Temporomandibular Disorders

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:jaw area and associated muscles

  • 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:

  1. Direct trauma due to a car accident, a blow, or a fall
  2. whiplash-type injuries
  3. unconscious habits such as tooth clenching and/or grinding
  4. unusual stress (family, job, money)
  5. 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:

  1. chronic headache (variable in its intensity duration, and location)
  2. dizziness or lightheadedness (from seconds to several minutes)
  3. ringing, buzzing, whooshing, or other sounds in the ears
  4. fullness in the ears, nose, or sinuses
  5. pain in the face
  6. pain, or a "foreign body" feeling in the throat
  7. difficulty in swallowing
  8. pain in, or in the back of, the eyes, and other visual problems
  9. clicking of the jaw joint
  10. pain in or around the jaw joint, or in the face, when chewing or talking
  11. a stiffness or "tired feeling" in the muscles of the face
  12. unusual fatigue or lack of energy
  13. mysterious skin rashes (that may not respond to usual medications)
  14. hot or cold "spots" throughout the body
  15. 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.

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