TMJ

Temporomandibular Joint/Muscle Dysfunction

What is Temporomandibular Joint/Muscle Dysfunction (TMJ)?

Temporomandibular joint syndrome (TMJ), temporomandibular disorders (TMD) and craniomandibular disorders (CMD) are some of the more modern terms currently used to identify this myriad of illness's. TMD, as it is most often referred to, is a complex, multifaceted disorder of the jaw joint, in which there is derangement of the internal workings of the jaw joint and potential affiliated masticatory muscle pain and dysfunction. Patients may experience only the internal derangement, only the muscle pain and dysfunction, or both simultaneously.

How common is TMD, who gets it and how? In a pamphlet written by the National Institute of Dental Research (NIDR), studies are cited showing a range of 10 to 77 percent of the population suffering some form of TMD. Literature yields figures of 20 to 60 million Americans having TMD. These ranges are unscientifically broad, and NIDR admits that the "Discrepancies in these test results are due, in large measure, to dental science's lack of a single definition to characterize the problem."

Women representing all socioeconomic levels account for 80 to 90 percent of TMD patients, and the female gender may be considered the #1 risk factor for TMD. Since TMD primarily affects women between the ages of 20 to 45 years old, some studies suggest there is a hormonal relationship that predisposes female patients to TMD.

Trauma to the jaw joint at any time during one’s lifetime can be considered to be the #2 risk factor for TMD. The approximately 10 to 20 percent of patients who are male and who complain of having TMD symptoms, almost always have experienced what is called macrotrauma. This is a blow to the joint, whiplash, intubation, excessive opening of the jaw during extractions, etc. These events can precipitate the joint derangement and subsequent pain. TMD's celebrity patient, Burt Reynolds, was hit in the jaw with a chair while filming a movie. This accident initiated two years of pain, vertigo, nausea and substantial weight loss.

Parafunctional habits such as grinding one’s teeth during the night while sleeping (nocturnal bruxism) or excessive clenching of one’s teeth together during the day can be considered the #3 risk factor for TMD. While in women this disorder can also be triggered by macrotrauma, the majority of female patients note a more gradual onset resulting from microtrauma, e.g., bruxism, clenching, malocclusion, etc. Jenny Craig herself struggled thru years of debilitating TMD pain and is well documented in a her book: "The Jenny Craig Story".

A paper published in the mid 1980s reveals that TMD patients see on average 6.9 specialists before receiving a definitive diagnosis. The fortunate ones see only one professional. Others, like Burt Reynolds and Jenny Craig see more than 10!. The most obvious symptoms such as joint, face, neck, back and shoulder pain; joint clicking; popping when opening or closing the mouth, lend themselves to a fairly direct diagnosis—one that Dr. Hayden is well trained to identify and treat.

However, remote symptoms, including visual disturbances, ataxia, hearing loss, and vertigo, can lead a patient from one doctor to another to undergo expensive batteries of tests that yield negative results and leave the patient increasingly frightened and frustrated.

TMD is highly complex and involves more than one single etiologic factor. In fact, more than 100 different causes may be involved ranging from hormones, stress, illness, trauma, parafunctional habits, inherited joint/ligament disease's, occlusion/bite, etc., etc., etc..

Determining an accurate diagnosis may be elusive. Dr. Hayden is highly trained to recognize the causes when they are related to the jaw joint, facial muscles, and to the occlusion (bite). If the cause appears to be unrelated to the jaw joint, facial muscles, or the occlusion, Dr. Hayden will refer you in the appropriate direction—Medical Doctor, Physical Therapist, or other health related professional.

The literature is filled with statements such as the following: "Rarely in the history of dentistry have so many labored so long only to end with such extreme disagreement. "Few afflictions have spawned so much vocal controversy within the scientific community, where available treatments—some grounded in science, others of questionable value—are more numerous than symptoms.

An inherent dilemma of TMD is that it crosses the boundaries of two disciplines—dentistry and medicine. Greater interaction between the two professions is necessary in both the treatment and research of TMD if progress is to be made on all fronts.

Home Care for Temporomandibular Joint/Muscle Dysfunction (TMJ)

-The following instructions will aid in the healing of a sore jaw joint.

Do NOT chew gum.

During the initial phase of treatment, particularly if symptoms are acute, stay on a definite soft diet (baby food, soups, milkshakes, eggs, hamburger, etc.)

For the next few months, be sure to cut all foods into small, bite sized pieces and try to avoid opening your mouth any wider than the thickness of your thumb. (1-2 inch).

Do not eat hard crusts of bread, rough meat, raw vegetables, or any other food that will require prolonged chewing.

Do not chew peanuts, ice cubes, or any other substance that is repeatedly milled between your back teeth.

Do not chew gum, bite your lips, clench your teeth or habitually chew the insides of your cheeks.

Try to not thrust your lower jaw forward, as when biting off a piece of thread, applying lipstick, smoking, or through force of habit.

If you must yawn, limit the distance your mouth opens by pulling your lower lip up over the edges of your lower teeth and try to avoid opening your mouth any wider than the thickness of your thumb. (1-2 inch). Place your hand in a fist under your chin to also help prevent your mouth from opening too wide.

Make every effort not to strain your jaw joints unnecessarily by such activities as talking excessively, deliberately popping your jaw joint as one would pop the knuckles of his hand, leaning on the palm of your hand while reading or watching TV, etc. Try to sleep on your back. Avoid sleeping on the side of your face or on your fist.

Apply a cold compress to the area (first 24-48 hours) for 20 minutes at a time every hour. Do not leave the cold compress on longer than 20 minutes at a time.

After the initial 48 hours of the onset of symptoms, apply warm (heat) to the affected area. Continue this for the next few days up to one week after the onset of symptoms. If your symptoms do not subside or go away seek advice from your dentist, physcian, or Dr. Hayden immediately.