Would you believe a couple of tiny, bony structures at the tip of where our jaws connect to our skull are the source of a host of common ailments? They’re called condyles, and they sit atop our jawbone, protected by articular discs that function much like the kneecaps in our knees. When these discs degenerate or slip, “it hurts like a son of a gun,” says Dr. Jeffrey Brown, DDS, a TMJ and sleep specialist in Fairfax.
Dislocation causes TMJ which stands for Temporomandibular Joint Disfunction. When someone suffers from TMJ, the articular discs and jaw joints aren’t in their proper position and can throw off many other vital systems. Not only facial and neck pain and tension, but snoring, migraines, ringing in the ears, crooked neck joints, posture issues, teeth grinding and bite issues, muscle spasms, movement disorders, vertigo and dizziness, sleep apnea, poor breathing, Tourette’s Syndrome, Parkinson’s and even death from severed arteries can result from dysfunction in these tiny discs.’
But how do these tiny discs get misaligned? It can result from poor orthodontia. But surprisingly, it can date all the way back to the day we were born. “When we’re born, we come through the birth canal of our mother. Mom's hips are never 100% straight. The skull gets twisted coming through the canal. And, if not treated, we’re forever like that,” Dr. Brown explains. He’s even confident that as many as half of us suffer from some form of TMJ. “Notice the anchors on the local news – how many of them hold their heads at funny angles?” It’s called “dystonia,” and it results from years of muscle tension adapting to TMJ.
Dr. Brown has been pioneering diagnoses and treatments of the disorder for years, and has lectured all over the world on the subject. He began to learn about TMJ when he studied Dental Sleep Medicine and finally met Dr. Brendan C. Stack, Sr., an orthodontist who pioneered work on the condition in the 1960’s. Sadly, Dr. Stack died during COVID, but Dr. Brown says, “he taught me a tremendous amount of knowledge about what TMJ disorder really means.”
In his office, Dr. Brown demonstrated where these discs are and what happens when they misalign. “To identify what’s going on, we get a very specific MRI and a handful of X-rays to figure out what's going on as a good baseline. And that's really where it all begins: analysis of the discs, analysis of the bones.” One X-ray of a patient shows a before and after picture of how far left his neck was bent and his spine compressed before the condition was corrected. “Look at that left side. You can fully imagine the blood vessels within his skull being crimped and pinched and twisted, pinching off the blood flow. That means the heart has to work double overtime to pump more blood to the brain keep you alive, because of the blockages. It’s like the drains in the house are clogged!”
When blood doesn’t drain properly from the brain, one effect can be the build-up of beta amyloid crud, which can lead to Alzheimer's. When the patient’s TMJ was corrected with a simple lightweight wire appliance that expanded his mandible and rubber spacers called turbos that corrected his bite, “Not only did his headaches vanish, but his cognitive abilities improved tremendously,” Dr. Brown said. In younger patients, when the jaw is correctly aligned, teeth can grow to create a leveled bite; in older patients, sometimes a crown or two can be more effective.
Dr. Brown’s appliance, referred to as an ALF (advanced lightweight functional), is handy in correcting some orthodontic work that can actually cause TMJ issues. “Most orthodontists work along an X/Y axis, ignoring the vertical Z axis, where TMJ damage most often occurs. It’s a touchy subject for an $11 billion industry that I’ve been trying to educate for years,” he sighed. “What we need is more three-dimensional orthodontal thinking.”
Sometimes discs are either absent or so degraded that only surgery will suffice, which Dr. Brown also performs. It was necessary recently in the case of a young woman whose pain was so severe she was suicidal. “We didn’t have time to putz around with orthodontics,” Dr. Brown said. “Afterwards, she was 1000 percent better and is now training to be a doctor.”
Of course, correctly identifying and healing a problem can take time. At the Sleep & TMJ Therapy center, right next to his office, is Ruth Bravo, a TMJ Massage Therapist who helps Dr. Brown’s patients retrain their head and neck muscles that have adapted to and tried to compensate for various misalignments. “Your muscles adopt memory, so what we try to do is retrain your muscles and your brain to go from being tight and compressed to releasing tension,” she explains.
Ruth uses a “cold laser” and a Neubie direct-current electrical stimulation system along with facial and neck massage to first loosen tight muscles. Then she shares exercises and self-relaxation techniques that help to increase blood circulation and relieve pain.
“It’s better than Advil and it lasts for days,” quips Dr. Brown. “My patients are always happy to see me, but Ruth they want to take home.” At home, Ruth recommends facial and neck massage with a small spikey ball, first thing upon waking, along with shoulder, arm and neck stretches.
Dr. Brown’s website sleepandtmjtherapy.com is a font of information and videos to try to explain what he does in even greater detail, or you can just book an appointment at 703-821-1103. He’s passionate about education because “a lot of people don’t even know why they’re hurting,” he says. “They just haven’t heard of this. So that’s what we’re trying to do, spread the word that this is something that’s easy to fix and very effective and helps lots of people get better. This really works.”
"Most orthodontists work along an X/Y axis, ignoring the vertical Z axis, where TMJ damage most often occurs. It’s a touchy subject for an $11 billion industry that I’ve been trying to educate for years.... What we need is more three dimensional orthodontal thinking."" Dr. Jeffrey Brown
"A lot of people don’t even know why they’re hurting.... They just haven’t heard of this. So that’s what we’re trying to do, spread the word that this is something that’s easy to fix and very effective and helps lots of people get better. This really works." Dr. Jeffrey Brown