What is TMJ?
The Temporomandibular Joint, more commonly referred to as the jaw joint or TMJ, assists in the basic opening and closing movements of the jaw. Unfortunately, this joint is a common area for recurring pain. When someone has pain, trouble chewing, or trouble opening or closing, there problem is called Temperomandibular Dysfunction or TMD for short.
What is TMD and Why is it so Hard to Treat?
TMD is actually a broad group of associated symptoms that cause pain in and around the jaw joint. There are 7 distinct diagnostic classifications of TMD pain and 57 distinct diagnostic classifications for orofacial pain (pain in and around the head). If you are the patient, all of these symptoms mix together to make it painful to eat, talk, and live. If you are like most TMD patients, you have lived with chronic pain much longer than you can tolerate. If you are a doctor, breaking the cycle of TMD pain is sometimes difficult and requires an expert to make a correct diagnosis. Getting the correct treatment is entirely dependent of making the correct diagnosis. It is important to separate TMD from other orofacial pain problems and determine which type of TMD each patient presents with.
What are the Symptoms of TMD?
Common symptoms of TMD are:
- Earaches or ringing in the ears
- Clicking, popping, or grating sounds in the jaw joint
- Teeth clenching or grinding
- Sore and painful jaw muscles
- Chewing pain
- Difficulty opening and / or closing
- Episodes of ‘locked jaw’ where it is difficult to open or close fully
- Changes in bite (how your teeth hit)
- Shoulder, neck, or facial pain
Chronic Pain and Chronic Pain Syndromes
Most TMD patients have lived with chronic pain quite a while before seeking diagnosis and treatment. While persevering through pain is an admirable characteristic, living with chronic pain often introduces a new and unique set of symptoms that must be treated along with TMD in order for patients to receive relief. The easiest way to understand chronic pain syndromes is to remember that pain is transmitted by nerve pathways from a painful site to the brain for interpretation. If you think of the body’s nervous system as paths in a meadow, then it’s not hard to imagine the concept of chronic pain syndromes. The more traffic the meadow path receives, the wider and clearer the path is. The wide and clear path encourages more traffic and more wear. The path may become a ‘preferred path’ that is actually easier and faster to travel than other paths. The nervous system in our bodies can act this way too. Chronic pain patients may experience more frequent and or more intense painful stimuli than a patient that has not had to endure chronic pain. Chronic pain syndromes are unique problems that often must be diagnosed and treated along with TMD.
The Psychological Impact of Chronic Pain
TMD patients are not crazy! There is almost always a very specific diagnosis that can be made to explain the set of symptoms a TMD patient is experiencing. The specific diagnosis leads to a specific treatment protocol which is most likely to help each patient. However, chronic pain takes its toll on almost everyone. Somewhere in the diagnostic process of evaluating a TMD patient, there should be a frank discussion of how the patient is dealing with chronic pain. If appropriate, there are proven programs to assist chronic pain patients that result in less pain for the patient. That is one reason we believe in a team approach to the treatment of TMD patients.
How is TMD Diagnosed?
Successful treatment starts with an accurate diagnosis. When you appoint for a TMD evaluation you should expect the following:
- An interview with the doctor: to allow you to describe your symptoms, when they started, how they affect your life, a history of therapies previously attempted and their outcomes;
- A thorough review of your medical history to determine if any medical condition or medication could be a contributing factor to your TMD.
- Joint Imaging: Computed Technology (CT) imaging of your jaw joint to gain a 3 dimensional image of each joint. If CT scans and examination indicate a need, you may be referred for an MRI imaging, which is the gold standard of joint imaging.
- Physical examination of your jaw joint to determine specific points of tenderness, presence & nature of clicks, pops, and crepitis (a deep grating sound);
- Physical examination, of the muscles that work the joint;
- Range of motion observation & measurements to compare your situation to normative values;
- Bite analysis in which models of your teeth are mounted on a chewing simulator to determine if improper bite could be a contributing factor to TMD.
- A thorough consultation which includes discussion of your specific diagnosis, a discussion of all treatment options for that specific diagnosis, an opportunity to have your questions answered.
How is TMD Treated?
We believe successful TMD treatment starts with an accurate diagnosis and involves a team approach. There are specific treatment protocols for each diagnostic classification. Depending on each patient’s diagnosis and circumstance, TMD treatment may include:
- Urgent management of acute episodes: this may include the use of prescriptions, short term bite plate devices to temporarily eliminate mis-bites as a causative agent, and physical therapy.
- A decision about whether your TMD should be treated non-surgically or surgically. Many TMD diagnoses are very successfully treated non-surgically. Sometimes a joint is so damaged that surgery is the best option.
- Correcting mal-aligned joint-disc position: Every joint, including the jaw joint, is a ball, a socket, and a cartilage disc in-between to keep bone from grinding against bone. Sometimes the disc can be out of place, causing pain. Attempting to restore the proper relationship of the joint parts helps to alleviate the pain of TMD.
- Correcting mal-aligned jaw position: sometimes the upper and lower jaws just don’t fit together correctly causing the joint to hurt. In that case a temporary bite plate can be used to confirm the diagnosis and alleviate the symptoms prior to moving forward to correct the problem.
- Correcting mal-aligned tooth position: many times teeth don’t fit together well requiring the TMJ muscle complex to adjust the position of the lower jaw in order to chew effectively. This may result in acute joint and muscle pain. Correcting tooth position may help alleviate symptoms.
- Correcting postural syndromes that contribute to TMD: It is very frequent that TMD patients have an adapted head posture that contributes to increased jaw, head, & neck pain. We work extensively with a physical therapy group to help correct this problem when necessary.
- Addressing chronic pain as a contributing factor: many TMD patients have been dealing with joint pain for a sufficient time that chronic pain syndrome needs to be addressed. Chronic pain syndrome is a unique diagnosis, separate from TMD and often must be addressed as a part of TMD therapy in order for patients to have the best results. We work with a pain management group that have excellent outcomes.
- Addressing stress as a contributing factor: Stress is a part of modern life, but can really complicate recovery from TMD and intensify pain. Simply put, stressed people clench and grind their teeth more. If a TMD patient clenches or grinds their teeth extensively, they hurt more. We work with a behavior management group that has been very effective in teaching TMD patients stress management techniques to help minimize the adverse effects of stress.