|  | |  | | | | Temporomandibular Disorders (TMDs)
Temporomandibular disorders (TMDs) are problems that affect your temporomandibular joint (TMJ), or jaw joint. They also can affect the muscles of the face that help you to chew.
If you place your fingers just in front of your ears and open your mouth, the movement you feel is your TMJ. It is a small ball-and-socket joint with three parts:
- The ball, called the condyle
- The socket, called the glenoid fossa
- A small, fibrous disk that sits between the condyle and the glenoid fossa
Studies estimate that 20% to 30% of people have TMD symptoms. Although there is some disagreement, it appears that more women than men develop TMDs. The reason isn't clear. One theory is that the collagen that holds the disk in position between the ball and socket is structurally different in women. This may cause more women to have dislocated disks, which can lead to TMDs. In addition, some studies have suggested that hormones like estrogen play a role.
TMD is a general term, not a specific condition. If your dentist tells you that you have TMD, it's a lot like your doctor telling you that you have a knee problem. Often, people will say they "have TMJ." TMJ is the name of the joint, not a disease or condition.
The causes of TMD are not understood completely, but can include:
- Trauma to the jaw, either by a direct blow or prolonged clenching or grinding of the teeth (bruxism)
- Tension or stress, which triggers muscle spasms
- Poor alignment of the teeth (malocclusion)
- Arthritis of the jaw joint
- Tumors of the jaw joint
Also, some general medical problems, such as rheumatoid arthritis or osteoarthritis, can affect the jaw joint.
Symptoms of TMD include:
- Pain or tenderness in the area in front of your ear, especially when you chew, speak or open your mouth wide
- An occasional feeling of the jaw being stuck open or closed
- Facial-muscle spasms that make it difficult to open your mouth or that make it feel as though your teeth don't meet normally
- Clicking, popping or cracking sounds or a grating sensation in the jaw when you open or close your mouth
- Headaches that tend to start in the front of the ear and spread to the rest of the head or neck
An important part of the diagnosis is reviewing the history of your problem. This includes how long you've had symptoms and when they occur.
Your dentist will:
- Look at the way your jaw moves
- Examine your teeth for signs of habits such as clenching or grinding (bruxism)
- Probe the TMJ and the muscles of your jaw and neck for signs of tenderness
The dentist might use a stethoscope to listen for joint sounds that would suggest a disorder involving the disk or bones of the joint.
Your dentist will determine whether your problem is a muscle disorder or if it involves the bones or disk of the joint. Usually, a regular X-ray or a panoramic X-ray can rule out a serious disorder within the joint.
If a more detailed view of the joint is necessary, magnetic resonance imaging (MRI) or a computed tomography (CT) scan might be used.
The exam also will be used to check for other conditions that could be causing your symptoms. Examples include arthritis, sinus infections, toothache, earache and neurological problems. These conditions and TMDs have similar symptoms.
If you have a TMD, your dentist or physician will be able to tell you what type it is and how it can be treated.
TMDs can last only for a few weeks when they are caused by trauma to the jaw, for example. Other types of TMD, such as a problem caused by arthritis or bruxism, can last months or even years, depending on how they respond to treatment.
A TMD caused by bruxism or clenching may be prevented by using a nightguard. This is a molded piece of plastic used to reduce the pressure on the jaw. If you clench your teeth due to tension or anxiety, addressing this may prevent TMJ problems. It may help to work with a psychologist or have relaxation therapy or biofeedback.
The treatment of a TMD depends on its cause.
Most TMDs are related to sore muscles that sometimes have spasms. This type of TMD usually responds to conservative treatment. Examples include:
- Soft diet — Avoid hard or crunchy foods. Cut food into small pieces and chew with your back teeth rather than biting into large items, such as a thick sandwich, with your front teeth.
- Physical therapy — This can include heat, massage and ultrasound.
- A nightguard to help stop teeth clenching and grinding
- Stress reduction therapy, including biofeedback and psychological counseling
- Over-the-counter pain relievers
- Prescription drugs that ease inflammation
- Prescription drugs that relax muscles
- Bite adjustment — This might include reshaping teeth slightly so that they meet properly.
- Replacement of missing teeth
- Orthodontic therapy
If these measures do not help, surgery might be considered. Arthroscopic surgery often is an option. This technique uses two or three very short incisions. A tiny camera is inserted through one incision. Surgical instruments are inserted through one or two other incisions. Inflamed tissue is removed and the joint is flushed.
If the jaw is locked shut because of a dislocation or scarring, open surgery might be necessary. The surgeon can reposition the jaw and remove or adjust the obstructing disk.
Call your doctor if:
- Your jaw movement is limited.
- You have injured your jaw and are taking over-the-counter pain medication, but the pain doesn't go away after several days.
- You have swelling in the area of your TMJ.
- Jaw pain keeps you up at night or makes eating difficult.
With proper care and control of habits, the symptoms should go away. Some cases may go away in less than a month. Other cases, such as those involving arthritis or people with long-standing or severe bruxism, may take longer.
American Academy of General Dentistry
211 East Chicago Ave.
Suite 900
Chicago, IL 60611-1999
Toll-Free: (888) 243-3368
Fax: (312) 440-0559
http://www.agd.org/
National Institute of Dental and Craniofacial Research
National Institutes of Health
Bethesda, MD 20892-2190
Phone: (301) 496-4261
E-Mail: nidcrinfo@mail.nih.gov
http://www.nidcr.nih.gov/
American Association of Oral & Maxillofacial Surgeons
9700 West Bryn Mawr Ave.
Rosemont, IL 60018-5701
Phone: (847) 678-6200
E-Mail: inquiries@aaoms.org
http://www.aaoms.org/
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