TMJ or TMD (Temporomandibular Joint Disorders)

Categories of TMD And TMJ Problems
TMJ (temporomandibular joint) or TMD (temporomandibular joint disorder) typically fall into three categories. The severity of problems associated with the disorder and its underlying cause can vary from patient to patient and have a number of causes.

Myofascial Pain
The most common manifestation of TMD is myofascial pain. This is facial pain that is caused by the muscles being stressed, under tension or muscle spasms. Bruxism (grinding) and jaw clenching add to this discomfort. Hereditary conditions affecting the structure of the joint can also lead to myofascial pain.

Local Insults
Injury to the jaw area include a displaced disc, dislocated jaw or an injury to the condyles. The condyles are the hinge ends of the mandible (lower jaw) that fit into the upper joint space of the temporal bone of the skull.

Systemic disorders
There are a number of degenerative joint diseases that can cause or intensify TMJ. They include a number of degenerative joint diseases such as rheumatoid arthritis or osteoarthritis.

Causes Of TMD
The most common cause of TMJ symptoms does not originate from a specific physical event. It typically is the body's response to stress. People with high stress lifestyles are more likely to experience high stress levels. Anyone who is experiencing a high stress level over a period of time due to personal or business problems may also be at risk of experiencing this condition.

This stress may present itself in the form of bruxism. Teeth grinding is a reflex and may occur when the patient is awake, or it may occur during sleep. The patient may also clench his or her teeth and continually tighten the face and jaw muscles.

TMD also can be caused by an incorrect bite or occlusion. This may be the result of improper tooth growth, in which the teeth grow into a suboptimal position and affect the bite. Braces or orthodontic procedures can also cause TMD.

Injury from an impact can dislocate the jaw and require medical treatment to re-align the jaw properly. Whiplash or a blow to the head can cause physical damage to the jaw and surrounding muscles and require medical treatment to correct the problem.

Degenerative bone disease can affect any part of the body, and the TMJ area is as much at risk as any other part. Progressive loss of cartilage or bone degradation caused from a degenerative bone disease such as osteoarthritis or rheumatoid arthritis are often linked to TMD.

Infection and Fibromyalgia are also recognized as causes of TMD that require medical intervention.

Diagnosing TMD
A thorough examination by a dentist specializing in TMJ disorders is necessary to diagnose the type and extent of the problem. The dentist will examine the patient's mouth and teeth. The muscles are palpated to determine the level of tenderness, and the patient's jaw is measured for range of motion. There may also be diagnostic imaging such as a CT or specific x-ray's performed on the patient.

Treatment Of TMD

Home Treatment Of TMJ Problems
Low level or episodic TMD may be temporary and dissipate without any medical intervention. Stress related TMJ symptoms may diminish as the patient's problem decreases or ends.

Non-medical self care may include hot or cold packs, massaging and stretching the jaw joint (only in some cases), a soft diet and avoiding opening the mouth extremely wide.

Surgical Treatment Of TMD
Prolonged symptoms of pain, swelling and reduced mobility should be treated by a dentist specializing in TMD. There are a small percentage of patients for whom orthognathic surgery may be the only treatment. This is due to extended degeneration of the bone or cartilage, or extreme misalignment of the jaw or teeth. Procedures can include partial or total joint replacement, arthoplasty, arthoscopy and arthocentesis. Thankfully, this is seldom required, and conservative medical intervention is usually successful for the vast majority of patients suffering from TMJ symptoms.

Orthodontic Treatments
Orthodontic treatments include bite adjustment and dental restoration such as crowns or bridges to correct the problem. A dentist specializing in TMD can evaluate the need for orthodontic procedures as a treatment or a Phase II plan for TMJ symptoms.

Oral Appliance Therapy
A popular and effective treatment for TMD is a custom night guard or splint. These devices are acrylic mouthpieces that hold the upper and lower teeth apart to minimize the effects of grinding or clenching the teeth. A night guard is worn while sleeping, and a splint is worn throughout the day. Over time, the device corrects the patient's bite by repositioning the jaw. The decision to use a splint or a night guard is one that the dentist will discuss with a patient to determine the most suitable application.

Drugstore night guards or splints are inexpensive, but they may have limited or little impact on successfully reducing TMJ symptoms. Not only may they be ineffective, but they may actually worsen the problem. Each person displays a unique set of symptoms and has behaviors that differ from other individuals. Therefore, it's important to provide an appliance that fits each patient's distinctive needs.

A night guard or splint, custom made to fit each individual's specific problem, can reduce painful symptoms and correct bit and alignment problems with long term use.

TMJ symptoms can be sporadic or ongoing. They are uncomfortable at best and can become a debilitating condition that is chronic and long-term. A dentist who specializes in TMD can diagnose the condition, recommend a proper course of treatment for immediate relief and suggest a permanent solution to this widespread and painful condition.