What is TMD?
The temporomandibular joint or TMJ is located at the end of your lower jawbone where it meets the base of the cranium in front of each ear. Each of these joints must make some very special movements to allow the jaw to open and move side to side. This is done by the chewing muscles, and supported by a disc that allows the joint to pivot and slide. TMD refers to problems associated with the TMJ, tendons, muscles, nerves, blood vessels, teeth and the brain as it interacts with some or all of these structures. This pain is often linked to other diseases and can affect other parts of the body. These problems can lead to chronic pain on one or both sides of the face. More than twice as many women than men suffer from TMD. This condition is a very common source of facial pain second only to problems with teeth. The experience can be frightening with significant disability for moderate to severe cases. This area of the body is perceived with greater impact than a hand or leg problem. The amount of brain dedicated to sensory and motor activity far outweighs other areas, resulting in pain seeming to be greater than for a similar injury elsewhere.
Trauma (falling, auto accident, physical activity, fracture) is one of the many causes along with bruxing (grinding of teeth), systemic illness, clenching (holding teeth together firmly), poor bite relationship of the teeth, growth disorders, tumors, arthritis, stress (psychosocial factors), and many others. This problem is common after 30 years of age; however, many children and young adults are affected by TMD.
What are the symptoms of TMD?
- Pain in the TMJ(s) in front of the ear (sharp pain) or earache (anteriorly displaced disk, tendinitis).
- Pain in the muscles of the head or neck (myalgia:headaches and soreness).
- Pain when chewing or opening (yawning).
- Difficulty opening or closing the mouth (muscular,trismus).
- Locked jaw (ankylosis,anteriorly displaced disk).
- Sensitive teeth (hyperemia , periodontal ligament mobility).
- Jaw opens to the side instead of straight up and down.
- Damaged teeth (cracks,fractures).
- Damaged soft tissues (scalloped tongue,ridges inside cheeks,scalloped lips).
- Clicking jaw joints (disc displacement with reduction).
- Impaired nerve function (neuralgia,paresthesia).
- Difficult chewing (teeth do no fit together properly,malocclusion).
- Sensitive facial skin (hyper/hypo esthesia).
- Hyperawareness and anxiety related to the facial pain. Chronic pain can also cause psychological illness as a maladaptive behavior. This in turn can increase habits such as bruxing and clenching, thereby contributing to a vicious cycle of pain and anxiety.
Some or all of the above symptoms may be present. Sometimes pain is referred to other structures. For example pain in some of the chewing muscles can make the top back teeth hurt even though they are clinically healthy. Muscles tend to hurt from overuse and can cause headaches and limit mobility of the jaw. Often your doctor must be a detective to determine the exact cause of pain before proper treatment is done. These skills take many years of experience and postgraduate training to perfect. A complete TMD exam should include a comprehensive history and clinical exam. Often models of your teeth and special TMJ x-rays will be needed to reach a diagnosis. Each patient should receive a customized cost effective treatment plan based on his or her unique history and clinical findings. Be sure to ask your doctor if he is comfortable treating TMD or if a referral is needed. There is not an ADA recognized specialty in TMD treatment, however, there are dentists who have developed a focus in their practice to help patients with these problems.
What are the treatments for TMD?
- A splint (night guard) is used to support the jaw and its related structures in an orthopedically correct posture thereby helping these structures heal faster.
- Tomograms are special radiographs (x-rays) of the TMJ to determine the health of
the bony structures and their posture.
- Medications are used to control pain caused by inflammation and relax the muscles.
- Soft diet to reduce the stress on the jaws.
- Stress management exercises or psychotherapy (cognitive behavioral therapy).
- Physical therapy for the TMJ and muscles and posture training.
- Less frequently when gross abnormalities exist with the jaws or the way the teeth fit together, orthodontics, equilibration (adjusting of the teeth), restorations or more rarely surgery to move the jaws so the teeth fit together in harmony with the TMJ and supporting musculature.
Mild cases often do not require treatment, as they are self-limiting and will resolve on their own. If you have moderate pain or disability a consultation with a properly trained dentist is prudent. Most people experience relief of pain with one or more of the first six treatments mentioned above. The length of treatment can vary from a few months to a longer interval if the symptoms persist. Simple common sense such as soft diet and not chewing gum are very important in helping your dentist treat the problem quickly. Managing stress by organizing your life with lists and resolving sources of conflict are mandatory for people with symptoms that respond to these negative stimuli. Overall one must use therapies that allow the jaw to rest and
heal by removing the irritants that resulted in the initial damage, and clinical treatment that will help speed the natural healing process. Failure to properly treat TMD can lead to exacerbation of the symptoms and continuing damage to the supporting structures. Sometimes the cause is related to a field outside of the dentist expertise. For example the pain could be attributed to a neurogenic problem and your dentist will make the appropriate referral to ensure proper diagnosis and treatment.
Can my TMD problems be cured?
