaw system, increasing local blood flow in the tissues, and stretching stiff and painful muscles to decrease postural tone in the sore muscle.

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Internal Derangements of the Temporomandibular Joint

woman grabbing her jaw in pain from internal derangements of the tmj

Internal Derangement is not a diagnosis but a category of conditions and it simply means abnormal function of the intra-articular structures. It is a non-specific term applied as a descriptive subdivision term for the group of non-arthritic TM joint disorders (e.g., DDWR, DDNR, open dislocation, full & partial open locking). The ICD-10 code for derangement of the TMJ is M26.61, with a modifier regarding the side (1 for right, 2 for left and 3 for bilateral). There is also a code for articular disc disorder M26.69, with same modifiers if is unilateral or bilateral.

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