TMJ & TMD

Who should get TMJ, TMD or MSD Therapy?

First review the TMJ-TMD-MSD SIGNS AND SYMPTOMS form. If you have some of the signs and symptoms, print, fill in and bring the TMJ-TMD-MSD QUESTIONNAIRE to your first appointment. You should read What’s the fee for the initial TMJ-TMD-MSD exam? After reading the answer to that question, Contact Us to schedule an appointment. When you come to our office Dr. David Alpan will review these two forms, do an oral and physical exam, ask you more questions and then advise you what to do. If he determines that you need TMJ Therapy,TMD Therapy or MSD Therapy he will recommend a TENS Treatment for $150 to see if that will help relieve or eliminate your symptom(s). If not, he will recommend Phase 1 therapy or refer you to another health-care practitioner.

What are signs? These are what the trained health practitioner finds during the examination. Usually the person being examined is unaware of signs.

What are symptoms? This is what the person is aware of and tells the therapist. Many people live with symptoms without complaint thinking they are normal because it does not hurt or bother them enough.

If you have chronic pain, putting off the initial TMJ examination, TMD examination or MSD examination may result in more symptoms and more pain. As the body adapts, many of these signs and symptoms get harder and more costly to relieve or eliminate.

Now you may want to Request an Appointment Online; then print and complete the TMJ-TMD-MSD QUESTIONNAIRE and the NEW PATIENT INFO AND HEALTH QUESTIONNAIRE and bring these forms with you to your first appointment.

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What is TMD?

TMD stands for Temporal Mandibular Disorder, which describes an incorrect relationship of the mandible (lower jaw) to the temporal bones on the left and right side of the skull. It is commonly referred to as "TMJ problems." The muscles in the face move the lower jaw when you speak, yawn, chew and swallow. The lower jaw has a special relationship with the upper jaw and temporal bones. When this relationship is not normal, chronic pain in the face, head, neck, shoulders, jaw joint, etc, may occur. Your teeth and bite support the facial muscles in this special relationship.

What causes TMD? One or more of the following may cause TMD:

  1. Mal-occlusion (bad bite) forces muscles in the face to strain while speaking, chewing and swallowing. Many people can adapt to this bad bite without any apparent signs or symptoms.
  2. Pressure on the skull bones during birthing and by the doctor assisting the birthing process.
  3. Genetics passed from grandparents and parents to their children.
  4. Sleeping patterns during growth and development years.
  5. Trauma from falling, car accidents (whiplash), being struck by a person or object.
  6. Arthritis or other illnesses.
  7. Emotional trauma can also cause symptoms or aggravate existing TMD symptoms.
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What is TMJ?

TMJ stands for Temporal Mandibular Joint or jaw joint. This is the joint where the mandible (lower jaw) articulates (hinges) with the temporal bones on both sides of the skull. A disc in this joint separates the mandible from the temporal bones. When you speak, yawn, chew or swallow, this is where the lower jaw articulates with the temporal bones. The jaw joints can be found with your fingers when you open and close your mouth. They are just in front of your ears.

"TMJ" is used to communicate with the general public regarding the many signs and symptoms in the jaw joint (TMJ), and the head, neck and muscles in the face (TMD). Some TMJ Therapists lump the signs and symptoms in the jaw joint, head, neck and the facial muscles together and call it TMD. TMJ and TMD signs and symptoms are included in the TMJ-TMD-MSD SIGNS AND SYMPTOMS form and the TMJ-TMD-MSD QUESTIONNAIRE form.

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What is TMJ Therapy?

The technology used by Dr. David Alpan to diagnose and treat Muscle Skeletal Disorder (MSD), or Tempero-Mandibular Disorder (TMD), or Tempero-Mandibular Joint (TMJ) signs and symptoms was developed in the 1960’s by Bernard Jankelson, DDS, in Seattle, Washington. Dr. Jankelson developed the Myomonitor, an electronic device, to do TMJ Therapy. He then founded Myotronics, the organization that continues to educate dental and medical professionals about diagnosing and treating these disorders. Robert Jankelson, DDS, continues the work of his father in Myotronics where they continue researching and developing newer and better technologies for MSD diagnosis, TMD diagnosis, TMJ diagnosis and MSD treatment, TMD treatment and TMJ treatment.

