Temporo-Mandibular Joint Disorder & Associated Problems

Why choose
Dr Gabriel J. Rich III, DDS?
  • DDS, Georgetown University School of Dentistry
  • Fellow Academy of General Dentistry Honorary
  • Fellow American College of Dentists Honorary
  • Fellow Academy of Dentistry International Associate
  • Fellow American Academy of Implant Dentistry Member
  • American Dental Association Team Dentist
  • Carolina Hurricanes Hockey Club

TMD (TMJ Disorder)

TMJ DisorderIn a properly-aligned bite, the teeth, jaw joints and muscles work together without strain or tension. The biting surfaces of upper and lower teeth fit together neatly while the jaw joints work in unison. When you chew or swallow, the muscles on both sides of the face contract evenly to bring the teeth together and relax during other times.

When there's a problem with the bite, upper and lower teeth do not meet correctly. Without you being aware, the muscles must use extra force and the jaw joints often shift position in order to bring the teeth together. The result, over time, can be TMD, or temporo-mandibular dysfunction.

This refers to problems with the muscles and joints that join the mandible bone of the jaw to the temporal bone at the base of the skull. TMD, sometimes called TMJ, is a cycle of pain, muscle spasms, and jaw joint problems that combine when the teeth, chewing muscles, and jaw joints don't work together in harmony.

Symptoms may include headaches, worn teeth, painful muscles in the face, neck, and shoulders, clicking and popping of the jaw joint, earaches, pain behind the eyes, difficulty opening and closing the mouth, ringing in the ears, tingling hands, and other problems.

There are many causes of TMD, such as grinding and clenching of teeth, an injury, and emotional stress. But a very common cause is a bad bite. A problem bite often exists when teeth are missing, misaligned, or worn down.

These conditions can prevent the upper teeth from meshing correctly with the lower teeth. This forces the jaw to shift position and the muscles to work harder than they should to bring the teeth together. And when you are not chewing, your jaw muscles may not fully relax, even though they feel normal to you.

TMJ DisorderDiagnosis and treatment

Millions suffer from TMD, but with treatment, Dr. Rich can help you relieve or manage TMD pain and restore harmony to your teeth, muscles and jaw joints. The first step is to analyze your bite to identify specific problems.

Once it is determined that a bad bite is causing your TMD or other problems with your teeth or jaw joints, a number of procedures can be used to stabilize your bite and allow chewing muscles to stay in their comfortable, relaxed position. You may need to wear a custom-crafted bite splint, called an orthotic, for a period of time to relax the muscles, restore balance to the jaw joints and stabilize the bite. These are small, removable and very comfortable since they are created specifically for the patient's mouth.

Once your bite is stabilized, Dr. Rich can permanently correct it. Depending on your situation, Dr. Rich may have you wear a long-term orthotic or recommend replacing missing teeth, moving teeth or placing crowns and/or veneers. In some cases, team treatment with an orthodontist or other specialist may be advised.

Regardless, there is a solution to TMD once it is established that this is the source of your problems. Modern dentistry and the experienced care of Dr. Rich will help you overcome the frustrations of TMD for good!



Sleep Apnea

Sleep ApneaSleep Apnea is a serious problem that affects millions of Americans and is coming to light as one of the most under-diagnosed, life threatening medical disorders in our society. It is statistically more dangerous than drunk driving and has been associated with high blood pressure, cardiovascular disease, diabetes, weight gain, depression and stroke.

The Greek word "apnea" means without breath. Those who suffer with Sleep Apnea endure a nightly pattern where they stop breathing for up to a minute, then wake up gasping for air. This can occur for a hundred or more times a night.

For those who have had Sleep apnea diagnosed, a physician may recommend a CPAP machine is often recommended to receive steady oxygen levels throughout the night. A CPAP (continuous positive airway pressure) device is a mask that fits over the face and forces oxygen into the airway under pressure.

However, for many who've tried a CPAP, the device almost seems medieval. Not only is it very encumbering, it limits movement during sleep and can make it difficult to sleep. For these reasons, it is estimated that nearly 50% of CPAP users drop out of treatment.

Because one's tongue, tonsils and soft palate are directly related to night-time breathing, involvement of specially trained dentists has become beneficial to treating many Sleep Apnea sufferers. With the results of a sleep study and interaction with your physician, Dr. Rich can develop an alternative treatment that is comfortable, convenient and effective.

Dr. Rich begins by creating a custom-made mouthpiece. This appliance is designed to posture your lower jaw forward, thereby opening the airway and allowing you to breathe freely all night. The appliance has an extremely smooth finish and is a comfortable fit for your mouth.

If you (or someone you know) suffer with Sleep Apnea, or have been told you are a heavy snorer (a precursor to Sleep Apnea), it is advised that you seek treatment before more serious health problems develop.

"As a victim of severe tetracycline stains and grinding I was a late forties person who didn't smile in pictures. I finally bit the bullet and made the investment in myself. I got 8 veneer/crown combinations on the top. I now have a beautiful smile.

What Dr. Rich was able to do for me was a miracle. My new smile is absolutely natural.... What I was supposed to be the whole time. I tell everyone "Dr. Rich is a true artist."



"I have been a patient of Dr. Rich's for almost 20 years. He is a wonderful dentist! He has made me happy with my smile and I am very picky. My bonding has lasted a very long time and looks natural. I would not trust anyone else with my smile!"



"I was very pleased with your painless and efficient dentistry, during the 10 years I was under your care. During that time, you put in some crowns, replaced fillings and did some cosmetic dentistry-closing the gap in between my two front teeth, so that I now have a perfect smile."



"Dr. Rich is hands down the best dentist in Wilmington, but what really sets his practice apart is that he has surrounded himself with the best staff imaginable. From check-in to cleaning to checkout they make the process comfortable, understandable and fun."
Gary