TMJ disease

Temporomandibular Disease

Now that we have established our bearings let’s sort out what this problem that we call TMJ or TMD is all about. I am sure that everyone can reflect on someone whom they know that stated, I have TMJ. This is an understandably amusing statement considering the fact that we all have two temporomandibular joints (TMJ’s). However, understanding what was really wrong with that person is where our confusion begins. What condition, out of the several different conditions afflicting this area, did that individual really have.

For the sake of discussion we will attempt to simplify in a very unscientific manner what are actually the most common maladies comprising TMD. As it effects the vast majority of patients, TMD can be broken down into two fundamental conditions. The first is a muscular disorder where related symptoms and jaw dysfunction are primarily a result of muscular spasm in the muscles of jaw function. This condition is more precisely described as myofascial pain dysfunction or MPD.

The second condition is primarily an anatomical disorder whose symptoms and dysfunction result predominantly from anatomical dysfunction of the temporomandibular joint (TMJ). More simply put, this form of TMD results from a failure of the gears or parts of the joint to work smoothly or in harmony with one another. In a rare moment of simplistic brilliance, the medical community has named this problemInternal Derangement. Now, on the surface it would seem pretty simple for someone to figure whether they were suffering from MPD or Internal Derangement.

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Unfortunately, as you may have guessed, this is not always so. Both conditions present with very similar symptoms which can include but are not necessarily limited to the following: jaw pain, difficulty with jaw opening, earaches, headaches, pain behind the eyes, jaw joint popping and clicking, dizziness, and difficulty chewing food or closing your teeth together.

Already you can begin to see the dilemma with which the misinformed patient and doctor may be presented. We have at least two different conditions that the patient and some doctors have lumped semantically into the single term TMJ or TMD. Whereas two patients claiming to have TMJ may have very similar clinical signs and symptoms, they may actually present with very different physical conditions. To complicate the situation further, as you may have suspected, the two conditions, about which we have spoken, often require different modalities of treatment (Figure 2).

 

TMJ or TMD
Myofacial Pain Disfunction MPD
May Have Both
Internal TMJ Derangement True TMD
Muscular Disorder An Anatomical Disorder
SYMPTOM:
Facial Pain
Difficulty with jaw opening
Headaches
Neck Pain
Overlap
SYMPTOM:
Facial Pain
Jaw joint pain
Joint clicking or noise
Difficulty with jaw opening
Earaches
Headaches
TREATMENT:
Soft diet
Bite Splints
Anti-inflammatory medications (Advil, Motrin)
Muscle relaxants
Physical Therapy
Surgery never indicated
  TREATMENT:
Soft diet
Bite Splints
Anti-inflammatory medications (Advil, Motrin)
Physical Therapy
Surgery may be indicated

 


How Do We Treat TMD?

As you have learned from our above discussion, the treatment of TMD depends on what form of TMD that you have. Therefore, it is imperative that we, as doctors, must learn specifically if you have TMD and, if so, what kind of TMD do you have. Following a thorough medical history and physical examination, the clinician, whether that is your general dentist or your oral and maxillofacial surgeon, is likely to suggest any or all of the following:

  • Jaw rest
  • Muscle relaxants and/or anti-inflammatory medication
  • A bite splint or night guard
  • That you have x-rays taken (Panorex, Arthrotomograms or MRI)
  • That you seek the assistance of a registered physical therapist.

All of these modalities are aids in establishing a diagnosis and sometimes assist in rendering definitive treatment. A patient responding to the use of bite splints, muscle relaxants and physical therapy is likely to be suffering from the muscular disorder MPD. Moreover, a patient with the anatomical condition (Internal Derangement) will sometimes receive relief from his/her symptoms with these simple and conservative measures. On the other hand, a patient not responding to these treatment measures may be suffering from a more refractory form of Internal Derangement, which may require confirmation through more sophisticated diagnostic measures such as x-rays and/or MRI. In the event that these diagnostic modalities confirm anatomical disease and the patient continues to suffer from disabling pain and dysfunction your doctor may at this time suggest a surgical approach.

 

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