Temporomandibular disorder or TMD is a broad term referring to problems
with the jaws and their functioning. It is commonly referred to as
"TMJ".This system is very complex and problems are caused by a
variety of factors. This web page will attempt to give you a general overview
of TMD so you can better understand the problems you may have been having.
The Temporomandibular
System
The temporomandibular
system consists of three basic components; the temporomandibular joint or TMJ,
the teeth, and the neuromuscular system.
TMJ- This is the term often used to describe TMD, but it
specifically refers to the joints that work your lower jaw, or mandible. These
two joints are found just in front of the ears. Their close proximity to the
ear is why some patients experience ear symptoms and can often hear the joint
pop or crack. These two joints never act alone, that is, when your jaw
functions, both joints will be working. There is a small cartilage disc between
your lower jaw and skull in the joint. Some TMD problems are caused by
dysfunction of this disk. When healthy it acts as a sort of "shock
absorber" for the joint.
Teeth- The teeth are like the third leg of a tripod, the
TMJ’s being the other two legs. The alignment of your bite and the functioning
of the TMJ’s are intimately connected. Problems in any of the three areas may
affect the other two.
Neuromuscular- This system is the nerves and muscles which
work the temporomandibular system. It is important to realize that only the
lower jaw, or mandible, moves during jaw function. The upper jaw, or maxilla,
does not move; it is firmly attached to the skull. Therefore, the nerves and
muscles are involved in moving the lower jaw only. The nerves transmit the
messages for the muscles to move the jaw. They also transmit pain signals to
the brain causing you to feel discomfort. The muscles are fairly large and are
found from the side of your head down to your neck. Other related muscles that
do not specifically work the jaw, but are sometimes symptomatic are found in
the neck, face, and upper back.
What Defines TMD
A wide spectrum of specific and non specific disorders that
produce symptoms of pain and dysfunction of muscles of
mastication,Temporomandibular joint and other associated structures.
Symptoms and
signs of TMD can include some or all of the following.
Jaw pain and/or stiffness
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Headaches, usually at the temples and side of head
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Vague tooth soreness or toothaches which often move around
the mouth
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Sensitive teeth
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Painful or tender jaw joint
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Difficulty opening jaw
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Pain and fatigue when eating hard or chewy foods
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Clicks, pops, or grinding sound in jaw joint
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Ear pain
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Cervical neck tension and pain
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Tooth wear
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Diagnostic classification of Temporomandibular Disorders
Congenital or Developmental Disorders
- Aplasia
- Hypoplasia
- Hyperplasia
- Neoplasia
Disc Dearrangement Disorders
- Disc displacement with reduction
- Disc displacement without reduction
TMJ dislocation
Inflammatory disorders
- Capsulitis/Synovitis
- Polyarthritides
Osteoarthritis
- Primary osteoarthritis
- Secondary osteoarthritis
Masticatory Muscle disorders
- Myofacial Pain
- Myositis
- Myospasm
- Myofibrotic
contracture
- Neoplasia
Temporomandibular disorders come in many forms and varying
degrees of severity. Basically TMD is a problem when you either experience pain
and/or a loss of jaw function. The pain can range from a mild ache in the
morning to a chronic debilitating pain. Loss of function can be mild jaw
stiffness to being unable to open the jaw barely at all.
The symptoms of TMD can be an obvious jaw pain in the
muscles near the mouth, but can also often exhibit as headache at the temples
("temporal headache"). This is due to inflammation in the large jaw
closing temporalis muscle which is on either side of your head. To find this
muscle place your hands on your temples and clench your teeth hard and you will
feel this powerful muscle contract. Patients often feel this symptom is a
tension headache or sinus headache but it can be easily differentiated during a
TMD exam. Patients understandably (and many doctors) fail to make this
connection between TMD and headaches.
The pain of TMD can come from either the muscles or the TM
joint itself; often it comes from a combination of the two. The muscles can
ache due to causes discussed below. Pain in the joint is usually due to
inflammation within the structure itself. Sometimes the symptoms are found in
other facial structures; such as dull ear pain, toothache, neck pain, etc. This
referred pain is fairly common but it is important to rule out medical and/or
dental causes of these pains prior to TMD treatment.