As with many joint related problems, once there has been significant injury we try to manage the symptoms with therapy but often these problems will return when these structures are stressed beyond the body’s ability to repair. Joints often will not heal to 100%. Most joints have been damaged from chronic illness over many years, and may never perform as before the damage occurred. This means one must be vigilant for the recurrence of symptoms and apply the appropriate therapy. Routine dental appointments will allow the dentist to monitor your condition and maintain your wellness. You should inform your doctor if a procedure needs to be done that could hurt your pre-existing TMD problem. This includes, routine dental work, cleanings and extractions. Care should be taken not to reinjure yourself during intense physical excursion such as participation in sports.
The above article represents a brief overview of a very complicated subject; you should consult a qualified dentist for an appropriate diagnosis of your problem.
Splints are appliances that are permanently or temporarily attached to the body. They are used to posture the body in a position to support and protect a structure that needs to heal. In the case of your temporomandibular joint (TMJ-jaw joint) the splint can be plastic or metal and fit over the bottom or top teeth. The TMJ splint postures the jaw during swallowing and chewing in a position that is less traumatic to the teeth, TMJ and muscles. It also acts as a preventive appliance to reduce grinding and clenching of teeth.
Often people have a bad fit between their top and bottom teeth or clench and grind their teeth excessively. This condition can result in sore jaw muscles, headaches and a sore TMJ. Swelling in the TMJ and spasm of the jaw muscles can further alter the bite of your teeth by moving the lower jaw. As the pain and swelling improve, the jaw shifts position and the bite changes. To accommodate these changes we make appointments for the patient to have the splint adjusted to the new jaw position. When the pain goes away and the jaw posture is stable between appointments the need for adjustments to the splint decreases and eventually stops. This process can take from one to three or more months. Once this final posture is reached we may decide to do something to the teeth which would allow them to meet in the same jaw position established on the splint. These options will be discussed with you at that time. Some people must continue to wear a splint for extended periods of time to protects themselves from destructive clenching or grinding habits.
|TMJ SYMPTOMS AND PHYSICAL THERAPY||
TMJ problems develop for many reasons. Whether problems arise from a large trauma (auto accident) or small trauma, (clenching or bruxing), the jaw joints and muscles can experience inflammation, pain and sometimes swelling. Muscles surrounding the TMJ respond by contracting in an attempt to protect these painful joints. Soon the muscles go into spasm. This muscle spasm produces even more pain and thus a viscous cycle of pain, muscle contraction and muscle spasm begins. Because the muscles become tight, the joints are unable to move freely and frequently the jaws become stiff which limits the ability to open one’s mouth. Physical Therapy helps to reverse some of these responses to joint trauma.
|WHAT IS DONE?||
Heat and cold treatments help to reduce pain, inflammation, muscle spasm and increase circulation. These may include ice, hot packs, and ultrasound.
Joint and soft tissue mobilization is a hands on technique to loosen restrictions in muscles and the jaw joints, that can lead to stiffness and pain. These techniques improve movement and decrease pain.
Exercises have benefits beyond increasing strength. They help improve flexibility, strengthen muscles to improve head and neck posture, help your jaw stay aligned, and improve coordination.
Postural Training not only helps improve posture of your head, neck and shoulders, but the posture of your jaw, too.
A Licensed Physical Therapist will evaluate your specific needs, and apply these techniques to help you achieve optimal health.
|WHAT IS BIOFEEDBACK?||
A process of using sensitive non-invasive physiological monitoring instruments to "tune into" moment to moment changes that we usually are not consciously aware of. The biofeedback therapist assists people in learning self/body control.
|WHAT PROBLEMS CAN IT TREAT?||
Biofeedback has been found by research and practice to help a person gain a measure of self/body control of many stress-related medical illnesses. These include headache (migraine and tension), high blood pressure, irritable bowel syndrome, and palpitations.
|WHO SHOULD CONSIDER BIOFEEDBACK?||
Persons who are willing to assume more responsibility for their health and who want to be active participants in their own health care. Biofeedback can be an effective adjunct to dental treatment and help a person develop non-chemical and non-surgical methods of improving their well-being.
|HOW LONG DOES TRAINING TAKE?||
A series of sessions with an experienced clinician is usually required to acquire the unique skill of self-regulation. A person usually spends 6 to 12 sessions, the first session lasting 90 minutes and subsequent visits lasting 50-60 minutes one time per week. When techniques have been mastered, instruments and the therapist are no longer needed.
|HOW DO I GET STARTED?||
Referral by your dentist is required. This enables the therapist to work closely with your doctor in regard to special considerations such as medications and dosages.
|IS IT COVERED BY INSURANCE?||
Many policies cover 50-80% of the cost. For further information, check with your insurance company.
|IS SELF-REGULATION OF MY BODY DIFFICULT TO LEARN?||
Usually not. By following instructions of the biofeedback therapist, most people experience good results. Some people who have their own will-developed but disfunctional methods of self control sometimes take longer to shift to the better and easier self-regulation methods offered through biofeedback.
|CAN IT HELP WITH STRESS MANAGEMENT?||
Identifying toxic stressors in our lives, as well as developing stress management strategies using new self-regulation skills, is an integral part of biofeedback therapy.