Dr. David Alpan’s father, Jack Alpan, DDS, NMD, a general dentist from 1960-1997, took the post graduate classes given by Dr. Bernard Jankelson in 1973 at the University of Southern California School of Dentistry in Los Angeles, where Dr. Jack got his DDS degree. Dr. Jack purchased the Myomonitor from Dr. Jankelson and began diagnosing and treating his patients with MSD, TMD and TMJ problems. He helped approximately 2,000 patients during those twenty-four years relieve or totally eliminate many of their symptoms. He told his son about these patients’ medical histories during his formative years. He told his son how much personal satisfaction he got from relieving or eliminating so many of the MSD symptoms, TMD symptoms and TMJ symptoms.

Based on his father’s and thousands of dentists’ success with Dr. Jankelson’s technology and seeing this technology used by Dr. Chase at the University of the Pacific (UOP) School of Dentistry in San Francisco, Dr. David Alpan chose this technology for TMJ diagnosis and TMJ treatment in his practice. He took the postgraduate classes at Myotronics and earned the Master of Science in Dentistry (MSD) degree for writing his Master’s Thesis on TMD research he did during his two year orthodontic specialty training at UOP School of Dentistry. He has been doing TMJ therapy in private practice since 1998, when he founded Aesthetic Orthodontics in Los Angeles, California. In 1999, he opened an office in Beverly Hills, California and Las Vegas, Nevada. To learn more about Dr. David Alpan, click here.

The following explains the function of the Myomonitor, a TENS device, used in TMJ Therapy:
The Myomonitor (muscle monitor) is the electronic device used to relax the muscles in your face in order to relieve muscle strain that results in signs and symptoms. It is powered by a nine-volt battery. The scientific name for this device is a Transcutaneous Electronic Neuromuscular Stimulator (TENS). The TENS device is attached to leads, which are attached to both sides of your face and neck. When it is turned on, it sends a painless electronic impulse through the leads to stimulate the nerves in the face, which contract the muscles in the face that move the lower jaw. There are 42 contractions and relaxation cycles per minute. This causes the muscles to produce endorphins - natural hormones that relax the muscles. After pulsing for 90 minutes, the muscles become more relaxed. Now you may notice that the lower jaw has moved to a new position, or maybe not. If the lower jaw does move into a new position, the teeth now come together differently while on the Myomonitor than before the TENS Treatment began. This neuro-muscular bite is different from the accommodated bite, which the patient adapted to and which may be causing the signs and symptoms of MSD, TMD or TMJ.

If Dr. David Alpan recommends 1-3 TENS treatments, and there is no change in the relationship of the lower to upper jaw and there is no alleviation or elimination of your symptoms, he will discuss other options, or refer you to another health-care provider.

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What is the fee for the initial TMJ exam, TMD exam or MSD exam?

The fee for the initial exam is $150. This fee includes the following:

If, in fact, you need MSD therapy, TMD therapy or TMJ therapy, Dr. David Alpan can’t tell you exactly how long you will be in treatment. 1-3 TENS treatments for $150 each may alleviate or eliminate your symptoms. Occasionally 1-3 TENS treatments with minor tooth adjustments alleviates or eliminates symptoms. If these procedures don’t help you, Dr. David Alpan may recommend Phase 1 TMJ Therapy or he may refer you to other therapists.

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How do I schedule my first appointment?

1. Call us immediately at one of the telephone numbers at the bottom of every page on our website OR click on the email links next to the phone numbers to send us an email OR

2. Schedule an appointment online OR

3. Click on Contact Us where you'll find the phone, fax, email address and map of our three locations AND

4. Click the Gold Star on the left menu bar to access and complete the New Patient Forms. After completing the forms, please bring them with you to your first appointment.

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What is the fee for Phase 1 TMJ therapy, TMD therapy or MSD therapy?

