TMJ & TMD Treatment · Daly City, CA · Bay Area

Jaw Pain, Headaches, Clicking

When the Bite Is Out of Harmony, Everything Hurts.

TMJ disorders affect far more than the jaw. Chronic headaches, neck pain, ear symptoms, and facial tension are often driven by a bite problem that has never been identified. Kois Center-trained occlusal analysis — evidence-based, systematic, and specific to your anatomy.
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TMJ & TMD Treatment in Daly City, CA

Your Jaw, Your Bite, and Everything Connected to Both.

TMD — temporomandibular disorder — is not a single condition. It is a family of related problems involving the temporomandibular joint, the muscles of mastication, and the structures surrounding both. It manifests differently in different patients: some have jaw pain and clicking, others have chronic headaches with no jaw symptoms at all, and many have both. The connecting thread, in the majority of cases, is a bite that is not in harmony with the joint.

Dr. Hovden is a Clinical Instructor at the Kois Center — one of the world’s leading institutions for evidence-based occlusal analysis and treatment. The Kois approach to TMD is systematic and diagnostic: it identifies the specific nature of the problem before any treatment is recommended. No appliance is prescribed without understanding why the problem is occurring. This distinction matters enormously in a condition as complex and multifactorial as TMD.

His comprehensive examination includes TMJ joint palpation, muscle palpation, bite analysis, range of motion assessment, and clinical photographs — at every new patient visit, and whenever a patient reports relevant symptoms. Many TMD cases are identified during routine examination before the patient is aware that their jaw is contributing to their symptoms.

TMJ & TMD Treatment at a Glance

What to expect at this practice

Approach

Diagnosis before treatment — Kois-based systematic occlusal evaluation

Credential

Kois Center Clinical Instructor & Spear Visiting Faculty — teaching-level occlusal expertise

Diagnosis

Joint palpation, muscle assessment, bite analysis, range of motion, 20+ clinical photos

Treatments

Custom orthotics & splints, bite adjustment, night guards, lifestyle guidance, specialist referral

Timeline

Most patients notice improvement in 4–8 weeks with appropriate splint therapy

Investment

Financing available — clear treatment plan and cost before starting

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Kois Center Clinical Instructor

Evidence-based occlusal analysis & TMD diagnosis

TMJ Assessment Every Visit

Palpation, bite analysis & range of motion at each exam

Diagnosis Before Treatment

No appliance before understanding the underlying cause

AACD Accredited Fellow

1 of 80 practicing dentists worldwide.
1 of 2 in the Bay Area

Financing Available

Mon–Thu 8:00 AM – 5:00 PM · Daly City

Understanding the Condition

What Is TMD — and Why Is It So Often Misdiagnosed?

The temporomandibular joint (TMJ) is a complex hinge-and-sliding joint — one on each side of the face in front of the ears — that connects the lower jaw to the skull. It is one of the most frequently used joints in the body, engaged in every bite, chew, and spoken word.

Because the symptoms of TMD are so varied — and because they frequently refer pain to distant sites like the temples, ears, and neck — TMD is chronically underdiagnosed and frequently misattributed. Patients are treated for migraines, ear infections, cervical spine problems, and sinus conditions when the underlying driver is a bite and joint problem that has never been examined by a dentist.

The field distinguishes between three primary categories of TMD: disc displacement disorders (the cartilage disc inside the joint is out of position, often producing clicking); degenerative joint disease (arthritis affecting the joint); and masticatory muscle disorders (muscle tension and pain in the chewing muscles, often occlusal in origin). Many patients have elements of more than one category — which is why accurate diagnosis, not standard appliance therapy, must come first.

  • The Temporomandibular Joint
    A synovial hinge-and-glide joint where the condyle (ball) of the lower jaw sits in the glenoid fossa (socket) of the skull, separated by a cartilage disc. The disc should remain between the condyle and the fossa during all jaw movements. When it does not — producing clicking, popping, or locking — a disc displacement disorder is present.
  • The Muscles of Mastication
    Four paired muscles — the masseter, temporalis, medial pterygoid, and lateral pterygoid — control jaw movement. When the bite is out of harmony, these muscles work in suboptimal positions, generating chronic tension. The temporalis muscle, covering the side of the head, is a primary source of dentally-caused headaches. Muscle palpation reveals tenderness that most patients are not consciously aware of.
  • The Occlusion (Bite)
    How the teeth come together — the occlusion — directly determines the position and load on the joint and the tension in the muscles. A bite that forces the jaw into a compromised position creates a chronic strain that the muscles and joint absorb over time. Correcting the bite reduces this strain. This is the central principle of Kois-based occlusal therapy for TMD.
  • The Referred Pain Network
    TMD pain commonly presents far from the joint itself. Headaches at the temples (temporalis referral), ear pain and fullness (shared nerve pathways with the joint), neck and shoulder pain (muscle tension cascade), and facial pain can all originate from the jaw system. This is why patients are often misdiagnosed and why dental evaluation is essential for anyone with unexplained chronic head and neck pain.
Recognising TMD

