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Temporomandibular Joint Disorder

The Patient’s Guide To

Symptoms, Causes and Diagnosis

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CONTENTS

Introduction 2 Symptoms 2Jaw noises 2TMJ Pain and Other Symptoms 3 Causes 3WhosuffersfromTMD? 4Joint Anatomy 4ImpactonYourBite&SmileEsthetics 4WhodiagnosesTMD? 5Diagnosis 5Treatment 6

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IntroductionTemporomandibular joint disorder (often abbreviated as TMJ, TMJD or TMD) involves conditions affecting the temporomandibular joint, jaw muscles and nerves on one or both sides of the head that result in jaw, face, and head and neck pain.

The pain and discomfort may be mild to severe, can be intermittent or constant, and may last for many years. According to the Academy of General Dentistry (AGD), TMD symptoms may recur during stressful times, whether good or bad.

SymptomsThere are a variety of TMD symptoms, the severity and affects of which vary widely from one person to another. The jaw pain, discomfort and/or malfunction associated with symptoms typically

leads people to seek medical assistance, which can confirm a diagnosis of TMJ disorder and jumpstart the treatment process.

The American Dental Association (ADA) cites the temporomandibular joint (TMJ) as one of the most complex joints in the body. Involved

in its function are several muscles, ligaments and bones. The joint itself is comprised of a disc between a ball and socket, and it is this disc that cushions the forces on the joint, enabling the jaw to move and function normally. Any conditions that prevent these components from working properly may cause a disorder.

Jaw NoisesIt’s important to note that not all jaw noises – whether clicking or popping – are a sign of TMD, especially if you don’t have any symptoms. Also, it’s not uncommon to experience some discomfort in the jaw joint or chewing muscles from time to time. For example, your jaw might feel sore after chewing a lot of gum or taffy for long periods of time. If the pain is severe and lasts longer than a few weeks, see your dentist.

Anatomical factors within the joint or surrounding also may interfere with the bite and cause TMD. Some disorders may be caused by arthritis and dislocation, while other instances may result from disease. For example, low-level infections and auto-immune diseases are among the possible causes of TMD noted by the TMJ Association. In addition, some people may be genetically predisposed to TMD.

However, the AGD notes that some mental or physical activities that trigger stress or induce parafunction may cause or aggravate TMD, since most of the pain associated with the condition results from overusing the jaw muscles - such as when clenching or grinding the teeth – which typically occurs under stress.

Proper and Healthy Function Depends on the Balance of Your:

• Jaw Joints• Jaw Muscles• Teeth

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TMJ Pain and Other SymptomsThe most common symptom of TMJ disorder is pain in the chewing muscles or jaw joint, the onset of which is typically the first step toward diagnosis. TMJ pain is usually described as a dull ache in the temporomandibular joint and surrounding areas, such as the ears, neck and shoulders. Some people may have no pain, but still experience jaw functionality difficulties.

Other symptoms of TMJ disorder include:

• Pain or soreness in the jaw that is more prevalent in the morning or late afternoon• Clicking or popping when opening or closing the mouth• Sensitive teeth in the absence of dental problems• An earache in the absence of an infection• Ringing in the ears or ears feeling like they are blocked/plugged• Difficulty opening and closing the mouth and/or chewing• Upper and lower teeth that do not align properly• Stiffness or “locked” feeling in the jaw when talking, yawning or eating• Jaw pain when chewing, biting or yawning• Recent changes to the bite• Frequently waking up with headaches or experiencing frequent tension headaches

CausesAccording to the Academy of General Dentistry (AGD), though trauma to the jaw or jaw joint – such as a jolting injury to the head, face or neck – sometimes plays a role in TMD, in most instances the cause is unknown.

The most common factor contributing to TMD is a bite problem affecting the joint itself. Interferences in the structure of individual teeth may force displacement of the lower jaw, leading the muscles to reposition the joints out of their sockets to force the upper and lower teeth to fit together. Also, wear and tear on the teeth caused by aging, teeth grinding and clenching, or activities outside of normal function – called parafunction – may cause uneven surfaces on the teeth, leading to interferences in the bite and improper jaw closure.

Chewing Muscles

Temporalis: This fan-shaped muscle is located on the side of the skull. It lifts and lowers the jaw, as well as pulls the lower jaw backward. Over-activation of this muscle is responsible for headaches in many people.

Masseter: This is the main muscle for chewing that closes the mouth, and it exerts tremendous force when biting down.Internal (medial) pterygoid: This muscle lifts the lower jaw to close the mouth.External (lateral) pterygoid: This is the muscle that lets you open your mouth and move your lower jaw forward, as well as from side to side.

