TMD Orofacial Pain & Tempromandibular Disorders

TEMPOROMANDIBULAR DISORDERS (TMD)  are a common subgroup of orofacial pain disorders, often incorrectly referred to as “TMJ”. TMJ is the commonly used abbreviation for temporomandibular joint or jaw joint. There are two basic types of TMD: MYOGENOUS TMD (muscle generated pain) and ARTHROGENOUS TMD (jaw joint generated pain). 

MYOGENOUS TMD usually results from overwork, fatigue or tension of the jaw and supporting muscles resulting in jaw-ache, headache and/or posterior neckache. ARTHROGENOUS TMD usually results from inflammation, disease or degeneration of the hard of soft tissues within TMJ. Capsulitis/Synovitis (inflammation), disc dislocation (internal derangement) and degenerative arthritis are the most common arthrogenous disorders of the TMJ. 

TMD Symptoms include pain or discomfort in or around the ear, jaw joint, and/or muscles of the jaw, face, temples and neck on one or both sides. The pain may arise suddenly or progress over months to years (crepitus), locking, limited or deviant jaw opening and chewing difficulties are also associated with TMD.

CAUSES FOR TMD are unclear as TMD usually involves more than a single symptom and rarely has a single cause. TMD is believed to result from several factors acting together, including jaw injuries (trauma) and joint disease (arthritis). Tooth clenching/grinding (bruxism) and head/neck musle tension, while not scientifically proven to be a cause of TMD may perpetuate TMD symptoms and often need to be controlled to reduce and manage TMD. It is important for the TMD sufferer to understand that the disorder can be chronic in nature and highly dependent upon multiple factors including emotional stability. Because there is no quick fix or immediate cure for TMD, the most successful and scientifically proven treatment techniques focus on self management and control of aggravating factors.

FACTORS ASSOCIATED WITH TMD

  • Trauma: Direct trauma to the jaws has been scientifically associated with the onset of TMD symptoms. Direct trauma to the jaw can occur from a blow to the jaw, hyperextension or overstretching of the jaw, and in some cases, compression of the jaw. Lengthy/forceful dental procedures, intubation for general anesthetic and surgical procedures of the mouth, throat, and upper GI can also traumatize the TMJs.
  • Abnormal Habits: Habits such as tooth/jaw clenching, tooth grinding, lip biting, fingernail biting, gum chewing and abnormal posturing of the jaws are common but have not been scientifically proven to result in TMD. However, these jaw habits are often associated with TMD and may be contributing factors that perpetuate and aggravate ongoing TMD symptoms. 
  • Occlusion: Dental occlusion refers to the way in which the teeth fit together or the bite. Historically, the dental profession has viewed abnormal bite as a primary causative factor in TMD. Recent research studies however do not confirm that malocclusion causes TMD. In large population studies, most patients with TMD have normal occlusion and the majority of people with malocclusion do not have TMD. 
  • Psychological Factors: Many patients report onset of jaw dysfunction symptoms or aggravation of preexisting TMD symptoms with increases in emotional stress, depression and/or anxiety. Scientific studies indicate that TMD patients experience levels of depression/anxiety that are higher than the non-TMD population. To date, it has not been established whether depression/anxiety is present prior to the onset of TMD and contributes to its cause, or whether the chronic pain associated with TMD leads to depression and anxiety. Many patients will experience increased tooth clenching and grinding during periods of emotional stress, psychological imbalance or pain.
  • Diseases of the TMJs: Several types of arthritis may develop in the TMJs like any other joint in the body. It is common for osteoarthrosis to be present in the aging population. Many other diseases such as Parkinson’s Disease, Myasthenia Gravis, strokes, Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease) may lead to excessive or uncontrollable jaw movements. Diseases such as Tetanus (lock jaw) may lead to uncontrollable jaw muscle contracture.
  • Other Factors: Abuse of drugs and the use of certain prescription medications can affect the central nervous system and muscles to contribute to TMD.

MANAGEMENT OF TMD

Because there is no known “cure” for TMD, management of patients with TMD symptoms is similar to management of patients with other rheumatologic disorders. The goals of TMD management include decrease in pain, decrease adverse pressure or loading on the jaw joints, restore functions of the jaw and restore normal daily activities. These goals are best achieved by identifying all contributing factors and implementation of a well defined management program to treat physical and emotional/psychological factors. The management options and sequence of treatment for TMD are consistent with other musculoskeletal disorders found in the body. As in many musculoskeletal conditions, the signs and symptoms of TMD may be temporary and self limiting, without serious long term effects. For these reasons, special effort should be made to avoid aggressive or nonreversible therapy such as surgery, extensive dental treatment or orthodontic treatment. Conservative management techniques such as behavior modification, physical therapy, medication, jaw exercise and orthopedic appliances have proven to be safe and effective in the majority of TMD cases. Most patients suffering from TMD achieve good long term relief with these reversible therapies. Scientific research demonstrates that over 50% of TMD patients treated with conservative management have few or no ongoing symptoms of TMD.

Remember, a proper diagnosis is essential in the treatment/management of TMD/Orofacial pain.

TMD EVALUATION at the Oral Medicine/Orofacial Pain Clinic at UIC Craniofacial Center includes:

  • Comrehensive History of all jaw/head/neck symptoms, medical history, dental history, personal history, family history and psychological history.
  • Comprehensive Physical Evaluation of the TMJs, cervical spine, muscles of the jaw/head/neck, neurological-neurovascular structures, teeth, gums, and soft tissues.
  • Psychological Evaluation including a brief interview and testing when indicated.
  • Additional Tests may include X-rays and diagnostic imaging, biopsies, blood tests, urinalysis, neurological tests and diagnostic injections.

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