The Symptoms Are More Varied Than Most People Expect.

TMD rarely presents as just jaw pain. Many patients have been managing these symptoms for years without knowing their jaw is the source.

Jaw Pain & Soreness

Pain or aching in the jaw joint itself, in front of the ear or along the jaw. May be worse in the morning (from nighttime grinding) or in the evening (from daytime clenching or extended chewing). May be present on one side or both.

Chronic Headaches

Headaches in the temples or sides of the head — often described as tension-type or pressure headaches — that begin at the temples or spread from them. Dentally-caused headaches often occur in the morning or worsen through the day with use of the jaw. Frequently misdiagnosed as migraine or tension headaches.

Clicking or Popping

Audible or palpable clicking, popping, or crepitus (grating) during jaw opening or closing — usually indicating disc displacement. Not all clicking is painful, but it signals a structural problem that may progress. Clicking that is accompanied by pain, limitation in opening, or locking warrants prompt evaluation.

Ear Symptoms

Ear pain, fullness, muffled hearing, and tinnitus (ringing in the ears) — without any actual ear pathology — are common TMD presentations. The chorda tympani nerve and the auriculotemporal nerve have direct anatomical connections between the TMJ and the ear, explaining why joint problems regularly produce ear symptoms.

Neck & Shoulder Pain

The muscle tension generated by a compromised bite and overworked jaw muscles cascades into the neck, shoulder, and upper back. The sternocleidomastoid and trapezius muscles — which attach from the skull and jaw region downward — are commonly involved. Patients with chronic neck pain that has not resolved with physiotherapy should have a dental occlusal evaluation.

Limited Jaw Opening

Difficulty opening the mouth fully — or sudden “locking” where the jaw cannot open or close beyond a certain point — indicates significant disc displacement or muscle spasm. This requires prompt assessment. Restricted opening interferes with eating, dental treatment, and quality of life and typically does not resolve without treatment.

Experiencing any of these symptoms? Call 650-755-6000 to arrange an evaluation. Dr. Hovden’s comprehensive examination includes TMJ assessment, muscle palpation, and bite analysis at every new patient visit — so many TMD cases are identified before the patient connects their symptoms to their jaw.

What Drives TMD

TMD Is Rarely Caused by One Single Thing.

Understanding the contributing factors to a patient’s TMD is essential before any treatment is recommended. Most patients have a combination of factors, and treating only one without addressing the others produces incomplete results. This is why accurate diagnosis precedes treatment in every case at this practice.

The Kois Center approach to occlusal diagnosis systematically evaluates each potential contributing factor — identifying which are primary drivers and which are secondary contributors. This determines the treatment approach and the likely prognosis.

  • Bite Misalignment (Occlusal Disharmony)
    The most common primary driver. When the teeth do not come together in a position that is harmonious with the natural resting position of the joints, the muscles and joints are forced to compensate — generating chronic strain, tension, and eventually pain. Even small occlusal discrepancies can produce significant symptoms over time.
  • Bruxism (Tooth Grinding & Clenching)
    Parafunctional activity — grinding and clenching beyond normal function — places far greater loads on the joint and muscles than chewing does. Bruxism is strongly associated with TMD and tooth wear, and is frequently driven by underlying occlusal problems that the nervous system attempts to resolve during sleep.
  • Trauma
    Direct trauma to the jaw — from a fall, accident, sports injury, or dental procedure — can damage the joint, disc, or surrounding structures. Post-traumatic TMD may appear immediately or develop over months as the initial inflammation resolves and structural changes become apparent.
  • Disc Displacement
    The cartilage disc inside the joint can become displaced from its correct position between the condyle and the fossa. This produces clicking (the condyle riding over the displaced disc during opening) and, if the disc becomes stuck, locking. Disc displacement may be a consequence of occlusal problems or may develop independently.
  • Degenerative Joint Disease
    Arthritis affecting the TMJ produces degradation of the joint surfaces, crepitus (grating), and progressive pain and limitation. Osteoarthritis of the TMJ is more common in older patients and in those with a history of prolonged occlusal loading. Imaging is typically required to assess the degree of joint degeneration.
  • Stress & Postural Factors
    Psychological stress increases muscle tension and clenching behaviour, exacerbating TMD. Postural issues — particularly forward head posture — alter the position of the jaw and increase strain on the muscles and joint. These factors are assessed as part of a comprehensive TMD evaluation and addressed through lifestyle guidance and appropriate referrals.
The Kois Approach to TMD Diagnosis

