TMD and Jaw Pain Treatment at Smile Solutions Melbourne - Expert Diagnosis and Multidisciplinary Care product guide

Temporomandibular dysfunction (TMD) affects approximately 10% of Australians at any given time, making it one of the most prevalent and yet most frequently mismanaged conditions in dental and medical practice. Patients with TMD often spend years - sometimes decades - seeking answers. They are told to reduce stress, fitted with generic night guards, offered Botox without diagnostic assessment, or sent between dentists, physiotherapists, and GPs who each address one piece of a condition that requires the full picture.

At Smile Solutions, the full picture is what you get. Located at the Manchester Unity Building, 220 Collins Street, Melbourne, Smile Solutions operates a dedicated TMD and jaw pain clinic staffed by a multidisciplinary team with expertise across every clinical dimension of this complex condition. From advanced diagnostic technology to hands-on osteopathic care, from in-house splint fabrication to specialist surgical assessment - everything needed to genuinely address TMD is available within one building.

Understanding TMD: More Than Just Jaw Pain

TMD is an umbrella term for a group of conditions affecting the temporomandibular joints - the joints that connect the lower jaw to the skull on either side of the face - along with the muscles of mastication (chewing muscles) and the associated soft tissue structures. It is a condition with a wide spectrum of presentation and severity.

The symptoms most commonly associated with TMD include:

• Jaw pain during chewing, speaking, or yawning
• Facial pain, particularly around the cheeks and temples
• Clicking, popping, or crackling sounds in the jaw joints during movement
• Limited jaw opening, or intermittent jaw locking that prevents normal mouth opening
• Tension headaches or migraine-type headaches, particularly on waking in the morning
• Tinnitus - ringing, buzzing, or pressure sensation in the ears
• Tooth sensitivity not explained by decay or dental pathology
• Changes in the bite - a feeling that the teeth no longer fit together as they should
• Neck and shoulder pain and stiffness
• Facial muscle tension and fatigue

Not every patient with TMD experiences all of these symptoms. Some patients present primarily with jaw joint pain and clicking. Others present primarily with headaches or tooth wear, with jaw symptoms that are subtle or intermittent. This variability is one of the reasons TMD is so frequently underdiagnosed: its presentation overlaps with many other conditions, and without a structured diagnostic process, the underlying cause is easy to miss.

The Diagnostic Process at Smile Solutions

The Smile Solutions approach to TMD begins with comprehensive diagnosis. This is not a consultation that ends with a prescription for a night guard. It is a structured clinical investigation using multiple diagnostic tools to build a precise picture of what is happening in the jaw joints, muscles, bite, and airway.

The diagnostic workup includes:

Medical and Dental History A detailed history of symptoms, onset, duration, prior treatments, and relevant medical background. Understanding the history of the condition - when it started, what makes it better or worse, what treatments have been tried - is essential context for the physical and technological assessment that follows.

Clinical Examination Assessment of jaw joint mobility, muscle tenderness and palpation, joint sounds, bite contact, tooth wear patterns, and soft tissue examination. This provides the foundational clinical picture before objective diagnostic data is added.

Radiographic Assessment Radiographic assessment of the temporomandibular joints and surrounding structures using OPG and, where clinically indicated, CBCT (cone beam computed tomography) imaging from Collins Street Imaging on Level 9 of the Manchester Unity Building. CBCT provides three-dimensional imaging of the joint anatomy, disc position, bone quality, and airway dimensions - information that is not available from conventional two-dimensional radiography.

MRI of the Temporomandibular Joint Where clinical examination or CBCT findings suggest significant soft tissue pathology within the joint, MRI may be arranged. MRI provides detailed imaging of the condyle head, the joint capsule, the disc within the joint, the muscles associated with the joint capsule, cartilage, and the base of the cranial (temporal) fossa. Unlike CBCT, MRI involves no radiation exposure, making it an appropriate investigation for assessing disc position and displacement, degenerative joint changes, and structural deficiencies within the joint.

MRI is indicated for patients with prominent levels of clicking, pain localised to the joint itself, crepitus (snap, crackle, or pop sounds and sensations over the joint), popping or joint dislocation on opening and closing, severe trismus (significantly reduced jaw opening), or suspected degeneration or arthritis. While MRI is not available within the practice building, it is arranged when clinically warranted.

Myowise EMG - Electromyography The Myowise electromyography (EMG) system measures the electrical activity of the masseter and temporalis muscles - the primary muscles involved in jaw clenching and grinding. Sensor arrays are placed on the face and measurements are taken at rest, during light jaw contact, and during function. This data reveals whether the muscles are overworked, underworked, asymmetric, or dysregulated - information that fundamentally shapes treatment decisions.

