TMJ Disorders Richmond VA, Temporomandibular Joint

Welcome to Dr. Hershkin's Temporomandibular Joint Disorders Page!

Mission Statement

Dr. Adam Hershkin believes in using evidence-based medicine to help his patients make real and positive improvements and treating each patient with a caring, committed approach that is individualized for each and every patient. He and his staff are passionate about the pursuit of excellence in the treatment of temporomandibular disorders and are constantly learning so as to provide the highest quality and effectiveness of treatment for every patient. Dr. Hershkin has suffered from TMD for almost 20 years and, thus, has a very unique perspective relating to the diagnosis and treatment of this difficult disease. As a result of his experiences as a patient, he is able to understand and relate to his patients in a way that is very meaningful.

New Patients

Dr. Hershkin sees only TMD patients on Wednesdays so that he may completely concentrate on these patients. He commits this time to only see TMD patients so that he may spend adequate time to gather vital information as well as to answer all of your questions. Dr. Hershkin will take the time during this visit to educate you with regard to the normal TMJ anatomy and function as well as what has gone wrong with your joint. Your first visit is very important because this will be the foundation of our relationship with you. During this appointment, we will obtain important background information such as medical history and history of present illness. It will also give you a chance to get to know your doctor. At this appointment, your doctor will perform a detailed clinical exam and take x-rays if necessary to complete the picture of your problem. Please feel free to come prepared with as many questions as you may have for Dr. Hershkin. You can educate yourself about your symptoms by reviewing the patient education information on this website.

Patient Education

WHAT IS TMJ?

TMJ stands for temporomandibular joint, or the jaw joint. In fact, you have two of them. It is made up of the condylar process of the mandible (lower jaw) and the glenoid fossa of the temporal bone (part of the skull base). If you place your fingers just in front of your ears and open your mouth, you can feel the mandibular condyle moving in the joint. These are complex joints that are capable of both hinging and sliding movements. In addition, there is a meniscus (cartilage disc) that lies between the two bones and is meant to move with the condyle of the mandible. The bones and the meniscus are covered with “fibrocartilage,” a type of cartilage that is not meant to bear weight or to withstand compressive forces.

WHAT IS TMD?

TMD stands for temporomandibular disorders and encompasses a range of facial pain/dysfunction conditions that include intra-articular (inside the joint) and muscular problems. One of the major problems with TMDs is that there is still no consensus on the cause, how to prevent, or how to treat these disorders. Fortunately though, if we pay heed to the quality scientific evidence that is available to us, we can treat these problems successfully. For most patients, the problem is nothing more than a strained/sprained joint. While most practitioners view TMD as a predominantly dental problem, the truth is that the TMJ is a joint, much like an ankle, a knee or a shoulder and should be diagnosed and treated as such. For those patient with acute injuries, resting the joint and performing simple, conservative treatment will resolve the problem in a short period of time. For others the problem is chronic and requires more advanced treatment modalities. Because the TMJ complex is made up of living bone, ligaments and muscles, it is capable of repair, adaptation and healing.

WHAT ARE THE SYMPTOMS?

Pain in front of the ears (during opening, closing, chewing)
Clicking, popping, grinding, swooshing noises in the joints
Jaw locking closed or open
Pain or fatigue in the chewing muscles
Headaches
Earaches
Tinnitus (ringing in the ears)
Changes in occlusion (teeth not hitting correctly)

WHAT ARE THE CAUSES?

Overt trauma to the joint apparatus
- Blow to the jaw
- Whiplash
Chronic overloading of the joint
- Bruxism (grinding of the teeth)
- Clenching
- Abnormal movements
Sprain of the joint
Ligament laxity (loose joints)
Systemic disease
- Connective tissue disease
- Rheumatoid arthritis
- Fibromyalgia
Cervical spine factors
- Degenerative disease of the neck
- Abnormal posture

It is very important to understand that many patients do not fit neatly into one of these categories, but rather are suffering from a combination of factors that contribute to their overall facial pain. For many people, symptoms seem to start without obvious reasons. Like osteoarthritis of other joints in the body, doctors do not know the causes. True scientific research disproves the popular belief in the dental community that malocclusion (bad bite) or orthodontics (braces) causes TMDs. TMD is an orthopedic problem and not a dental problem.

HOW IS TMD DIAGNOSED?

As with causes and treatments, there is no widely accepted standard for diagnostic testing. The gold standard for disease detection in TMD patients is an in depth clinical examination by a skilled practitioner. Radiographic examination (x-ray) is often indicated, as well. There are many high-tech gizmos available for acquiring additional diagnostic information but they are not necessary based upon the scientific evidence that is available at this time.

WHAT ARE THE DIAGNOSES OF TMD?

Muscular Disorders

Sprain: overstretching of tissue
Sprain: rupture of fibers
- continuity remains intact
Myositis: inflammation of muscles & attached connective tissues
- damage occurs in contractile fibers
Splinting: protective rigidity guarding against painful movement
- causes muscle tenderness to palpation
Fatigue: may be significant factor in inducing pain
Tenderness: implies damages muscle fibers
Hyperactivity: caused by emotional stress, leading to pain - dysfunctional cycle
Myofascial pain: hallmark of many generalized muscle pain syndromes
- Trigger points - localized hyperirritable foci

Joint Disorders

Synovitis: inflammation of a synovial membrane, which line those joints which possess cavities, namely synovial joints. The condition is usually painful, particularly when the joint is moved. The joint usually swells due to fluid collection.
Effusion: an abnormal collection of fluid in a body cavity or space
Osteoarthritis: disease of cartilage and bone; aka degenerative joint disease
Internal Derangement: disruption of the function of the ligaments and cartilage of a joint
Hypermobile Joint: laxity of ligaments or certain bony anatomy that predisposes to patients dislocating TMJs (open lock)
Rheumatoid arthritis: inflammatory systemic synovitis

HOW ARE TMDs TREATED?

Dr. Hershkin has a wide range of treatment modalities at his disposal to help you with your symptoms. He is well trained in administering proven treatments ranging from simple, conservative, home-based therapies all the way to custom total joint replacements. Conservative therapies are always preferred over invasive techniques when possible. After you have been examined and diagnosed, Dr. Hershkin will thoroughly review all recommended treatment options with you. The decision as to which treatments will be employed will always be your decision.