Loss of jaw function can be due to muscular and/or joint
problems as well, just as pain can. The degree to which each is involved is
determined through thorough history and exam.
Causes of TMD
Temporomandibular disorders rarely have a single cause. Any
one of the following factors may contribute to TMD. Each patient presents with
an individual combination of factors that are determined during history taking
and clinical exam.
Trauma - Acute trauma to the jaws such as a car accident, a
fall, a punch, etc. can cause damage to the muscles and/or joint. The acute
pain and loss of function is usually responsive to conservative treatment.
Sometimes trauma to the joint can cause chronic damage which may eventually
contribute to a TMD problem at a later time.
Bruxism - Bruxism refers to a non functional grinding and
clenching of the teeth. Some do this while awake but more often it is done
while sleeping. Most people grind their teeth while sleeping to some degree.
For whatever reason some people do this very hard to the point where they wear
the enamel from their teeth. This bruxing is done by the jaw muscles and by the
morning they can be painful due to fatigue. This constant pressure also can
damage the TMJs over time. Bruxism is the most common factor found in TMD.
Malocclusion - This term means "bad bite".
Sometimes when the teeth do not bite together in harmony with the shape and position
of the joints it can place pressure on the joints. Missing teeth can sometimes
contribute to this as well. The misalignment can also put strain on the jaw
muscles. This factor can be mild to severe. Though the bite is an important
part of the whole system it is only altered after conservative measures and
only if it is felt improvement will result. In some patients discrepancies
(known as interferences) become apparent after wearing the NTI device for a few
months and a bite adjustment is recommended. Treatment of the bite for TMD is
usually not needed but its contribution to the whole must be examined.
Emotion - Emotional stress often plays an integral role in
the development of TMD. This occurs due to two basic reasons. Stress increases
both the severity and duration of bruxism while asleep. Also, many will
subconsciously clench and/or grind their teeth more while awake during times of
stress. The other way stress contributes to TMD is that during times of stress
your adaptability and pain threshold will go down. As a result you are more
likely to experience symptoms of TMD if other factors already exist (bruxing,
joint damage, etc.).
Emotional conditions beyond daily life stress can contribute
to TMD as well. Depression, anxiety disorders, and the like can often have TMD
problems arise. These conditions are quite stressful and it is not hard to
imagine why TMD would develop.
Ergonomic - Your job and how you do it can contribute to TMD
and related problems. If you work at a computer all day, for example, you may
be holding your head in such a way that places strain on your TM system.
TMD Treatment
Treatment
plans for TMD are as varied as the patients that present with it. Each patient
must be treated differently depending on the uniqueness of their problems and
the contributing factors. Pain Relief Info.
It is very
important to realize that the goal of TMD treatment is to minimize pain and
establish a return to function. TMD conditions are not "cured" but
are managed instead. The basic goal is to allow the muscles and joints to heal
through rest and care. Often damage to the joint itself can not be reversed,
but the body can often heal it enough to return to function without pain. We
also want to teach you to recognize the symptoms early and manage them yourself
once we give you the tools to do so. This condition can often recur later on
but early care can minimize the severity.
The basic
philosophy of treatment is to do the conservative and reversible treatments
first. Irreversible treatments, such as surgery or orthodontics, are only
considered if conservative steps have failed to bring lasting relief. These
more radical treatments are rarely used. Most patients respond well to simpler
care.
The
following treatment modalities may be used in each case.
- Patient
education and self care
- Rest and
relaxation
- Cognitive behavioral
intervention
- Pharmacotherapy
- Occlusal
therapy
- Occlusal therapy
- Orthopedic appliances
- Physiotherapy
- Rehabilitation
of Denatal deficits
- Management
of trigger points
Surgical
Treatment
- Arthrocentesis
- Arthroscopy
- Arthroplasty
- Discectomy
- Condylectomy
Occlusal Splint - Also called a night guard is designed to
protect the teeth from further wear. These also will reduce the severity of
grinding at night and allow the muscles to rest. In more severe cases it needs
to be worn all day as well to allow the TMJ and muscles to rest.