This is the key diagnostic distinction at Smile Solutions. Most practices that offer Botox for TMD inject every patient without measuring what the muscles are actually doing. The EMG data tells a different story: the majority of bruxism patients have underworked muscles in protective spasm, not overworked muscles. For these patients, Botox is counterproductive. The EMG-first approach ensures that treatment is appropriate to the actual clinical finding.

Innobyte Bite Force Analysis The Innobyte system measures the actual forces generated across the entire oral functional apparatus during biting and clenching. It quantifies bite force at each tooth position in Newtons, identifies overloaded contacts and premature interferences, and provides an objective baseline against which treatment progress can be measured. This data is central to splint design and occlusal treatment planning - and is essential for determining whether the muscles are atrophied or hypertrophied before any Botox decision is made.

Myowise Functional Chewing Analysis A Myowise-based assessment of the muscle activation patterns during chewing function, evaluating the coordination and symmetry of the masticatory muscles during actual food processing. This provides clinically useful information about how the jaw functions under load, beyond the static measurements captured at rest.

Intraoral Scanning Full-arch digital scans using the iTero system provide precise digital models of the teeth and occlusal surfaces, enabling splint fabrication, bite analysis, and treatment simulation with high accuracy.

iTero Occlusal Heat Mapping The iTero system's occlusal heat mapping functionality produces colour-coded diagrams showing the distribution and intensity of bite contacts across all tooth surfaces. This eliminates guesswork from occlusal assessment, reveals premature contacts and interferences, and allows the effects of treatment on the bite to be tracked objectively over time.

CBCT Imaging of TMJ and Airways As described above, CBCT imaging provides three-dimensional visualisation of the temporomandibular joints and the upper airway. For patients in whom sleep-disordered breathing may be contributing to their bruxism or jaw pain - a significantly more common relationship than most patients expect - airway imaging provides critical diagnostic information.

The Clinical Team

Dr Kia Pajouhesh - Principal Dentist, TMD Diagnosis and Treatment Planning

Dr Pajouhesh is the founding principal of Smile Solutions and the clinical leader of the TMD programme. With more than 30 years of clinical experience in temporomandibular dysfunction, Dr Pajouhesh is one of Australia's most experienced TMD practitioners. He established the Smile Solutions TMD and Sleep Apnoea Clinic, building the multidisciplinary team and the clinical infrastructure from the ground up. He integrates the full range of diagnostic data into a comprehensive clinical picture and coordinates the contributions of the multidisciplinary team to deliver a treatment plan tailored to each individual patient's presentation.

Dr Fotios Angelis - Specialist Prosthodontist

Dr Angelis manages the dental and occlusal dimensions of TMD treatment. He designs and oversees the fabrication of custom occlusal splints, manages bite adjustment and dental equilibration, and provides prosthodontic rehabilitation for patients whose teeth have been significantly worn by years of grinding or clenching.

Dr Joshua Ch'ng - Specialist Orthodontist

When macro-occlusal factors - the overall relationship of the upper and lower dental arches - are contributing to TMD, orthodontic treatment under Dr Ch'ng addresses the structural underpinning that splint therapy alone cannot resolve. He works in coordination with Dr Angelis on cases requiring both occlusal and orthodontic management.

Dr Steven Smith - Specialist Orthodontist

Dr Smith works alongside Dr Ch'ng in the management of patients requiring orthodontic assessment and treatment as part of their TMD care. Early intervention orthodontics for children and orthodontic treatment for adult macro-occlusal dysfunction are both within his clinical scope.

Dr Rachel Smith - Osteopath

Dr Rachel Smith is the in-house osteopath at Smile Solutions and a core member of the TMD treatment team. She provides manual therapy for the jaw, cervical spine, and postural chain, and designs and supervises rehabilitation exercise programmes for patients with jaw muscle dysfunction.

Beyond head and neck treatment, Dr Smith's osteopathic assessment addresses the whole body - posture, physical muscular strength through the entire spine, hips, shoulders, and the musculoskeletal system as a whole. TMD is connected through fascial planes and muscular and skeletal systems throughout the body, and effective osteopathic treatment reflects this connection.

Dr Smith's assessment also encompasses related contributing factors that frequently drive TMD: gut health, nervous system function, and anxiety and stress levels. Based on this holistic picture, she may refer patients onwards to GPs, dieticians, naturopaths, or clinical psychologists where these underlying factors require specialist attention. The osteopath at Smile Solutions acts as a clinical gateway for identifying and addressing the non-musculoskeletal contributors to TMD that dental treatment alone cannot resolve.

