Temporomandibular Disorder
(TMD)
Classic Symptoms of TMD
TMD symptoms can stem from the temporomandibular joints (TMJ), masticatory muscles, or both. Successful treatment relies not only on determining the anatomy underlying the discomfort, but also what factors are causing or perpetuating it. Only then can obstacles be removed to allow the situation to improve and the body to begin healing itself.
What is TMJ?
TMJ is neither a disease nor syndrome; it stands for temporomandibular joint. It is the joint in front of the ear that allows the jaw to move. These joints, one on the right and one on the left, are comprised of the mobile mandible (lower jaw bone) and the stationary temporal bone of the skull. Like all joints in the body, they are moved by muscles and stabilized by ligaments.
These joints are built to perform and adapt with the forces and load involved in routine mandibular function. The TMJs are unique in that both joints are moving during use. The hard and soft tissues of the TMJs work together and reciprocally when executing intricate and complex actions like chewing, speaking, and facial expression. One side cannot be isolated from the other, meaning, we cannot choose to move only the right or left side during mandibular activity.
The temporomandibular joints are arguably the most frequently used joints in the body, either consciously or subconsciously. The temporomandibular system can be compromised by overuse, disease, or trauma. The resultant temporomandibular disorder or dysfuction (TMD) is typically associated with pain and/or limited jaw function. Characteristics or symptoms of the condition are diverse and unique to each patient. The exact cause of a person’s TMJ disorder (TMD) is often multifactorial and can be difficult to determine, which is why a comprehensive evaluation is imperative for correct diagnosis and treatment plan.
Muscles of Mastication
The muscles attach to the lower jaw (mandible), upper jaw (maxilla), skull and neck. The muscles of mastication open and close, protrude, and laterally move the jaw, enabling you to talk, chew, and swallow. The neck and shoulder muscles support the muscles of mastication by stabilizing the skull during movement, jaw function, and postural changes.
Myalgia and Myofascial Pain
Muscle Pain and Referred Muscle Pain respectively, are chronic in nature. Myalgia can involve a single muscle or group of muscles. It can result from acute strain or chronic over- use or misuse of muscles (e.g. poor posture, stress, subconscious fatiguing behaviors).
The location of pain may not be the origin or source of the pain. Myalgia motivates the development of trigger points which cause pain in other areas (referred pain). Painful muscles can restrict mandibular movements as a means of protection. This guarding reaction is called protective co-contraction which is one of the reasons patients experience difficulty opening, changes in your bite, or pain during function.
Cervicalgia
Neck pain and TMD often go hand in hand. The bones, muscles, ligaments, and nerves of the neck and jaw display significant interaction. In fact, cervicalgia and TMD coexist in a profound number of patients. When you view the entire body as a unit of interrelated structures working together, you can appreciate how the neck and jaw function dependently on one another. Injury or diminished function in one group of muscles will be compensated by neighboring muscles making them vulnerable to overwork and pain onset. There is also a recognized pattern of pain referral between the neck and face, specifically the muscles of
mastication.
A comprehensive orofacial pain exam includes full evaluation of the cervical muscles and their range of motion. Determining the level of cervical involvement in an orofacial pain complaint can make or break treatment success. Treatment focused on the wrong target can never be expected to succeed.
Bruxism
Clenching and grinding of the teeth are parafunctional habits. These are muscle driven activities that may be consciously or often subconsciously done but don’t serve a functional purpose. Other activities in this group include lip or cheek biting and posturing of the mandible (lower jaw).
The intensity and frequency of parafunctional activity varies for each patient and can be exacerbated by stress and anxiety, changes to sleep, diet, and medications. For a long time, clenching and grinding activity has been associated with jaw pain and TMJ disorders. While for some, this is true, other patients have evidence of activity, but no complaints of pain. The research suggests that parafunctional habits are common and do not necessarily result in TMD symptoms, but may serve as the initiating or perpetuating factor for a certain group of patients. We will assess and treat the suspected activity based on the signs and symptoms present even in the absence of pain.
Treatment for TMD
All of our patient relationships begin with extensive, one on one conversations. Gathering a thorough history and physical evaluation is vital to our success. Knowing the person not just the symptoms allows us to determine together which treatments to choose, how they are sequenced, and when they should be modified for the best possible outcome.
TMJ problems are the result of tired, injured or sore muscles, inflamed tendons, or compromised ligaments, bone and cartilage. As the cause of TMD is multifactorial, it can be impossible to pinpoint how much of which factor deserves the most attention; therefore, our treatment approach is conservative, reversible, and minimally invasive.
Options include:
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Physical self-regulation strategies
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Jaw exercises and physical therapy
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Medications (oral, topical, injectable)
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Oral appliance (bite splint)
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Massage
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Acupuncture
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Trigger point injections for pain and muscle tension in the jaw and neck
muscles
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Botox injections in the jaw muscles