During the initial TMJ exam, Dr. David Alpan will determine what the best treatment is based on your signs and symptoms and your answers to his questions. If he determines that you will benefit from TMJ therapy he will prescribe 1-3 ninety minute TENS treatments at $150 each. If your symptoms persist after the 3 TENS treatments Dr. David Alpan will re-evaluate your condition and either recommend Phase 1 TMJ treatment or refer you to other therapists.

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How long will I be in MSD, TMD or TMJ therapy?

Nobody can know before treatment starts how long you will need treatment. In some cases, one TENS treatment solves the problem. In others, TENS treatment may last six months. When the teeth on the right and left side hit at the same time or when the upper teeth on the right and left side hit the removable dental Splint or mandibular orthopedic repositioning appliance (MORA) at the same time and this relationship holds for a few months without requiring adjustments, TMJ treatment is complete. When signs and symptoms are alleviated or totally eliminated TMJ therapy is finished. In many patients the symptoms are only lessened. TMD treatment is also referred to as "Pain Management." Some permanent changes caused by MSD, TMD or TMJ injury or genetics, etc., may not be reversed with TMJ therapy.

When symptoms can only be lessened, Dr. David Alpan will refer you to other health care providers – Chiropractor, Osteopathist, Cranial Osteopathist, Podiatrist, Physical Therapist, Bio-feedback Therapist, Psychologist, Acupressure specialist, Acupuncturist, Massage Therapist, etc. Anyone that works with MSD can help you.

Sometimes a team of doctors must treat a patient with MSD, TMD or TMJ problems at the same time. The longer the condition has existed, the longer and more expanded the treatment may become. It is for this reason that Dr. David Alpan recommends that every child be examined at age seven (7). Anyone with chronic pain or any of the other MSD-TMD-TMJ Signs and Symptoms should be examined as soon as the signs or symptoms are noticed.

After TMJ therapy is done, Dr. David Alpan may be able to move the teeth with regular tooth braces, Damon Braces or iBraces to retain the relationship of the lower jaw to upper jaw and skull that alleviated or eliminated your symptoms. In some patients, surgery may be required. You swallow 2,000 times during every 24 hour period. Each time you swallow your teeth come together. When they come together as they should and you still have MSD, TMD or TMJ problems because of other factors, Dr. David Alpan will refer you to other therapists.

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What happens after MSD, TMD or TMJ therapy?

If all you needed was 1-3 TENS treatments and your symptoms are gone, then nothing else happens. After Phase 1 TMJ therapy, something can be done to permanently retain the relationship of the lower jaw to upper jaw and skull without the removable dental Splint or mandibular orthopedic repositioning appliance (MORA).

Some of the alternative ways to accomplish this are:

  1. Orthodontic treatment with tooth braces = Phase 2 TMJ therapy done by Dr. David Alpan or
  2. Crowns, implants, bridges, partial or full dentures done by your general dentist

Dr. David Alpan does orthodontic treatment in Phase 2 TMJ treatment when you don’t want to continue wearing the removable dental Splint. If you don’t want orthodontic treatment, he will refer you to your general dentist or a specialist if necessary.

After your teeth are moved with orthodontic treatment, the new muscle-skeletal relationship should hold for the rest of your life. After orthodontic treatment, you have to wear a retainer at home and while you sleep for the rest of your life in order to prevent relapse of the moved teeth. Using a retainer after orthodontic treatment is required for everyone. Some grinding habits may still require a dental night guard long term.

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Will a retainer be necessary?

No, a retainer is not necessary if we did not move your teeth with orthodontic treatment. If we have completed Phase 2 TMJ therapy, then, yes, a retainer is necessary. Sometimes a dental night guard may be worn long term if a grinding habit still persists with no other MSD, TMD or TMJ symptoms or signs.

In most instances, after Phase 1 TMJ therapy is complete, orthodontic treatment (Phase 2 TMJ therapy) can move the teeth in order to maintain the relationship of the lower jaw with the upper jaw and skull so that there is no strain on the muscles of the face that move the jaw when you speak, yawn, chew and swallow. If orthodontic movement of the teeth is used to maintain this relationship, you will have to wear a retainer to prevent relapse of the moved teeth.