Diagnosis First. Then Treatment. Not the Other Way Around.

Many patients with TMD have been given a standard appliance — a flat-plane night guard — without a thorough evaluation of what is actually causing the problem. When the appliance does not work, they are told their TMD is untreatable. In most cases, the appliance did not work because it was not designed for the specific nature of their problem.

Dr. Hovden’s Kois Center training provides a systematic, evidence-based diagnostic framework that establishes exactly what type of TMD the patient has, what is driving it, and what the appropriate treatment approach is — before any appliance is fabricated or any treatment is provided.

The Jay R. review — the most widely shared review at this practice — describes a first visit that included “TMJ evaluation, muscle palpation, 20+ photos, pocket measurements, bite analysis” and concludes: “This wasn’t a sales consultation; it was an actual diagnostic exam.” That is the standard applied at every comprehensive examination at this practice.

  • Detailed Symptom History
    When symptoms began, what makes them better or worse, whether they are present on waking or develop through the day, what treatments have been tried, and what the impact on daily function is. The history often reveals the primary driver before the examination begins.
  • Joint Palpation & Assessment
    The joint is palpated bilaterally — directly and through the ear canal — to assess for tenderness, crepitus, and deviation in movement. Range of motion is measured (normal is 40–60mm opening). Joint sounds are characterised: clicking, popping, or crepitus, and at what point in the opening arc they occur.
  • Muscle Palpation
    The temporalis, masseter, medial pterygoid, and accessory neck muscles are systematically palpated for tenderness. This maps the muscle involvement pattern and distinguishes primarily muscular TMD from primarily joint-based TMD — a distinction with direct treatment implications.
  • Occlusal Analysis
    How the teeth come together is assessed in centric relation (the physiologic joint position) and in all excursive movements. Interferences — teeth contacts that force the jaw out of its ideal position — are identified. The Kois deprogrammer is often used to establish the true joint position free of muscle memory and habitual bite patterns.
  • Clinical Photography & Imaging
    Standardised clinical photographs document the occlusion, tooth wear patterns, and soft tissue. Radiographs assess bone and joint health. CBCT imaging may be used to evaluate joint anatomy in detail when disc displacement or degenerative change is suspected.
  • Diagnosis & Treatment Planning
    All findings are synthesised into a clear diagnosis: what type of TMD, what is driving it, and what the appropriate treatment approach is. A clear treatment plan — with costs, timeline, and realistic prognosis — is provided before any treatment begins. Specialist referral is recommended when the problem exceeds what dental treatment can address.
Treatment Options

The Right Treatment for the Right Diagnosis.

Treatment is selected based on what the evaluation reveals — not prescribed as a standard starting point. Every patient is different. Every treatment plan reflects that.

Custom Dental Orthotics & Splints

A precisely designed and calibrated removable appliance worn over the teeth repositions the jaw to a more stable joint position, reduces muscle strain, and prevents the damaging effects of bruxism. A Kois-designed orthotic is not a generic flat-plane appliance — it is calibrated to a specific jaw position established through careful diagnostic measurement. Most patients notice significant symptom improvement within 4–8 weeks of consistent use.

Bite Adjustment (Occlusal Equilibration)

When specific tooth contacts are forcing the jaw into a compromised position, selective adjustment of those contacts — occlusal equilibration — can eliminate the interference and allow the muscles and joint to settle into a more comfortable position. This is a conservative procedure performed in stages, guided by careful diagnostic planning. It is only recommended when the bite analysis confirms that specific interferences are the primary driver.

