Thomas E. Bramanti, D.D.S., Ph.D., is a Board-Certified TMJ Expert.
Dr. Bramanti is the recognized expert in the Central Valley for treatment of TMJ Disorders. He provides complete diagnosis and relief for all types of TMJ dysfunction, muscle and facial pain, and amazing headache relief.
Dr. Bramanti has established premier practice and prestigious academic career providing the best care available for TMJ Disorders.
Dr. Bramanti is a Clinical Assistant Professor in Oral and Maxillofacial Surgery at the University of California San Francisco (UCSF). With unmatched expertise, Dr. Bramanti brings clinical and academic skillsets that offer the most advanced and comprehensive TMJ treatment options that exist today.
Dr. Bramanti is uniquely trained to diagnose and treat a wide variety of TMJ Disorders, headaches and migraines, facial pain and postural changes. His expertise encompasses routine and advanced scopes of therapies to bring pain relief and health to your condition.
Dr. Bramanti makes it his priority to ensure that you are fully informed, have been given the full spectrum of treatment choices, and that you understand your treatment plan and follow-up care. Dr. Bramanti will outline all the treatment options available in a way that you can understand, and take the time necessary to answer any questions so you can make your TMJ treatment decisions with confidence. His focus is on clarity of understanding your condition and treatment paths bringing you peace of mind. From your initial consultation to follow-up, Dr. Bramanti is dedicated to your comfort and care.
Key SUMMARY points about temporomandibular joint disorders (TMD)
- Temporomandibular disorders (TMD) are disorders of the jaw muscles, temporomandibular joints, and the nerves linked to chronic facial pain.
- It may be caused by too much strain on the jaw joints and the muscle group that controls chewing, swallowing, and speech. This may be due to teeth grinding, injury to the jaw, head, or neck, or arthritis.
- Symptoms may include jaw pain, muscle soreness, headaches, earaches, limited mouth motions, and jaw clicking, popping, or locking. There may also be pain in the face, shoulder, neck, or back.
- Treatment may include an orthopedic appliance, medicine, resting the temporomandibular joint, physical therapy, and behavior changes.
- TMD symptoms can come back during times of stress. It helps to be aware of what triggers your symptoms so you can prevent a recurrence.
What are TMJ disorders (TMD)?
Temporomandibular disorders (TMD) are disorders of the jaw and neck muscles, temporomandibular joints, and the nerves linked to chronic facial pain. Any problem that prevents the complex system of muscles, bones, joints and nerves from working together in harmony may result in a temporomandibular disorder.
The temporomandibular joints (TMJ) are the 2 joints that connect your lower jaw to your skull. More specifically, they are the joints that slide and rotate in front of each ear. They include the lower jaw (mandible) and the temporal bone (the side and base of the skull). The lower jaw is the largest and strongest bone in the human skull. It is the only moving bone on your face. Attached to it are major muscles for chewing (mastication). This bone facilitates jaw movement for chewing and speaking and works in conjunction with several muscles.
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Thomas E. Bramanti, D.D.S., Ph.D.
Board-Certified Diplomate American Board of Periodontology/Implant Dentistry
Board-Certified Diplomate American Board of Oral Implantology/Implant Dentistry
Certified TMJ Expert, The Pankey Institute
Fellow American Academy of Implant Dentistry
Clinical Assistant Professor at UCSF in the Department of Oral and Maxillofacial Surgery
Clinical Assistant Professor UCSF-Fresno Medical Education Program, School of Medicine
The TMJs are among the most complex joints in the body. These joints, along with several muscles, allow the mandible to move up and down, side to side, and forward and back. When the mandible and the joints are correctly aligned, smooth muscle actions can take place. These include chewing, talking, yawning, and swallowing. When these structures (muscles, ligaments, disk, jaw bone, temporal bone) are not aligned they don’t move well together. This may cause several problems to occur.
TMD is classified by the following:
- Myofascial pain. This is the most common form of TMD. It results in discomfort or pain in the connective tissue covering the muscles (fascia) and the muscles that control jaw, neck, and shoulder function.
- Internal derangement of the joint. This means a dislocated jaw or displaced disc. A disc is the cushion of cartilage between the head of the jaw bone and the skull. Or it may mean an injury to the condyle. This is the rounded end of the jaw bone that articulates with the temporal skull bone.
- Degenerative joint disease. This includes osteoarthritis, rheumatoid arthritis in the jaw joint or trauma to the jaw and joint.
You can have 1 or more of these conditions at the same time.
What causes TMD?
In many cases, the actual cause of this disorder may not be immediately clear.
- Sometimes the main cause is too much strain on the jaw joints and the muscle group that controls chewing, swallowing, and speech. This strain may be due to clenching or bruxism. This is the habitual, involuntary clenching or grinding of the teeth.
- Traumatic injury to the jaw, the head, or the neck may also cause TMD.
- Arthritis and displacement of the jaw joint disks can also cause TMD pain.
- In other cases, another painful health condition such as fibromyalgia or irritable bowel syndrome may overlap with or worsen TMD pain.
- Clinical, psychological, sensory, genetic, and nervous system factors have been identified that may put a person at higher risk of developing chronic TMD.
What are the symptoms of TMD?
The following are the most common symptoms of TMD:
- Jaw discomfort or soreness (often most common in the morning or late afternoon)
- Clicking or popping of the jaw
- Locking of the jaw
- Limited mouth motions
- A change in the way the upper and lower teeth fit together
- Clenching or grinding of the teeth
- Teeth sensitivity without an oral health disease
- Headaches with and without migraine
- Pain spreading behind the eyes, in the face, shoulder, neck, or back
- Ear aches or ringing in the ears (not caused by an infection of the inner ear canal)
- Dizziness
- Numbness or tingling feeling in the fingers
The symptoms of TMD may look like other conditions or health problems. Dr. Bramanti will be able to help you find a diagnosis and recommend an appropriate course of therapy.
How is TMD diagnosed?
A variety of methods are used to diagnose TMD. These include:
- Health history. Dr. Bramanti will ask if you have a past history of facial or jaw pain when you chew, bite, or open your mouth. Dr. Bramanti will also ask if you have had cracking, popping, or noise when opening or closing your mouth.
- Physical exam. Dr. Bramanti will check if you have muscle tenderness, facial or jaw pain when moving your jaw, or can’t open your mouth wide, and will also check for TMJ noises when you open or close your mouth.
- Imaging tests. Panoramic X-rays, CBCT scans, and MRIs may be used to clarify a diagnosis.
How is TMD treated?
Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition may be.
Treatment may include:
- An orthopedic appliance worn in the mouth full-time to bring a bite balance, muscle and joint health, as well as reduce teeth clenching and grinding
- Limited use of medicines
- Resting the temporomandibular joint (TMJ)
- Relaxation methods and stress management
- Behavior changes (to reduce or stop teeth clenching)
- Physical therapy
- Posture training
- Diet changes such as eating soft foods (to rest the jaw muscles)
- Ice and hot packs
- Surgery (as a last resort)
TMD symptoms can come back during times of stress. It is helpful to be aware of what triggers your symptoms so you can do things to prevent a recurrence. Dr. Bramanti will see you on a regular basis so your TMD can be continually evaluated.
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Contact Dr. Bramanti today to schedule a consultation at 559-438-7800.
Dr. Bramanti will determine the nature and extent of your condition and recommend a course of therapy to provide you with rapid pain relief.