Jaw pain, clicking or popping, morning headaches, a jaw that locks or feels tight. These all get lumped together as TMJ, but they do not come from the same place, and treating the wrong cause rarely helps for long.
So the most useful thing we do is work out which problem you actually have before treating any of it.
What happens at your first visit
This is a real workup, not a glance and a night guard.
- A conversation about your symptoms, when they started, what makes them worse, and what has already been tried.
- A hands-on exam of the jaw joints and the muscles around them. We palpate the muscles to find which are genuinely sore, and we load the joints, putting pressure through them deliberately to see whether that reproduces your pain. A joint that loads comfortably tells us something very different from one that does not.
- 3D CBCT imaging when the exam raises a question about the joint itself, showing the bone directly rather than inferring it from your bite.
- An MRI, occasionally. CBCT shows bone. When the question is the disc or other soft tissue, an MRI is what answers it, and we order one only when the answer would change the plan.
A finding on a scan is not automatically your diagnosis. Degenerative change in the joint is common on CBCT, including in people whose joints load comfortably and have no joint pain at all. The exam decides what is causing your symptoms. The scan informs it.
If you are looking for a TMJ specialist
Worth being straight with you about what we are.
Dr. Sandquist has done extensive postgraduate education in the jaw and the bite, and it has been a significant part of his work for nearly three decades. He is not an orofacial pain specialist, and he will not describe himself as one.
What he does bring is the diagnostic ability to work the problem through with you: often to resolution here, and where that is not possible, to a clear answer about where your treatment needs to happen instead.
Either way, you leave with a diagnosis. That is the piece most people are missing when they arrive, and it is what determines whether any treatment was ever going to work.
Referring a case out when it looks beyond what he can do is a normal part of that, not a failure of it. A lot of jaw pain never gets properly worked up in the first place, which is why so many people arrive having already been handed an appliance by someone who never established what was wrong.
How we treat it
Once there is a diagnosis, we start with the simplest thing that could solve it and work up only as far as we need to.
- Hands-on treatment. For some patients buccal massage and physical therapy are the whole answer, particularly when the pain is muscular rather than from the joint. No appliance, nothing irreversible.
- Orthotic therapy, our most common approach. A custom appliance lets the overloaded muscles settle, and then shows us where your joints actually want to rest. It is reversible, it removes no tooth structure, and it tells us something useful whether it works or not.
- Addressing what is driving the load, which often means clenching, and sometimes how you breathe and swallow.
- Restorative or orthodontic work, or a referral for surgery, when the orthotic has shown that the bite has to be permanently moved. That is a conclusion we reach with evidence, not an opening move.
We explain the full reasoning here, including what the published evidence does and does not support about splints.
What we do not start with
We do not begin by grinding down teeth, and we do not begin with crowns or orthodontics aimed at a bite problem nobody has confirmed is the cause. Those things cannot be undone. Anything irreversible should be the end of a process, not the way into one.
If clenching or grinding is part of the picture, it is often connected to stress or sleep. Worth mentioning even if it feels unrelated to your teeth. It usually is not.
One patient lived with twenty years of bite problems before we resolved it →
Dealing with jaw pain now?
Call 702-734-0776 or tell us what is going on. If it turns out to be something we should not be treating, we will tell you that early rather than after a course of treatment that was never going to help.