Joint Session: TMD

The subject is jaws. No, this won’t be about giant man-eating sharks. We’ll discuss, instead, the temporomandibular joint. That giant term for is nearly as scary as the movie shark, so let’s call it the TMJ, as the pros do. It’s where the jawbone (mandible) joins the temporal bone of the skull.  TMJ disorder, or TMD, is a condition all too familiar to dentists. When you finish reading this, you’ll know all about it, too.
 
You can easily feel your own TMJ working. Touch the side of your head, just in front of your ear, and press very lightly. Open and close your mouth. Feel it? It’s like a hinge, but it’s much more versatile than the ones on your car door. Keeping your finger in place, move your chin from left to right and back. Your finger’s picking up some different moves now. And there’s more! Jut your chin forward, then pull it back toward your throat. Amazing.This joint works in three dimensions.  It’s a mechanical marvel. In fact, it’s the most complex joint in the human body.
 
TMD SIGNS AND SYMPTOMS
It’s pretty strong, too. Human beings can chomp down with their molars at forces in excess of 170lbs. If we somehow increased that pressure, our teeth would break long before the TMJ even worked up a sweat.  It’s strong, but not invulnerable. Several types of problems crop up in the TMJ. These, collectively, are TMD. Temporomandibular Joint Disorder.
 
The common signs and symptoms of TMD are:

• Pain, particularly with jaw movement
• Clicking sounds with jaw movement
• Popping sounds with jaw movement
• Swelling in the side of the face
• Limited or restricted jaw range of motion
• Changes in the meshing of upper and lower teeth
• The pain of TMD is often quite severe. It can radiate from the joint to the neck and shoulders. Headaches and dizziness can come along with this pain.

 
HOW COMMON IS TMD?
It’s hard to pin down. For one thing, as stated earlier, TMD is a big tent covering a variety of conditions. There are three general categories. It depends on which parts (tissues) are involved.  One type involves the upper end (condyle) of the jaw bone plus the  “shock absorber” disc between the jawbone and skull.  The issues are dislocation, displacement, or other injuries.  Another category of  TMD involves the muscles that move the jawbone, and the membranes (fascia) covering these muscles. The third category is led by arthritis. Both osteoarthritis and rheumatoid arthritis can develop in this joint.
 
Thus, there’s no standard definition of TMD, so counting cases is tough. Most experts agree that at a minimum, about 5% of US adults have had TMD with severe pain. Something in the neighborhood of half of all Americans complain of TMD symptoms at least once in their lives. The data indicates it’s more common in females than in males.
 
CAUSE: GRINDING
Experts agree that one common cause of TMD is bruxism. That’s grinding or clenching the teeth. As noted earlier, the human jaw is a very powerful vise. When we clench our teeth we create forces 10 times more powerful than when chewing normally. It may seem strange, but the fact is many people aren’t even aware they’re doing this. It’s less strange when we clench or grind in our sleep, of course, and that’s when a lot of it goes on.  A typical pattern is clenching by day and grinding at night, all involuntarily. Why do we do this? A few reasons. Anxiety and stress are certainly related to bruxism.  Some other links are with:

• Abnormal bite
• Sleep apnea
• Missing or crooked teeth
• Snoring

 
CAUSE: TRAUMA
Ss many as half theTMD cases seen by health professionals involve trauma. A hard blow to the jaw or side of the head can badly injure the TMJ joint. Whiplash, too. Here’s an irony: sometimes patients get TMD in the dentist’s chair. Dentists sometimes have to hold a patient’s mouth wide open for long periods to complete certain procedures. This, too, can strain the TMJ. Serious freestyle swimmers normally rotate their heads to catch a breath of air. Some, apparently, also thrust their jaws to the side, and manage to strain their TMJs. Some people get TMD after snorkeling, perhaps from unconsciously clenching their teeth on the snorkel mouthpiece.
 
CAUSE: ARTHRITIS, ETC.
In some cases of TMD, the cause is neither grinding nor trauma. The Temporomandibular Joint (TMJ) is, after all, a joint. All that can go wrong with joints can go wrong with the TMJ. The list is headed up by rheumatoid and osteoarthritis. Various psychological, sensory, genetic, and nervous system conditions appear to increase the risk of developing TMJ. Hormonal issues are another suspect – this may explain why more women get TMD than men do.
 
DIAGNOSIS
When our experienced Royal Palm Beach dentists suspect TMD, they review the patient’s history and symptoms. In addition, they conduct a careful visual examination. Patients are often not aware they grind or clench their teeth.  Bruxism, though, leaves telltale signs of wear and tear on tooth surfaces. In some cases, however, dentists have to do special imaging to check the condition of the joint and tissues around it. Panoramic imaging, for example, helps sharpen the diagnostic details and so to refine the treatment.
 
WHAT HAPPENS NEXT?
Fortunately, in many cases TMD goes away by itself, untreated, and pretty quickly. In a day or two. When it doesn’t resolve this way the risks of ongoing health issues increase, including:

• Chronic jaw pain
• Difficulty and discomfort when chewing
• Severe headaches
• Back, shoulder, and neck pain
• Ringing in the ears

Issues like these can snowball. Patients who have trouble eating can slip into malnutrition. Posture can be affected, resulting in orthopedic problems. Habitual grinding and clenching can lead to broken teeth, and accelerate decay.
 
TREATMENT: MILD CASES
Mild cases call for mild treatment. Management, really. The aims are to ease any discomfort and to avoid making the situation worse. A short course of OTC meds such as NSAIDS is often very effective in relieving pain and reducing swelling. Ice packs can be helpful. It makes sense to give the jaw as much of a rest as possible. Hence, sticking to soft foods, and avoiding shouting, singing, and chewing gum, anything that puts the jaw to work. Patients should focus on awareness and catch themselves clenching, grinding, or clicking teeth during the day. Some find it helpful to learn and practice stress reduction techniques. This management approach is well suited to mild TMD cases. It usually rewards a patient with a quick return to normal.
 
TREATMENT: SEVERE CASES
TMD of middling severity calls for a focussed treatment approach. Dentists can prescribe stronger pain and anti-inflammatory medications when NSAIDs aren’t enough. Physical therapy is sometimes recommended, exercises to stretch and relax the jaw muscles. Dental appliances, (bite guards) are the most common short-term “hardware” solution, intended to deter the patient from clenching and grinding.
 
More severe, more persistent cases of TMD call for more aggressive tactics. Dentists can prescribe stronger medications for pain and inflammation when NSAIDs aren’t enough. Bite guards are very useful counters to grinding and clenching.  Physical therapy is an option to stretch and relax jaw muscles.
 
The most serious and unresponsive cases of TMD  require “irreversible” therapies. These make changes to the structure of a patient’mouth and jaw. Orthodonture, for example, when a misfit bite (malocclusion) is causing the TMD. Another strategy involves appliances that reposition the jaw itself. Sometimes, though, the best or only solution is surgery.
 
SUMMING UP
Temporomandibular Joint Disorder (TMD) is a label that covers a variety of conditions affecting that joint. Some of the causes it can be avoided, like chewing of hard foods. Accidental trauma, by definition, can’t be avoided, but with basic prudence, one can reduce its likelihood. There’s increasing confidence in the medical community that we may soon have a better understanding of how arthritis can be prevented. What we can all do, now, is have the regular dental checkups that’ll enable early detection and treatment of things like bruxism and misaligned teeth. If we can nip it in the bud, we’ll have a much better outlook for a TMD-free future.