Causes of an Unbalanced Bite:

• Unbalanced dental treatment• Allergies as a child• Tumb sucking or other oral

habits• Olddentistrythathasbroken

down or worn out• Theshiftingofteethafter

tooth loss• Sometypesoforthodontic

treatment

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Non-Muscular CausesInternal Derangement: Associated with a displaced disc in the jaw joint, a dislocated jaw or an injury to the condyle, which is the part of the lower jaw that acts like a hinge.Arthritis. Involves degenerative and inflammatory joint conditions.

Who Suffers from TMD?The AGD estimates that more than 10 million Americans suffer from TMD. Additionally, the TMJ Association predicts that as much as 65 to 85 percent of the U.S. population will experience some type of symptom in their lifetime.

It affects twice as many women as men and is most prevalent among people between the ages of 20 and 40.

Joint Anatomy

The temporomandibular joint slides and rotates in front of the ear on either side of the head. It consists of the temporal bone on each side of the skull and the lower jaw, which is also known as the mandible.

Four different chewing (mastication) muscles are paired on each side of the head and connect the lower jaw to skull. These muscles enable you to chew, open and close your mouth, and move your jaw forward, backward and side to side.

Because this area of the head and face contributes to chewing, jaw movement and bite (occlusion), TMJ

disorders may cause pain at rest or during common movements such as talking, chewing and yawning.

Impact on Your Bite & Smile EstheticsCertain causes of TMD also may affect your bite and subsequently impact the longevity of your teeth and dental restorations. If your dentist identifies problems such as wear, tooth mobility, muscle pain or other signs of malocclusion, your bite may need to be adjusted.

Ensuring a stable bite is essential to your oral health and the long-term durability and functionality of your teeth and dental work. Additionally, maintaining a stable occlusion and

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a proper bite helps ensure that your upper and lower teeth will come into contact in the most comfortable and pain-free manner possible. When the bite is out of

balance, it can also affect your posture, which further affects your muscles and can cause additional pain and strain in the body, including headaches.

Who Diagnoses TMD?Patients may see multiple healthcare professionals in their quest for relief, including primary care physicians; ear, nose and throat specialists; neurologists; pain specialists; and chiropractors, among others.

However, your dentist can diagnose and treat most cases of TMD. In fact, according to the TMJ Association, Ltd., most patients are diagnosed and treated by dentists and

oral surgeons. If other health conditions exist, the person also may be treated by another medical professional.

Diagnosis

The ADA emphasizes that TMD diagnosis is essential before treatment. However, there currently is no widely accepted standard test to identify all TMD conditions. Most tests are designed to eliminate other conditions as possible causes of the symptoms.

For example, facial pain can be a symptom of such conditions as sinus infections, certain headaches or tooth decay.

Regardless, a diagnosis can begin with a visit to your dentist, with whom a thorough oral health examination will be performed. The clinical examination will include an assessment of joint and muscle tenderness, clicking and popping, and ease of movement.

In addition, part of the examination should include your own description of your symptoms. X-rays also may be taken, as well as impressions of your upper and lower teeth, so that cast models can be made to study your jaw-to-bite relationship. These molds will be mounted on an instrument called an articulator, which is a device that mimics the jaw’s movement and joint closure. The dentist also may use a specialized computer bite analysis. This allows the dentist to measure forces on your teeth, proper balance of your bite and timing of your bite.During this study, your dentist can determine if a structural disorder exists within the joint itself, or if deflective interferences in the bite – such as uneven teeth – are affecting the joint’s ability to close properly, causing the TMD.

It Starts by Gathering Scientific Data

1.Carefulobservationsofsignsand symptoms2.Specialradiographsofyourteeth and jaw joints3.Detailedcastsofyourteeth4.Neuromusculartestingusingthe advancedinstrumentation

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Your complete medical history may be reviewed, and your dentist also may require specialized X-rays, a CT (computed tomography) scan or MRI (magnetic resonance imaging), as well as a simple in-office computer test termed Joint Vibration Analysis or Jaw Joint Sonography of your temporomandibular joint.

TreatmentThere are several modes of treatment from conservative to surgical. Of course, treatment should always

begin with conservative, reversible treatment options. It is often the case that most TMJ dysfunction will respond favorably to conservative options. These options include an orthotic (also known as a splint or ‘night guard’). It functions much like an orthotic in your shoe does – it realigns the jaws so that the joint is

not under stress when it shouldn’t be. Over time this will help relieve symptoms and prevent further damage.

If you have any signs and symptoms of TMJ dysfunction, contact your dentist for an examination as soon as possible. It is frequently a matter of just getting advice on what to do to manage the symptoms, or possibly an orthotic to help give the jaw joints a rest. This is a simple, conservative, and comfortable treatment that can often provide relief quickly.

Healing with Orthotics

Orthoticiswornforatleastthreemonthstorelievesymptoms

Bitepositionisrefinedforcomfortasthejawsystemheals

Secondphaseoftreatmentmay be indicated

Removable Orthotic

Fixed Orthotic

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Topeka, Kansas 66614

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