TMD: Temporomandibular Joint Primary Problems

Originally published March 2015 · Last updated May 2026

By Clayton A. Chan, D.D.S. — Founder/Director of Occlusion Connections™

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Recognizing the Stages of TMD

There are varying degrees of temporomandibular joint dysfunctions. Each one will present with varying degrees of concerns. Most early stages of TMJ often go unrecognized and untreated by most dentists.

Clicking, popping, or grating sounds are certainly NOT normal — they are clinical indicators that there is an underlying issue.

Important Clinical Note: It is important not to have any dentist decrease the vertical height of your teeth if you are at Stage II and later. Read more on Class II Division 2 Type Problems →

Note: This classification represents a consensus statement by members of a multidisciplinary organization of clinicians who have extensive experience in the diagnosis and treatment of patients with temporomandibular joint (TMJ) arthropathy and associated musculoskeletal disorders. These guidelines represent current accepted theory and practice among the membership.

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Clinical Considerations

The condyle and disc (TM joint) is just one of the many components that can exhibit these break downs in postural malalignment conditions. In order to help reverse the forces that contribute to condylar bone degeneration, disc displacement problems, and occlusal and muscular strains, it is important to decompress the condyles to allow adequate joint space to re-occur in the glenoid fossa.

This will require an evaluation by your dentist to see if you have:

• Masticatory dysfunctions
• Joint derangement problems
• Pain

The dentist should prudently recognize the various musculoskeletal occlusal signs and symptoms that are all precursors to TMD and orofacial pain problems.

A lower removable orthotic appliance is used by many TMJ patients who have experienced various stages of joint conditions to decompress (unload) the joints and compressed discs.

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The Principle of Decompression

In severe stages of TMJ, decompression is always a good principle and guide to follow — even if the disc is perforated. Disc reduction (decompression) is the therapeutic medical model; further compression is not.

Teeth are the load-bearing component of the masticatory system, not the joints. Teeth include the first and second molars, first and second bicuspids. Occlusal equilibration (grinding away enamel on the molars and bicuspid crowns and teeth) procedures must be re-evaluated as to whether they are positively contributing to joint compression (loss of vertical and mandibular positioning) — or whether they are helping to move the strained TMJ problems toward a decompressed condition of the joints.

TM joints become pathologic when occlusal vertical support is lost.

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The Broader Clinical Picture

TMD is rarely a single isolated problem. Patients presenting with TMJ primary problems often also experience:

• Chronic facial, temporal, and occipital pain — radiating from masticatory muscle hyperactivity into adjacent regions
• Cervical and shoulder tension — postural compensation patterns connecting jaw position to neck alignment
• Limited mouth opening or jaw locking — often associated with anterior or medial disc displacement
• Teeth grinding and clenching — driven by underlying occlusal-physiologic dysfunction, not just stress
• Facial profile changes over time — loss of vertical dimension affects the lower third of the face

For patients who have been managing these symptoms with repeated Botox or other pharmaceutical approaches without underlying resolution, see Why Repeated Botox Doesn’t Fix TMJ — The GNM Clinical Perspective →

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Reference

• Wilkes CH. Surgical treatment of internal derangements of temporomandibular joint. Archives of Otolaryngology — Head and Neck Surgery. 1991;117:64.

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Continue Learning

🔹 Understand the Clinical Picture

• TMD Problems That Challenge Dentistry — Four Main Categories →
• Degenerative Joint Disease: Clinical Considerations →
• TMD: Cervical Dysfunction Problems →
• TMD: Class II Division 2 Type Problems →
• TMD: Anterior Open Bite Tendency Problems →
• Limited Mouth Opening Problems →
• Lateral Pterygoid Muscle: Its Relevance to Clinical Dentistry →

🔹 Symptom and Treatment Considerations

• Teeth Grinding (Bruxism) →
• Clenching →
• Medications and TMJ Grinding and Clenching →
• Why Repeated Botox Doesn’t Fix TMJ — The GNM Clinical Perspective →

🔹 Understand the GNM Foundation

• Defining Gneuromuscular Dentistry →
• Gneuromuscular vs. Neuromuscular Dentistry →
• GNM Optimized Bite Protocol →
• What Is Bite Optimization →

🔹 Treatment and Initial Protocols

• Treatment: Lower Anatomical GNM Orthosis →
• Initial Treatment Protocol →
• Treatment →
• MRI — Disc Reduction Using GNM Optimization Protocols →
• Cervical Spine Injuries: Detecting Clinical Significance →
• Headaches and Relief Following Gold Standard for Assessment →

🔹 Find a GNM Dentist or Train With Dr. Chan

• Finding a GNM Dentist Near You →
• Doctor Education Hub →
• OC Masterclass Training — Levels 1–9 →
• OC Course Schedule →
• About Dr. Clayton Chan →

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Written by Clayton A. Chan, D.D.S. — Founder and Director, Occlusion Connections | Las Vegas, Nevada