Night Guards for Bruxism

When bruxism is a significant contributing factor — or when protecting teeth and restorations from grinding damage is the primary goal — a custom night guard provides a protective barrier between the teeth during sleep. Custom guards are fabricated to fit the specific bite and adjusted to ensure the jaw does not rest in a compromised position during wear. Learn about night guards →

Lifestyle Guidance & Self-Care

Practical modifications that reduce the load on the joint and muscles during the treatment period: avoiding hard, chewy, or tough foods; conscious awareness and reduction of daytime clenching; heat therapy for muscle soreness; gentle jaw exercises as appropriate; and stress management strategies where clenching is stress-driven. These are adjuncts to treatment — not substitutes for it.

Restorative Bite Correction

When the bite cannot be adequately corrected through equilibration alone — because teeth have worn down, drifted, or are missing — restorative treatment may be needed to rebuild the bite to the correct position. This may involve crowns, onlays, or implants. Restorative bite correction is planned around the Kois-diagnosed ideal joint position — ensuring the final result supports both the teeth and the TMJ system long-term.

Specialist Referral

TMD with a significant joint structural component — advanced disc displacement, degenerative joint disease, or a history of trauma — may benefit from collaboration with an oral and maxillofacial surgeon. Patients with significant pain management needs may benefit from referral to a pain specialist or neurologist. Dr. Hovden’s collaborative approach means the right treatment comes from the right provider — and dental treatment is not applied to problems that require a different specialist.

Why the Occlusal Standard Here Is Different

TMD Treatment by a Kois Center Instructor Who Also Teaches It.

Occlusal analysis — the systematic evaluation of how the bite relates to the joint and muscles — is the foundational skill for TMD diagnosis and treatment. Dr. Hovden is a Clinical Instructor at the Kois Center, one of the most prestigious evidence-based dental continuing education institutions in the world. He does not just apply Kois protocols — he teaches them.

He is also an Visiting Faculty at the Spear Institute in Scottsdale, AZ — where advanced restorative, occlusal, and aesthetic dentistry is taught to dentists from across the country. The combination of Kois systematic diagnosis and Spear restorative expertise means that when TMD treatment involves restoring the bite, the restoration is planned and placed at the highest level of technical and occlusal accuracy.

From a Patient’s First Visit

“He spent over an hour with me on the first visit — cancer screening, TMJ evaluation, muscle palpation, 20+ photos, pocket measurements, bite analysis. This wasn’t a sales consultation; it was an actual diagnostic exam.”
— Jay R., Google Review ★★★★★

Dr. Hovden completes well over 200 hours of continuing education per year since 2020 — including regular updates in occlusal science, TMD management, and restorative protocols. He is also a Former UOP Faculty Member for 39 years and the founder of the Bay Area Aesthetic Masters study club, committed to raising the level of care of local dentists for over 20 years.

  • Kois Center Clinical Instructor — Occlusal Analysis & TMD
    The Kois Center’s evidence-based approach to occlusal diagnosis is considered the gold standard in systematic bite evaluation. As a Clinical Instructor, Dr. Hovden does not just follow this protocol — he teaches it to other dentists. Every TMD evaluation at this practice reflects this standard.
  • Visiting Faculty — Spear Institute
    Visiting Faculty at dentistry’s most prestigious CE institution. Advanced restorative and occlusal expertise at a teaching level — directly applicable to cases where TMD treatment involves restoring or adjusting the bite.
  • AACD Accredited Fellow — 1 of 80 Worldwide
    The highest credential in cosmetic dentistry. When TMD treatment requires restorative work — crowns, onlays, or a full bite reconstruction — the aesthetic outcome of those restorations reflects the AACD standard.
  • TMJ Assessment at Every Comprehensive Exam
    Joint palpation, muscle palpation, bite analysis, and range of motion are included at every new patient examination and whenever relevant symptoms are reported. Many TMD cases are identified before the patient associates their symptoms with the jaw.
  • Well Over 200 CE Hours Per Year Since 2020
    Including regular updates in occlusal science and TMD management. The treatment approaches offered at this practice reflect the current evidence base — not approaches that were current a decade ago.
What Patients Experience

A Diagnostic Exam — Not a Sales Consultation.

The approach to TMD at this practice is described best by the patients who have experienced it.