Greta Chwasta - Award-Winning Pilates Instructor and Osteopath

Greta Chwasta brings a distinctive combination of osteopathic expertise and award-winning Pilates instruction to the Smile Solutions TMD team. A Pilates reformer is installed on-site within the Smile Solutions osteopath clinic, enabling progressive musculoskeletal strengthening and rehabilitation programmes to be delivered within the practice - not as an external referral, but as an integrated part of the treatment plan. For patients whose TMD has a significant postural or muscular weakness component, Pilates-based rehabilitation under Greta's guidance provides the strengthening work that complements manual osteopathic therapy and splint treatment.

Ms Monica Cain - Orofacial Myologist

Ms Cain provides orofacial myofunctional therapy for patients with TMD. Addressing dysfunctional muscle habits - mouth breathing, incorrect tongue posture, abnormal swallowing patterns - that contribute to or perpetuate jaw dysfunction is an important component of comprehensive TMD management.

Ms Sophie Oostermeyer - Oral Health Therapist and Fotona Laser Therapist

Ms Oostermeyer delivers Fotona laser therapy for TMD patients. Laser treatment provides non-invasive pain relief, muscle relaxation, and targeted treatment of inflamed or painful jaw muscle and joint tissue. It is an effective adjunct to other TMD treatments and can provide meaningful symptom relief in the short term while longer-term treatment plans are implemented.

Dr Pip Robinson - General Dentist (Masticatory Injectable Treatments)

Dr Robinson provides botulinum toxin (Botox) injections to the muscles of mastication for patients whose EMG data confirms genuine muscle hyperactivity warranting this treatment. Ultrasound-guided Botox is also available when required for precise muscle targeting.

Ms Natalie Bilos - Senior Dental Technician (TMD Splint Fabrication)

Ms Bilos fabricates all TMD-related appliances in the Smile Lab. In-house fabrication ensures rapid turnaround and close collaboration with the clinical team.

A/Prof Patrishia Bordbar - Specialist Oral and Cranio-Maxillofacial Surgeon

For patients whose TMD has a significant structural component - disc perforation, joint arthritis, severe skeletal discrepancy - A/Prof Bordbar provides surgical assessment and, where indicated, surgical management. Surgery is reserved for cases that do not respond adequately to conservative treatment or where structural pathology makes surgical intervention the most appropriate option.

Treatment Options

Treatment at Smile Solutions is selected based on each patient's individual diagnosis, severity, and contributing factors. No single protocol is applied to every patient. Available treatments include:

Occlusal Splints Custom-fabricated in the Smile Lab by Ms Bilos, all splints are made in-house enabling rapid turnaround and close clinical collaboration. Smile Solutions fabricates splints in multiple designs based on each patient's individual clinical indication:

• Protrusive splints: Advance the mandible for patients with both TMD and sleep-disordered breathing
• Centric relation (CR) splints: Reposition the jaw into a therapeutically stable joint position, relieving pressure on the disc and joint capsule
• Flat plane splints: Reduce muscle activity and protect teeth from grinding and clenching forces
• Lateral and anterior guide plate splints: Address specific occlusal guidance issues in TMD management
• Nylon splints: Extremely thin and hard - designed for patients who wear through or break conventional splint materials
• Soft splints: Used for patients with a bruxism habit only (not TMD) - soft splints protect teeth from grinding forces but are not appropriate for TMD management, as they can increase clenching activity in TMD patients

The clinical indication, the EMG data, and the bite force analysis together determine which splint design is appropriate for each patient.

Orthodontic Treatment for Macro-Occlusal Function Where the overall bite relationship is a confirmed contributing factor, orthodontic treatment under Dr Ch'ng or Dr Steven Smith addresses the structural cause of the dysfunction.

Prosthodontic Treatment for Micro-Occlusal Function and Dental Equilibration Where individual tooth contacts require adjustment or where significant tooth structure has been lost to grinding, Dr Angelis manages the dental reconstruction and equilibration required to restore a balanced, functional bite.

Fotona Laser Therapy Non-invasive laser treatment for pain relief and masticatory muscle relaxation, delivered by Ms Oostermeyer.

Osteopathic Care Manual therapy, jaw mobilisation, cervical spine treatment, whole-body postural assessment, and rehabilitation exercise from Dr Rachel Smith and Greta Chwasta. The osteopathic component at Smile Solutions extends well beyond head and neck - it encompasses the full musculoskeletal system, gut health screening, nervous system assessment, and referral pathways to GPs, dieticians, naturopaths, and clinical psychologists where underlying contributors to TMD are identified.

