Temporomandibular disorder or TMD is a broad term referring to problemswith the jaws and their functioning. It is commonly referred to as"TMJ".This system is very complex and problems are caused by avariety of factors. This web page will attempt to give you a general overviewof TMD so you can better understand the problems you may have been having.
The TemporomandibularSystem
The temporomandibularsystem consists of three basic components; the temporomandibular joint or TMJ,the teeth, and the neuromuscular system.
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| Muscles of Mastication and TMJ |
TMJ- This is the term often used to describe TMD, but itspecifically refers to the joints that work your lower jaw, or mandible. Thesetwo joints are found just in front of the ears. Their close proximity to theear is why some patients experience ear symptoms and can often hear the jointpop or crack. These two joints never act alone, that is, when your jawfunctions, both joints will be working. There is a small cartilage disc betweenyour lower jaw and skull in the joint. Some TMD problems are caused bydysfunction of this disk. When healthy it acts as a sort of "shockabsorber" for the joint.
Teeth- The teeth are like the third leg of a tripod, theTMJ’s being the other two legs. The alignment of your bite and the functioningof the TMJ’s are intimately connected. Problems in any of the three areas mayaffect the other two.
Neuromuscular- This system is the nerves and muscles whichwork the temporomandibular system. It is important to realize that only thelower 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 andmuscles are involved in moving the lower jaw only. The nerves transmit themessages for the muscles to move the jaw. They also transmit pain signals tothe brain causing you to feel discomfort. The muscles are fairly large and arefound from the side of your head down to your neck. Other related muscles thatdo not specifically work the jaw, but are sometimes symptomatic are found inthe neck, face, and upper back.
What Defines TMD
A wide spectrum of specific and non specific disorders thatproduce symptoms of pain and dysfunction of muscles ofmastication,Temporomandibular joint and other associated structures.
Symptoms andsigns of TMD can include some or all of the following.
Jaw pain and/or stiffness |
Headaches, usually at the temples and side of head |
Vague tooth soreness or toothaches which often move around the mouth |
Sensitive teeth |
Painful or tender jaw joint |
Difficulty opening jaw |
Pain and fatigue when eating hard or chewy foods |
Clicks, pops, or grinding sound in jaw joint |
Ear pain |
Cervical neck tension and pain |
Tooth wear |
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 varyingdegrees of severity. Basically TMD is a problem when you either experience painand/or a loss of jaw function. The pain can range from a mild ache in themorning to a chronic debilitating pain. Loss of function can be mild jawstiffness to being unable to open the jaw barely at all.
The symptoms of TMD can be an obvious jaw pain in themuscles near the mouth, but can also often exhibit as headache at the temples("temporal headache"). This is due to inflammation in the large jawclosing temporalis muscle which is on either side of your head. To find thismuscle place your hands on your temples and clench your teeth hard and you willfeel this powerful muscle contract. Patients often feel this symptom is atension headache or sinus headache but it can be easily differentiated during aTMD exam. Patients understandably (and many doctors) fail to make thisconnection between TMD and headaches.
The pain of TMD can come from either the muscles or the TMjoint itself; often it comes from a combination of the two. The muscles canache due to causes discussed below. Pain in the joint is usually due toinflammation within the structure itself. Sometimes the symptoms are found inother facial structures; such as dull ear pain, toothache, neck pain, etc. Thisreferred pain is fairly common but it is important to rule out medical and/ordental causes of these pains prior to TMD treatment.
Loss of jaw function can be due to muscular and/or jointproblems as well, just as pain can. The degree to which each is involved isdetermined through thorough history and exam.
Causes of TMD
Temporomandibular disorders rarely have a single cause. Anyone of the following factors may contribute to TMD. Each patient presents withan individual combination of factors that are determined during history takingand clinical exam.
Trauma - Acute trauma to the jaws such as a car accident, afall, a punch, etc. can cause damage to the muscles and/or joint. The acutepain and loss of function is usually responsive to conservative treatment.Sometimes trauma to the joint can cause chronic damage which may eventuallycontribute to a TMD problem at a later time.
Bruxism - Bruxism refers to a non functional grinding andclenching of the teeth. Some do this while awake but more often it is donewhile 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 wearthe enamel from their teeth. This bruxing is done by the jaw muscles and by themorning they can be painful due to fatigue. This constant pressure also candamage 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 positionof the joints it can place pressure on the joints. Missing teeth can sometimescontribute to this as well. The misalignment can also put strain on the jawmuscles. This factor can be mild to severe. Though the bite is an importantpart of the whole system it is only altered after conservative measures andonly if it is felt improvement will result. In some patients discrepancies(known as interferences) become apparent after wearing the NTI device for a fewmonths and a bite adjustment is recommended. Treatment of the bite for TMD isusually not needed but its contribution to the whole must be examined.
Emotion - Emotional stress often plays an integral role inthe development of TMD. This occurs due to two basic reasons. Stress increasesboth the severity and duration of bruxism while asleep. Also, many willsubconsciously clench and/or grind their teeth more while awake during times ofstress. The other way stress contributes to TMD is that during times of stressyour adaptability and pain threshold will go down. As a result you are morelikely to experience symptoms of TMD if other factors already exist (bruxing,joint damage, etc.).
Emotional conditions beyond daily life stress can contributeto TMD as well. Depression, anxiety disorders, and the like can often have TMDproblems arise. These conditions are quite stressful and it is not hard toimagine why TMD would develop.
Ergonomic - Your job and how you do it can contribute to TMDand related problems. If you work at a computer all day, for example, you maybe holding your head in such a way that places strain on your TM system.
TMD Treatment
Treatmentplans for TMD are as varied as the patients that present with it. Each patientmust be treated differently depending on the uniqueness of their problems andthe contributing factors. Pain Relief Info.
It is veryimportant to realize that the goal of TMD treatment is to minimize pain andestablish a return to function. TMD conditions are not "cured" butare managed instead. The basic goal is to allow the muscles and joints to healthrough 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. Wealso want to teach you to recognize the symptoms early and manage them yourselfonce we give you the tools to do so. This condition can often recur later onbut early care can minimize the severity.
The basicphilosophy of treatment is to do the conservative and reversible treatmentsfirst. Irreversible treatments, such as surgery or orthodontics, are onlyconsidered if conservative steps have failed to bring lasting relief. Thesemore radical treatments are rarely used. Most patients respond well to simplercare.
Thefollowing treatment modalities may be used in each case.
Conservativetreatment
- Patienteducation and self care
- Rest andrelaxation
- Cognitive behavioralintervention
- Pharmacotherapy
- Occlusaltherapy
- Occlusal therapy
- Orthopedic appliances
- Physiotherapy
- Rehabilitationof Denatal deficits
- Managementof trigger points
SurgicalTreatment
- Arthrocentesis
- Arthroscopy
- Arthroplasty
- Discectomy
- Condylectomy
Occlusal Splint - Also called a night guard is designed toprotect the teeth from further wear. These also will reduce the severity ofgrinding at night and allow the muscles to rest. In more severe cases it needsto be worn all day as well to allow the TMJ and muscles to rest.
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