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Conditions of TMD PDF Print E-mail
Temporomandibular Disorders, more commonly known as "TMD" is a term to describe a jaw joint disorder and the muscles that control the joints. The head, neck and facial pain associated with TMD problems often masquerade as a multitude of other conditions. Fortunately, it can be treated successfully by a dentist who has acquired the special training necessary to manage these disorders.

"TMJ" disorders (TMD) – also known as Craniomandibular Dysfunction and Craniofacial Pain – refer to problems involving both the jaw joints and the muscles of the head, neck and face. These are the two joints that connect the jaw to the skull located on each side of the head in front of the ears. When these joints are displaced, they can cause mild discomfort to severe pain.


The temporomandibular joints may be the most flexible, yet sophisticated joints in the body because they move up and down, side to side and in a wide range of motion. Muscles attach the bones and joints that allow such movements. It is estimated that as many as one in every four North Americans suffer from one or more of these symptoms:
  • Headaches
  • Pain behind the eyes
  • Unexplained tooth pain
  • Dizziness
  • Click, pop or grating sound in the jaw joints
  • Limited mouth opening
  • Locking jaw
  • Neck pain or stiffness
  • Earaches, stuffiness or ringing ears
  • Difficulty swallowing
The primary problem can be in the joints themselves, the muscles of the face and jaw or a combination of these. Because symptoms masquerade as so many other conditions, people travel from doctor to doctor in search of answers for pain relief. Many never think to seek out a dentist who is trained specifically in TMD.

You can observe the action of the jaw joint by placing your fingers on your jaw joints in front of your ears on the sides of your face. Open and close your mouth and you will be able to feel the movement. It should feel smooth without any clicking and popping when opening, closing or moving the jaw from side to side.

Causes

Structures that make it possible to open and close your mouth include the bones, joints and muscles. Your teeth are inserted into your jaw bone. At the end of your jaw bone are the TM joints which connect the jaw to the skull. Muscle spasm goes hand-in-hand with displaced jaw joints. Muscles attach both the bones and joints to allow movement to talk, chew, sing, shout and swallow. Any problem which prevents the complex system of muscles, bones and joints from working together in harmony may result in TMD.

There are various ways this system can be disrupted, such as trauma (whiplash), connective disorders (arthritis), or skeletal malformations (posture). Another cause of TMD relates to your teeth and your bite. A "bad bite" prevents your upper and lower teeth coming together in a way that provides the proper bracing support for misaligned teeth or back teeth that are too "short". When this condition is prolonged, the body begins to compensate by involving muscles in other areas; the neck, throat, upper back, arms and pelvis.

Stress

Another factor that impacts on TMD is stress. Stress overloads the adaptive capabilities of the jaw. Due to this stress some people unconsciously grind and/or clench their teeth creating strain on the jaw joints.

Muscle Spasm

We all swallow about 2500 times throughout the day and night. The upper and lower teeth must come together firmly each time. When the bite is unstable, the muscles must work harder than normal causing stress, strain and possibly stiffness. Eventually muscles feel tired and painful. A vicious cycle begins of increased tension, muscle spasm and pain.

Jaw Joint Displacement

When the jaw joints function properly, the bones do not actually touch because of a thin "disc" of cartilage that rides between them. The disc acts as a cushion and allows the joint to move smoothly. Each disc is held in place by ligaments and guided by muscle. If your bite is not meeting properly, the joint is pulled out of alignment – usually pulling the disc forward.

Since the disc no longer serves as a cushion, the joint itself now rubs against the bony socket and presses on pain fibers.

Treatment

Every case is unique! A thorough health questionnaire, examination and testing is performed to assess your condition, determine the cause and formulate a treatment plan. Your dentist will discuss the onset, duration and intensity of pain and may address stress and nutritional issues. Supplemental treatments and physical medicine modalities may include:
Ultrasound TENS (transcutaneous electrical neural stimulation)
Physical Therapy Chiropractic
Relaxation Therapy Hold/Cold Therapy
Nutritional Counseling Spray & Stretch
Various Injections Iontophroesis

Because problems associated with the jaw joints can be progressive, accurate and immediate diagnosis and treatment is crucial. Early treatment will help avoid more damage such as degenerative arthritis.

Dependent on your particular TMD problem, treatment may involve several phases:
  1. To offer proper diagnosis and appropriate treatment to combat head, neck and facial pain
  2. To help patients regain full function
  3. To stabilize the bite
Usually a temporary easy-to-wear splint (orthotic) of clear acrylic is made to fit over the top or bottom teeth until the bite stabilizes and the muscles are relaxed and out of spasm. Permanent correction may involve selective reshaping of the teeth, building crowns (reconstructive), orthodontics, or a permanent appliance. Sometimes following treatments all that is required is wearing a splint at night. Though infrequent, surgery to correct a damaged joint is only needed in about 3% of all TMD cases. Ultimately, with the conservative, non-surgical treatment your dentist provides, the teeth, muscles and joints will all work together.

If you have any of the signs or symptoms mentioned, talk to your TMD dentist.

Source: TMData Resources
 


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