TMD Management

Temporomandibular disorders come in many forms and varying degrees of severity. Basically TMD is a problem when you either experience pain and/or a loss of jaw function. The pain can range from a mild ache in the morning to a chronic debilitating pain. Loss of function can be mild jaw stiffness to being unable to open the jaw barely at all.

The symptoms of TMD can be an obvious jaw pain in the muscles near the mouth, but can also often exhibit as headache at the temples ("temporal headache"). This is due to inflammation in the large jaw closing the temporalis muscle which is on either side of your head. To find this muscle place your hands on your temples and clench your teeth hard and you will feel this powerful muscle contract. Patients often feel this symptom is a tension headache or sinus headache but it can be easily differentiated during a TMD exam. Patients understandably (and many doctors) fail to make this connection between TMD and headaches.

The pain of TMD can come from either the muscles or the TM joint itself; often it comes from a combination of the two. The muscles can ache due to causes discussed below. Pain in the joint is usually due to inflammation within the structure itself. Sometimes the symptoms are found in other facial structures such as dull ear pain, toothache, neck pain, etc. This referred pain is fairly common but it is important to rule out medical and dental causes of these pains prior to TMD treatment.

Loss of jaw function can be due to muscular and/or joint problems as well, just as pain can. The degree to which each is involved is determined through thorough history and example.

Causes of TMD
Temporomandibular disorders rarely have a single cause. Any one of the following factors may contribute to TMD. Each patient presents an individual combination of factors that are determined during history taking and clinical exam.

Trauma
Acute trauma to the jaws such as a car accident, a fall, a punch, etc. can cause damage to the muscles and/or joint. The acute pain and loss of function is usually responsive to conservative treatment. Sometimes trauma to the joint can cause chronic damage which may eventually contribute to a TMD problem at a later time.

Bruxism
Bruxism refers to a non-functional grinding and clenching of the teeth. Some do this while awake but more often it is done while sleeping. Most people grind their teeth while sleeping to some degree. For whatever reason, some people do this very hard to the point where they wear the enamel from their teeth. This bruxing is done by the jaw muscles and by the morning, they can be painful due to fatigue. This constant pressure also can damage the TMJs over time. Bruxism is the most common factor found in TMD.

Malocclusion
This term means "bad bite". Sometimes when the teeth do not bite together in harmony with the shape and position of the joints it can place pressure on the joints. Missing teeth can sometimes contribute to this as well. The misalignment can also put strain on the jaw muscles. This factor can be mild to severe. Though the bite is an important part of the whole system, it is only altered after conservative measures and only if it will result in felt improvement. In some patients, discrepancies (known as interferences) become apparent after wearing the NTI device for a few months and a bite adjustment is recommended. Treatment of the bite for TMD is usually not needed but its contribution to the whole must be examined.

Emotion
Emotional stress often plays an integral role in the development of TMD. This occurs due to two basic reasons. Stress increases both the severity and duration of bruxism while asleep. Also, many will subconsciously clench and/or grind their teeth more while awake during times of stress. The other way stress contributes to TMD is that during times of stress, your adaptability and pain threshold will go down. As a result you are more likely to experience symptoms of TMD if other factors already exist (bruxing, joint damage, etc.). Emotional conditions beyond daily life stress can contribute to TMD as well. Depression, anxiety disorders, and the like can often have TMD problems arise. These conditions are quite stressful and it is not hard to imagine why TMD would develop.

Ergonomic
Your job and how you do it can contribute to TMD and related problems. If you work at a computer all day, for example, you may be holding your head in such a way that places strain on your TM system.