TMD / TMJD / TMJ
All of the above abbreviations refer to what is commonly known as Temporomandibular Dysfunction. It is an orthopedic dysfunction of the jaw joint. It has many similar findings of other joint disorders (pain in the affected joint and associated ligaments and muscles). Characteristically, TMD, like all the other joint disorders, is aggravated by over usage, poor movement patterns and emotional stress (which heightens muscle spasm). If significant damage has occurred to the joint it will, like all joints, be more prone to swelling during changes in barometric pressure (changes in the weather).
TMD is a condition highlighted by a combination of various symptoms: Headaches, inexplicable ear symptoms (earache, dizziness, ringing in the ears aka tinnitus), clicking and popping of the jaw, difficulty opening/closing the jaw, neck pain, toothaches (including all symptoms related to occlusal dysfunction) and face pain. Historically, it was first described by Dr Costen, an ear, nose and throat specialist over sixty years ago. Patients presented to his office with ear symptoms that could not be explained by the presence of any organic ear disorder.
The causes of TMD fall into 2 major categories:
- Macro trauma (least common) – a violent, sudden blow to the lower jaw with or without an overt fracture
- Micro trauma (most common) – an insidious low grade stress to the jaw joint most commonly due to a poorly functioning occlusion/bite relationship between the upper and lower teeth (see Functional Occlusion causes)
Like all orthopedic disorders, TMD can be made worse by stressors outside the area of the functioning jaw joint apparatus:
- Nutritional Stress – can promote the body’s manufacturing of chemicals that promote inflammation
- Environmental Stress – any chemical toxins that affect the optimum functioning of the body (airborne allergens, heavy metal toxicity, reduced oxygen intake, root canal toxicity)
Postural Stress – stress and strain on the locomotor system (the body’s musculoskeletal system and its ability to move through and cope with its environment)
- Sleep Stress – Inability to sleep well (deep sleep) causes a reduction in what is referred to as restorative sleep. This affects the muscles and joints by preventing them from returning to a healthy state prior to the next day’s demands
- Breathing Stress – Inability to breathe through the nose results in poor body posture (postural stress), which in turn causes a poor jaw position. Breathing stress tends to worsen due to environmental stress. Please note that poor diet can increase allergic responses which in turn can also affect one’s ability to breathe through the nose.
- Endocrine Stress – Thyroid and adrenal hormone deficiency strongly influences muscle function. These two hormones most directly affect TMD but, it can also be affected by many other hormone imbalances.
- Emotional Stress – Hans Selye won a Nobel Prize for his insightful work into the effects that stress has on the functioning of the individual.
- Immune System – reduction or heightened reaction of the body’s defenses against external stresses (Nurtitional, Environmental) To synopsize: Increased emotional stress affects three critical systems within the body:
- GI system – contributing to poor absorption of nutrients from your diet
- Immune System – reduction or heightened reaction of the body’s defenses against external stresses (Nutritional, Environmental)
- Musculoskeletal System – Muscles will shorten (tighten) when under emotional stress
- Dental Stress – Poor occlusion (see Functional Occlusion) can impact the TMD most directly. In addition, cavitations from extracted or root canalled teeth can place stress on the nervous system of the jaws and face possibly exaggerating the pain from the jaw muscles and jaw joints.
In most cases TMD’s major source of stress comes from the occlusion. However, all of the above mentioned stresses influence the course of the disorder as well as the success of treatment. If external stresses are unrecognized, left untreated and/or ignored by the patient, treatment failure is most likely. Fortunately, at Groton Dental Wellness Spa, we have the ability to help you address these stresses either by coordinating treatment with your own health care professional(s) or by offering treatment at our new medical facility.
Dental Therapy for TMD begins with a thorough Diagnosis:
- Interview – review of your health/dental history and present condition
- Examination – hands-on evaluation of your jaw movement and occlusion as well as the muscles that help your jaw function
Accurate impressions of the upper and lower teeth and registration of your jaw position
X-rays of your jaw joints and skull, including the bones of your face followed by an orthodontic analysis (this will determine how you arrived at this point in your dysfunction as well as aid in establishing a treatment goal that is realistic for you)
- Axiographic analysis – examines how your jaw moves in space using a state of the art ultrasonic tracking device. This helps identify what movement of your jaw is most affected by your jaw dysfunction and will help objectively chart your progress as well as providing the laboratory with valuable information specific to your anatomy.
Possible Dental Therapy for TMD:
Use of various oral orthotics or specially designed mouth splint to help you return your muscles and joints to optimum position and function. This is in the category of “night guards”, that are designed to specifically treat your unique orthopedic problem. Depending on the nature of your problem, up to two orthotics may be used.
Hands-on therapy to address the jaw mobility issues. This may include the use of therapeutic local anesthetic and/or cold laser therapy into inflamed associated muscles, ligaments and tendons of the jaw. Manual mobilization techniques may also be used including, but not limited to, Craniosacral therapy, Myofascial release and Post-isometric Relaxation. This is dependent upon who you may be currently seeing for therapy.
Length of Therapy:
Length of therapy is dependent on the severity of your dysfunction and the presence of associated stressors. Initial therapy, which is designed to dramatically reduce pain and dysfunction, should last approximately three months. Second phase dental therapy for TMD usually depends on the severity of the occlusal dysfunction (see Functional Occlusion). Treatment may range from minor, precise reshaping of the surfaces of the teeth to coordinate better occlusion and optimum jaw function to orthodontic therapy and/or possibly the need for new crowns, bridges, dentures or partials to achieve long lasting jaw stability.
It is important to remember that TMD is no different from other joint problems in that total success in therapy does not mean a total reversal in joint damage. You may always have a certain level of dysfunction, just not to the extent that it dominates your life the way it had previously. You must ask the question: Can I live with the possibility that treatment would result in a 70-80% reduction in my symptoms and a restoration to acceptable function? If you can accept that, we can help.