What is TMD?
"TMD" stands for temporomandibular
disorders. It is often referred to as "TMJ" which is the
temporomandibular joint.. The TMJ connects the lower jaw (mandible) to the
temporal bone of the skull and is located just in front of the ear on each side
of the head. It is a highly complex system involving muscles and ligaments in
addition to the bones. Because TMJ refers only to the jaw joint, the term TMD
which covers both the joint and associated muscles is preferred.
What are the Symptoms of TMD?
Symptoms may be related to a disorder within the
joint itself and/or associated facial muscles. Pain may even be referred to the
area from other sources such as neck or teeth. Symptoms vary from patient to
patient depending upon which areas are involved and may include:
- pain in the TMJ and surrounding region
- joint noise such as clicking, popping, or
grating
- limited mouth opening and movement
- unexplained headaches or facial pain
including, dull, aching, constant pain
- earaches, ear noises, stuffiness
- neck and shoulder pain
- "toothache-like" pains
The severity and frequency of symptoms varies
with each individual.
What Causes TMD?
In most cases, more than one factor may be
responsible:
- Direct trauma due to a car accident, a blow,
or a fall
- whiplash-type injuries
- unconscious habits such as tooth clenching
and/or grinding
- unusual stress (family, job, money)
- diseases such as arthritis
How is TMD / Orofacial Pain Diagnosed?
A compete evaluation is necessary including a
thorough history and clinical examination of the jaws, face, head, and neck.
X-rays of the joint and orofacial structures may also be part of the
examination.
In some cases, diagnostic models of the teeth may
be needed. Because stress and tension can be a contributing factor, a
psychometric screening evaluation is often part of the examination.
On occasion, a specialized X-ray or an MRI may be
needed. Consultation with other health care professionals may also be requested
in order to reach a diagnosis and formulate an effective management program.
What is Involved with TMD Treatment?
In individualized treatment/management plan is
designed to reduce and/or eliminate symptoms of pain and dysfunction.
Treatment may vary from simple measures such as
eliminating hard, chewy foods from your diet and home exercises to more
extensive therapy which may include the following:
- removable intraoral appliances to reduce
pressure on the TMJs or change jaw position
- physical therapy to stretch and relax muscles,
increase neck function, and improve posture
- stress management program
- medication to control pain and to reduce
inflammation
- referrals to other health care practitioners
as needed
What is Orofacial Pain?
Strictly speaking, orofacial pain includes any
discomfort, pain, or abnormal sensation of the mouth, face, head, and adjacent
regions of the neck. Included in the category of orofacial pain would be
neuralgic type pain in the face, uncomfortable feeling or discomfort in the
face, or toothache-like pain in the teeth that are apparently
"normal". Because some orofacial pains are not related to TMD,
different diagnostic procedures may be necessary.
WHIPLASH INJURY PATIENTS
A whiplash injury can result in the development
of chronic headache, ear problems, dizziness, eye problems, and clicking and jaw
pain. Whiplash injuries have traditionally been considered to be a rather minor
and self-limiting type of problem which was not thought to be associated with
any related serious or permanent side effects. It has recently been documented,
however, that, following a whiplash injury (or other similar type of neck
injury), many "seemingly unrelated" symptoms can develop, even several
months following the actual injury, that are, in fact, now known to be directly
associated with, and related to, the effects of whiplash. The following symptoms
have been directly associated with a whiplash injury, and have been observed to
develop from several hours to several months following the neck injury:
- chronic headache (variable in its intensity
duration, and location)
- dizziness or lightheadedness (from seconds to
several minutes)
- ringing, buzzing, whooshing, or other sounds
in the ears
- fullness in the ears, nose, or sinuses
- pain in the face
- pain, or a "foreign body" feeling in
the throat
- difficulty in swallowing
- pain in, or in the back of, the eyes, and
other visual problems
- clicking of the jaw joint
- pain in or around the jaw joint, or in the
face, when chewing or talking
- a stiffness or "tired feeling" in
the muscles of the face
- unusual fatigue or lack of energy
- mysterious skin rashes (that may not respond
to usual medications)
- hot or cold "spots" throughout the
body
- pain in the scalp area
It has been reported that the "typical"
patient developing one or more of these previously mentioned symptoms following
a whiplash (or other similar neck injury) is most often a female between the
ages of twenty and fifty, although males and females in other age groups have
been noted to develop symptoms who has been examined by one or more of a variety
of medical specialists (neurologist, ear, nose, and throat specialist,
orthopaedist, internist), in addition to having had a rather wide variety of
sophisticated and expensive diagnostic tests ordered by their doctors in an
attempt to find the cause of their problem.
Most often, however, these tests fail to provide
any useful diagnostic information, and, in the absence of any other conclusive
data, the patient is often advised to seek the aid of a psychologist or
psychiatrist in order to explore the possibility of a psychosomatic origin to
their so-called symptoms, or they are simply advised to just "learn to live
with" their problem.
It is important to note...
Any whiplash injury patient who has developed any single, or any number of the
symptoms previously outlined, and who still "suffers" with their
symptoms of "unknown origin" following a series of inconclusive
medical tests, consultations, and treatment, may be suffering from
traumatically-induced temporomandibular joint dysfunction syndrome.
Temporomandibular joint dysfunction syndrome, or
TMJ syndrome, is a frequently undiagnosed or misdiagnosed (but rather easily and
successfully treated) malady. When identified and treated early, the cure rate
is remarkably high - about 90%. If left undiagnosed, however, and after the TMJ
becomes chronic, the cure rate drops drastically, and the patient may remain
with some permanent symptoms.
Thus, early identification and treatment by your
family dentist or a competent TMJ specialist is essential for the immediate and
future well-being of the patient.
