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Recent Articles What Are Temporomandibular Disorders?

Author: ITSMN | Posted: 2007-03-22

You may have seen articles about TMD or temporomandibular (jaw) disorders, also called TMJ syndrome. Perhaps you have even felt pain sometimes in your jaw area, or maybe your dentist or physician has told you that you have TMD.

If you have questions about temporomandibular disorders, you are not alone. Researchers, too, are looking for answers to what causes TMD, what are the best treatments, and how we can prevent these disorders.

TMD is not just one disorder, but a group of conditions, often painful, that affect the jaw joint (temporomandibular joint, or TMJ) and the muscles that control chewing. Although we don't know how many people actually have TMD, the disorders appear to affect about twice as many women as men.

Main Types

Experts generally agree that temporomandibular disorders fall into three main categories:

  • myofascial pain (most common form of TMD, which is discomfort or pain in the muscles that control jaw function and the neck and shoulder muscles)
  • internal derangement of the joint (meaning a dislocated jaw or displaced disc, or injury to the condyle)
  • degenerative joint disease (such as osteoarthritis or rheumatoid arthritis in the jaw joint)

A person may have one or more of these conditions at the same time.

Scientists are exploring how behavioral, psychological and physical factors may combine to cause TMD.

Researchers are working to clarify TMD symptoms, with the goal of developing easier and better methods of diagnosis and improved treatment.

What Is The Temporomandibular Joint?

The temporomandibular joint connects the lower jaw, called the mandible, to the temporal bone at the side of the head. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of your head. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. Muscles attached to and surrounding the jaw joint control its position and movement.

When we open our mouths, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft disc lies between the condyle and the temporal bone. This disc absorbs shocks to the TMJ from chewing and other movements.

What Causes TMD?

We know that severe injury to the jaw or temporomandibular joint can cause TMD. A heavy blow, for example, can fracture the bones of the joint or damage the disc, disrupting the smooth motion of the jaw and causing pain or locking.

  • Arthritis in the jaw joint may also result from injury.
  • Some suggest that a bad bite (malocclusion) can trigger TMD
  • Orthodontic treatment, such as braces and the use of headgear, has also been blamed for some forms of TMD

Disc Problems

Experts believe that most people with clicking or popping in the jaw joint likely have a displaced disc (the soft, shock-absorbing disc is not in a normal position

Stress

Experts suggest that stress (either mental or physical) may cause or aggravate TMD. People with TMD often clench or grind their teeth at night, which can tire the jaw muscles and lead to pain. It is not clear, however, whether stress is the cause of the clenching/grinding and subsequent jaw pain, or the result of dealing with chronic jaw pain/dysfunction.

What Are The Signs And Symptoms of TMD?

A variety of symptoms may be linked to TMD. Pain, particularly in the chewing muscles and/or jaw joint, is the most common symptom. Other likely symptoms include:

  • limited movement or locking of the jaw.
  • radiating pain in the face, neck or shoulders.
  • painful clicking, popping or grating sounds in the jaw joint when opening or closing the mouth.
  • a sudden, major change in the way the upper and lower teeth fit together.

Other may sometimes be related to TMD, such as:

  • headaches
  • earaches
  • dizziness
  • hearing problems

"Temporomandibular joint, or TMJ, dysfunction, can be a cause of secondary headache. Secondary headaches result from underlying disorders which produce pain as a symptom."

According to patient advocate and author Teri Robert, "sometimes, a headache is just that - a headache. Other times, a headache can be a symptom of another condition. In addition, there are different kinds of head pain, and treatments vary depending on the diagnosis. For these reasons, timely and accurate diagnosis is important."

What Are The Conservative Treatment Options For TMD?

The key words to keep in mind about TMD treatment are:

  • conservative
  • reversible

Conservative treatments are as simple as possible and are used most often because most patients do not have severe, degenerative TMD. Conservative treatments do not invade the tissues of the:

  • face
  • jaw
  • joint

Reversible treatments do not cause permanent, or irreversible, changes in the structure or position of the jaw or teeth.

Because most TMD problems are temporary and do not get worse, simple treatment is all that is usually needed to relieve discomfort. Self-care practices are useful in easing TMD symptoms, for example:

  • eating soft foods
  • applying heat or ice packs
  • avoiding extreme jaw movements (such as wide yawning, loud singing and gum chewing)

Learning special techniques for relaxing and reducing stress may also help patients deal with pain that often comes with TMD problems.

Other conservative, reversible treatments include:

  • physical therapy (focused on gentle muscle stretching and relaxing exercises)
  • short-term use of muscle relaxers and anti-inflammatory drugs

Health care providers may recommend an oral appliance, also called a splint or bite plate, which is a plastic guard that fits over the upper or lower teeth. The splint can help reduce clenching or grinding, which eases muscle tension. An oral splint should be used only for a short time and should not cause permanent changes in the bite. If a splint causes or increases pain, stop using it and see your doctor.

What Are The Surgical Treatment Options For TMD?

The conservative, reversible treatments are useful for temporary relief of pain and muscle spasm - they are not "cures" for TMD. If symptoms continue over time or come back often, check with your doctor.

There are other types of TMD treatment, such as surgery or injections, that invade the tissues. Some involve injecting pain relieving medications into painful muscle sites, often called "trigger points." Researchers are studying this type of treatment to see if these injections are helpful over time.

  • When Are Steroid Injections Indicated As A Treatment For Arthritis?
  • What Is Synvisc? Is Synvisc Only Used For The Knee?

Surgical Treatments Are Often Irreversible. When such treatment is necessary, be sure to have the doctor explain to you, in words you can understand:

Irreversible Treatments May Make TMD Worse

Implants

Scientists have learned that certain irreversible treatments, such as surgical replacement of jaw joints with artificial implants, may cause severe pain and permanent jaw damage. Some of these devices may fail to function properly or may break apart in the jaw over time. Before undergoing any surgery on the jaw joint, it is very important to get other independent opinions.

Vitek Implants

The Food and Drug Administration has recalled artificial jaw joint implants made by Vitek, which may break down and damage surrounding bone. If you have these implants, see your oral surgeon or dentist. If there are problems with your implants, the devices may need to be removed. For more information:

  • TMJ Implants- A Consumer Informational Update, From FDA

Other Irreversible Treatments

Other irreversible treatments that are of little value, and may make the problem worse include:

  • orthodontics to change the bite
  • restorative dentistry (which uses crown and bridge work to balance the bite)
  • occlusal adjustment (grinding down teeth to bring the bite into balance)

Conservative, Reversible Treatments Strongly Recommended Before Considering Invasive Treatments

Even when the TMD problem has become chronic, most patients still do not need aggressive types of treatment.