Temporomandibular disorders (TMD) occur as a result of problems with the jaw, jaw joint and surrounding facial muscles that control chewing and moving the jaw. In general, it is when the muscles, jaw joint, and teeth are not working in harmony together. The cause of TMD is not clear, but dentists believe that symptoms arise from problems with the muscles of the jaw or with the parts of the joint itself

What Are the Symptoms of TMD?

People with TMD can experience severe pain and discomfort that can be temporary or last for many years. More women than men experience TMD and TMD is seen most commonly in people between the ages of 20 and 40.

Common symptoms of TMD include:

  • Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide
  • Limited ability to open the mouth very wide
  • Jaws that get “stuck” or “lock” in the open- or closed-mouth position
  • Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain) or chewing
  • A tired feeling in the face
  • Difficulty chewing or a sudden uncomfortable bite – as if the upper and lower teeth are not fitting together properly
  • Swelling on the side of the face or May occur on one or both sides of the face
    • Other common symptoms of TMD include toothaches, headaches, neck aches, dizziness, earaches, hearing problems, upper shoulder pain and ringing in the ears.

How is TMD Diagnosed?

Because many other conditions can cause similar symptoms to TMD – including a toothache, sinus problems, arthritis, or gum disease – Dr. Rouhanian will conduct a careful patient history and physical examination to determine the cause of your symptoms.

The treatment option of choice given at Quince orchard Dental Care is typically a TMD device. This is an oral appliance that is used to help straighten and realign the patient’s jaw and bite.

TMD appliances through Quince Orchard Dental Care are custom-made dental appliances. These oral appliances are an alternative to other treatments such as restorations and orthodontics which can help realign the jaw and bite to reduce the problems associated with TMD.

Professional oral appliances made at Quince Orchard Dental Care will help TMD sufferers more effectively than those purchased over-the-counter. Over-the-counter TMJ appliances do not work because they cannot mimic a proper bite. Each individual is different and everyone has a different bite. In order for a TMD appliance to be effective at treating the condition, it must be professionally custom-made to each individual patient to provide the best results and treatment.

We use custom made appliances that fit over the upper and lower teeth, called splints and night guards. They prevent the upper and lower teeth from coming together, lessening the effects of clenching or grinding the teeth. They also correct the bite by positioning the teeth in their most correct and least traumatic position. The main difference between splints and night guards is that night guards are only worn at night and splints are worn all the time. Your dentist will discuss with you what type of mouth guard appliance you may need.

These TMD devices are just one of the options to treat TMD. The devices are not a permanent fix, but a temporary relief from the problem. Assuming there is no internal joint damage (90% of the time), is to fix the bite with ccorrective dental treatments such as replacing missing teeth, using crowns, bridges, or braces to balance the biting surfaces of your teeth or to correct a bite problem.

Many dental insurance plans cover TMD appliances, associated cost of restorations needed for repairing damage caused by TMD and for correcting the individual patient’s bite. Dental plan coverage can make TMD treatment and oral appliances affordable for many who are suffering from this disorder.

Some other basic, conservative treatments for TMD include:

  • Apply moist heat or cold packs. Apply an ice pack to the side of your face and temple area for about 10 minutes. Do a few simple stretching exercises for your jaw. After exercising, apply a warm towel or washcloth to the side of your face for about 5 minutes. Perform this routine a few times each day.
  • Eat soft foods. Eat soft foods such as yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans, and grains. In addition, cut foods into small pieces to decrease the amount of chewing required. Avoid hard and crunchy foods (like hard rolls, pretzels, raw carrots), chewy foods (like caramels and taffy) and thick and large foods that require your mouth to open wide to fit.
  • Take medications. To relieve muscle pain and swelling, try nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen (Advil, Motrin, Aleve). If needed Dr. Rouhanian can prescribe higher doses of these or other drugs for pain relief. Muscle relaxants, especially for people who grind or clench their teeth, can help relax tight jaw muscles.
  • Avoid extreme jaw movements. Keep yawning and chewing (especially gum or ice) to a minimum and avoid extreme jaw movements such as yelling or singing.
  • Keep your teeth slightly apart as often as you can to relieve pressure on the jaw. To control clenching or grinding during the day, place your tongue between your teeth.
  • Learning relaxation techniques to help control muscle tension in the jaw. Ask your dentist about the need for physical therapy or massage. Consider stress reduction therapy, including biofeedback.


Most people probably grind and clench their teeth from time to time. Occasional teeth grinding, medically called bruxism, does not usually cause harm. But when teeth grinding occurs on a regular basis, the teeth can be damaged and other oral health complications can arise.

Bruxism is often misdiagnosed because there are many different reasons why teeth wear down.  Experienced dentists can differentiate wear facets caused by bruxing, erosion effects due to acid exposure, aggressive brushing and abrasive foods.

 If you suspect you may be grinding your teeth, please call us and make an appointment.

Why Is Teeth Grinding Harmful?

In some cases, chronic teeth grinding can result in a fracturing, loosening, or loss of teeth. The chronic grinding may wear their teeth down to stumps. When these events happen, bridgescrownsroot canalsimplants, partial dentures, and even complete dentures may be needed.

Also, depending on the act of grinding, wear facets on a “bruxer” can be observed on the anterior teeth (the incisors and canine), but it can also be found on the posterior teeth, when the grinding is most severe. The damage on the teeth is the most obvious effect of bruxism. The lateral grinding, however, strains the jaw muscles as well as the temporomandibular joints, leading to earaches, hearing loss, headaches, depression, anxiety, eating disorders  and even change the appearance of your face.

Treatment and Management
If you are a bruxer, you should know that you are not in a hopeless situation. Your Gaithersburg dentist can talk to you about your options:

  • Mouth guards – these are made of acrylic and they are created by taken an impression of either of the patient’s jaws. The appliance has a vacuum fit, custom fit to your mouth so it is comfortable to wear during sleep.
  • Avoid or cut back on foods and drinks that contain caffeine, such as colas, chocolate, and coffee.
  • Avoid alcohol. Grinding tends to intensify after alcohol consumption.
  • Do not chew on pencils or pens or anything that is not food. Avoid chewing gum as it allows your jaw muscles to get more used to clenching and makes you more likely to grind your teeth.Train yourself not to clench or grind your teeth. If you notice that you clench or grind during the day, position the tip of your tongue between your teeth. This practice trains your jaw muscles to relax.

Sports Mouth Guard: Your Way to protect your Healthy Teeth and Jaws

A properly constructed mouth guard should be able to protect the teeth to reduce any impact and trauma to the jaw and the central nervous system of the brain. The use of mouth guards have been proven effective in minimizing the risk of traumatic brain injury for both children and adults, as well as to protect the wearer from things such as concussions, cheek lesions, jawbone fractures, tooth fractures, lip lesions, neck injuries and tongue lesions.

Mouth guards can be obtained through different ways. You can buy stock mouth guards at sports stores, make your own customized mouth guard through the boil and bite method or get a fully-customized mouth guard from your dentist.

Customized mouth guards are fabricated by the dentist by first taking an impression of your upper and lower Arch, so that a dental cast or mould can be formed where the mouth guard will be fabricated. Considering the labor involved and the function of the appliance, you can expect customized mouth guards to be more expensive but they are easier and more comfortable to wear.

In our dental office the use of sports guards are encouraged during various recreational and sporting activities. We can provide these to you in many colors and they can be personalized if you wish.