“I came in expecting to spend $20–30k on veneers. Dr. Hovden talked me out of it. That alone tells you everything about his integrity. He spent over an hour with me on the first visit — cancer screening, TMJ evaluation, muscle palpation, 20+ photos, pocket measurements, bite analysis. This wasn’t a sales consultation; it was an actual diagnostic exam. His assessment: my teeth are healthy, and with orthodontics + whitening I could get 90% of the result I wanted without touching my enamel… Beyond the big picture advice, he taught me things no dentist ever has — the correct angle to brush to prevent calculus buildup, why most mouthwashes are acidic and counterproductive, the RDA value of toothpastes, and the connection between missing bicuspids and airway issues. He’s been doing this for 40+ years… and only replaced 2 veneer cases in 8–10+ unit cases in his entire career. He refers to a top airway-focused orthodontist and clearly cares more about long-term outcomes than billing. If you want a dentist who will be honest with you even when it costs him money, this is the guy.”

Jay R. — Google Review

Your Questions, Answered Honestly

TMJ & TMD — FAQs

Something not covered? Call 650-755-6000 or book your consultation.

The TMJ (temporomandibular joint) connects the lower jaw to the skull. TMD (temporomandibular disorder) is the term for problems affecting this joint and the surrounding muscles. TMD is not a single condition — it encompasses disc displacement disorders, degenerative joint disease, and masticatory muscle disorders, often in combination. Symptoms range from jaw clicking and pain to chronic headaches, ear symptoms, and neck pain.

The most common driver is a bite (occlusal) problem — when the teeth do not come together in a position harmonious with the natural resting position of the joints, the muscles and joint are strained chronically. Other contributing factors include bruxism, trauma, disc displacement, degenerative joint disease, stress, and postural issues. Most patients have a combination of factors — which is why thorough diagnosis precedes treatment at this practice.

Accurate diagnosis requires a thorough examination: joint palpation, muscle palpation, bite analysis in centric relation and all excursive movements, range of motion assessment, and detailed symptom history. Dr. Hovden’s Kois Center Clinical Instructor training provides a systematic, evidence-based framework for this evaluation — identifying whether the problem is primarily joint-based, muscle-based, or occlusal before any treatment is planned.

Treatment is selected based on the specific diagnosis — not prescribed as a standard starting point. Options include custom orthotics and splints, bite adjustment (occlusal equilibration), custom night guards for bruxism, lifestyle and self-care guidance, restorative bite correction, and specialist referral when appropriate. No appliance is prescribed without first understanding the underlying cause.

Yes. When the bite forces the jaw muscles to work in compromised positions, they generate chronic tension — and that tension refers pain to the head. The temporalis muscle, which runs along the side of the head, is a primary source of dentally-caused headaches. This is why Dr. Hovden’s comprehensive examination includes TMJ evaluation and muscle palpation at every new patient visit — many chronic headache patients discover a dental cause they were unaware of.

A custom dental orthotic repositions the jaw to a more stable joint position, reduces muscle strain, and protects teeth from bruxism. A Kois-designed orthotic is not a generic flat-plane guard — it is calibrated to a specific jaw position established through diagnostic measurement. Most patients notice improvement in symptoms within 4–8 weeks of consistent use.

Coverage varies significantly by plan. Some dental plans cover orthotic fabrication; some medical insurance plans cover TMD as a medical condition. The team at this practice will help you understand what your plan covers. Financing is available for out-of-pocket costs.

Most patients notice noticeable improvement within 4–8 weeks of appropriate splint therapy. Completing the full course of treatment and any definitive bite correction may take several months. Some patients require ongoing management. Dr. Hovden will give you a clear picture of the expected timeline for your specific situation at consultation.

Yes. Custom night guards are precisely calibrated to your bite — not generic appliances. Where appropriate, the occlusal factors contributing to the grinding are also identified and addressed, rather than just managing the symptom. Dr. Hovden’s Kois Center occlusal training informs how the appliance is designed and adjusted to support the joint in its correct position during wear.

Seek evaluation any time jaw pain is persistent, interferes with eating or speaking, is accompanied by locking or significant limitation in opening, or is associated with regular headaches or neck pain. Early evaluation produces better outcomes — TMD typically does not resolve on its own and worsens with time if the underlying cause is not addressed. Call 650-755-6000 to arrange an assessment.

Chronic Headaches and Jaw Pain Deserve a Real Diagnosis — Not a Standard Appliance.

A systematic, evidence-based evaluation of your bite, your joint, and your muscles — by a Kois Center Clinical Instructor. A clear diagnosis. A treatment plan that makes sense. Book your consultation with Dr. Hovden today.

Book Your Consultation Call 650-755-6000

901 Campus Dr, Suite 202, Daly City, CA 94015 · Mon–Thu 8:00 AM – 5:00 PM · Financing Available