Restorative procedures, such as dental fillings, dental crowns,  dental bridges, partial dentures and full dentures, can also be fabricated to "retain" this muscle skeletal relationship. Sometimes a combination of orthodontic treatment and restorative dental procedures will create the ideal long term "retention."

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Can my family dentist do MSD, TMD or TMJ therapy?

Some general dentists have invested the time, effort and money to learn about this subject. It is not thoroughly taught in any of the dental schools in the United States. After the dentist graduates from dental school he/she must spend their own time, effort, and money away from their dental practices taking hundreds of hours of postgraduate courses all over the country to gather the data necessary to become a TMJ Therapist.

This is what Dr. David Alpan did while in dental school, and while in orthodontic specialty training, and after he graduated as an orthodontist in 1998. During his two years in specialty training to become an orthodontist, he spent hundreds of hours in the TMJ Clinic with Dr. Chase at the UOP School of Dentistry in San Francisco. He took many post-graduate courses on treating MSD, TMD and TMJ problems.

Myotronics, founded by Dr. Bernard Jankelson, has been developing sophisticated electronic equipment for the MSD, TMD and TMJ diagnosis and MSD, TMD and TMJ treatment and giving courses since the late 1960’s. Dr. Jack Alpan, his father (a general dentist), took their courses and training in 1973. Dr. Jack did MSD, TMD and TMJ therapy from 1973-1997 and gave public lectures on this subject that Dr. David Alpan attended during his formative years. Dr. Jack inspired Dr. David regarding the importance of MSD, TMD and TMJ diagnosis and treatment for the best practice of general dentistry or orthodontics. That motivated Dr. David Alpan to make the extra effort to learn more about MSD, TMD and TMJ diagnosis and treatment.

Dr. David Alpan wrote his Master’s thesis on a TMD research project he did during his two years of orthodontic specialty training. For this he was awarded the Master of Science in Dentistry (MSD) degree. Dr. David Alpan has been diagnosing and treating patients with an MSD, TMD or TMJ problem since his graduation as a dentist in 1996 from the UOP School of Dentistry in San Francisco.

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Do I still need to see my family dentist?

Yes, you still need to see your family dentist for regular dental check-ups and tooth cleaning. If your family dentist does MSD, TMD or TMJ treatment and he referred you to Dr. David Alpan for orthodontic treatment and Dr. David Alpan determines that you need MSD, TMD or TMJ therapy, he will refer you back to your family dentist for TMJ therapy.

Even during TMJ therapy your general dentist will monitor your oral health to determine if you need fillings, gum treatments, etc. Dr. David Alpan collaborates with his patient’s general dentist as part of the team effort to provide the best dental health care for each patient.

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Do I need to be referred?

No, you do not need to be referred; however, many general dentists do refer their patients to Dr. David Alpan for MSD, TMD and TMJ treatment. Dr. David Alpan may also refer you to other specialists if necessary.

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What foods do I have to avoid?

During the course of your MSD, TMD or TMJ therapy, you may have to wear a clear, plastic, removable dental Splint that fits over your lower teeth. To prevent excessive wear and breakage of this dental Splint or mandibular orthopedic repositioning appliance (MORA) it is best to avoid very hard foods – pop corn, ice crushing, hard nuts, hard candies, etc. When you feel discomfort from eating, don’t eat hard chewy foods.

If you don’t need a dental Splint, you can eat whatever you want. Of course, sugar and all refined and processed foods are not good for your teeth, gums and jaw bones. Eat whole natural foods (80% raw foods) that have had the least amount of processing as possible. All sweet things promote caries for 98% of the population and bone loss around the teeth for 80% of the adult population.

If you have any more questions regarding MSD, TMD or TMJ therapy not covered on this web page, please Contact Us by phone, fax, or email. We will gladly answer your questions. We look forward to seeing you at your Initial TMJ Exam appointment.

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