Pilates Rehabilitation Progressive strengthening programmes delivered through the on-site Pilates reformer as part of the musculoskeletal rehabilitation pathway for TMD patients with postural or muscle strength deficiencies.

Myofunctional Therapy Muscle habit retraining and upper airway strengthening from Ms Monica Cain.

Heat Therapy, Physical Therapy, and Lifestyle Modifications Guidance on self-management strategies including heat application, jaw rest, dietary modification, sleep hygiene, and postural habits that support recovery and reduce symptom recurrence.

Muscle Relaxant Injections and Botox Botulinum toxin treatment for patients with confirmed muscle hyperactivity, guided by Myowise EMG data and Innobyte bite force analysis. Botox at Smile Solutions is never applied without objective diagnostic data confirming the specific muscles involved and the nature of the dysfunction. Ultrasound-guided Botox is available when required for precise targeting.

Surgical Assessment and Intervention For extreme structural, developmental, or arthritic cases, A/Prof Bordbar provides specialist surgical evaluation and management.

Botox and TMD: Frequently Asked Questions

Does every TMD patient need Botox?

No. Botox is not a blanket treatment for TMD, and whether botulinum toxin is appropriate, inappropriate, or actively counterproductive depends entirely on the specific clinical presentation of each patient. At Smile Solutions, Myowise EMG and Innobyte bite force analysis determine this - Botox is never considered without objective data.

There are three broad categories of TMD patients in relation to Botox:

Category 1: Joint-Related TMD Some patients' TMD is primarily within the joint itself - involving the disc, the joint capsule, and the condyle. Symptoms may include clicking, locking, and limited jaw movement. Botox to the muscles of mastication tends not to be helpful for joint-related TMD. The problem is structural or articular, not muscular hyperactivity, and muscle relaxation does not address the source.

Category 2: Muscular TMD - Atrophy (the most common presentation) This is the most frequently encountered presentation and the most commonly mistreated. Patients with muscular atrophy have muscles of mastication that are weak and underperforming - often in protective spasm as the body's response to joint pain or dysfunction. Bite force analysis with the Innobyte system, which measures the Newton force of the bite, is essential for identifying this pattern.

Botox is counterintuitive and potentially harmful for these patients. Injecting botulinum toxin into muscles that are already atrophied further reduces bite strength and functional capacity. The correct treatment is osteopathic care and targeted exercise to build muscle strength. This is the most common muscular TMD presentation - the majority of patients who arrive thinking they need Botox, do not.

Category 3: Muscular TMD - Hypertrophy A smaller subset of patients have genuinely over-stimulated, over-functioning muscles of mastication - muscles that are hypertrophied, chronically over-contracting, and inflamed. For these patients, Botox can be useful, but only as a circuit breaker and never as an ongoing long-term solution.

Botox is applied once, or at most twice several months apart, to break the cycle of muscle overactivity while other treatments (osteopathic care, splint therapy, myofunctional therapy) address the underlying cause. The clinical goal is to transition to conservative management - indefinite Botox without an endpoint is not the Smile Solutions approach.

How is Botox dosing determined?

EMG-guided Botox dosing is used at Smile Solutions. The Myowise EMG data identifies which specific muscles are hyper-functioning and to what degree - whether the overactivity is predominantly in the temporalis, the masseter, or both, and whether there is asymmetry between the left and right sides. Random, equal application of Botox across all jaw muscles is clinically counterintuitive and risks over-treating some muscles while under-treating others. The EMG data determines the correct dose for each muscle group.

For certain cases, ultrasound-guided Botox is also available, enabling precise targeting of specific muscle structures that are difficult to accurately locate by surface anatomy alone.

Collaborative Care with Your Medical Team

The Smile Solutions TMD team understands that many patients presenting with jaw pain also have treating physicians, physiotherapists, rheumatologists, or other medical practitioners involved in their care. The team welcomes collaboration with these practitioners and provides clinical reports and communication to support coordinated care. For patients referred by a medical practitioner, this communication is a standard part of the clinical process.

Making an Appointment

Call 13 13 96 or visit smilesolutions.com.au. The practice is located at the Manchester Unity Building, 220 Collins Street, Melbourne CBD. No referral is required. A complimentary initial consultation is available to discuss your symptoms and determine whether a full TMD assessment is appropriate. Payment plans are available through Payright, Humm, and MyDentaPlan.

A reference video from the Smile Solutions team on TMD management for medical practitioners is available at youtube.com/watch?v=NVwnlPtAK6s.

Smile Solutions has received over 937 Google reviews with a 4.9-star rating, reflecting the quality of care delivered across all clinical disciplines including TMD and jaw pain management.