Temporomandibular Disorders (TMDs)
Overview:
What are Temporomandibular Disorders (TMDs)?
What are the TMD Symptoms?
What Causes TMD Disorders?
What Increases Your Risk?
How is a Temporomandibular Disorder Diagnosed?
How is it Treated?
Prevention of TMD
Home Treatments
What are Temporomandibular Disorders (TMDs)?
Temporomandibular disorders (TMD) is the name given to several problems with jaw movement and pain in and around the jaw joints. You may also hear TMD called TMJ or TM problems.
The jaw joints, or temporomandibular (TM) joints, connect the lower jawbone (mandible) to the skull. These flexible joints are used more than any other joint in the body. They allow the jaw to open and close for talking, chewing, swallowing, yawning, and other movements.
Many people have problems with jaw movement and pain in and around the jaw joints at some time during their lives. These joint and muscle problems are complex. So finding the right diagnosis and treatment of TMD may take some time.
What are the TMD Symptoms?
Symptoms of temporomandibular disorders (TMDs) are usually mild and temporary and typically do not get worse with time. Common symptoms include:
Joint pain when the jaw is moving, as when opening the mouth widely, chewing, or yawning. Such pain can occur:
Usually on one side of the jaw, but it can be on both sides.
Either gradually or suddenly, as when biting down on something hard or following a blow to the jaw.
Muscle pain or tenderness in the face, ear, head, neck, or shoulders.
Headaches. In children with TMDs, headaches are often related to grinding the teeth (bruxism).
Clicking, popping, cracking, or grating that is painful and occurs when opening the jaw (may be a sign of disc displacement). Clicking or popping noises without pain are common and do not require treatment.
The jaw locking in an open or closed position or not opening wide (disc displacement). If the jaw locks for more than a few moments, a muscle spasm usually follows.
Sometimes pain around the ear, with pressure or ringing in the ears (tinnitus), develops with TMDs. Some people with these symptoms report that they also have hearing loss, although test results show that their hearing is normal.
In most cases, symptoms often go away on their own. And they may recur over time without getting much better or worse. Occasional discomfort in the jaw joint or chewing muscles is quite common and usually is not a cause for concern. But for some people symptoms can be very painful, disabling, and last a long time.
What Causes TMD Disorders?
The most common cause of TMD symptoms is muscle tension, often triggered by stress. When you are under stress, you may be in the habit of clenching or grinding your teeth. These habits can tire the jaw muscles and lead to a cycle of muscle spasm, tissue damage, pain, sore muscles, and more spasm.
Common TMD Causes:
Muscle tension (tightness) and spasm. Muscle tension in the jaw, face, head, neck, and shoulders may make your jaw feel achy, stiff, and painful, especially when moving your jaw. Muscle tension may be:
Caused by stress and anxiety and by stress-related habits, such as daytime or nighttime clenching or grinding of your teeth (bruxism), excessive gum chewing, or nail biting.
A response to injury or structural problems within the joint.
TMD can start when there is a problem with the joint itself, such as:
An injury to the joint or the tissues around it.
Problems with how the joint is shaped.
Joint diseases, such as osteoarthritis or rheumatoid arthritis.
The articular disc that cushions the joint shifts out of place.
Disease, such as a tumor, or structural problems present at birth (congenital).
In many cases, TMD symptoms appear to be caused by both muscle tension (tightness) and joint dysfunction. It is not always clear which came first. For example, osteoarthritis can cause changes in the joint, which may then bring on muscle spasms. Conversely, muscle spasms over time hinder jaw function and can eventually cause osteoarthritis in the jaw joint. A similar relationship appears to exist between muscle tension and disc displacement within the joint.
Orthodontic treatment and malocclusion do not seem to trigger TMDs or make them worse.
When jaw joint problems are caused by diseases such as rheumatoid arthritis, treatment for that condition is important. Many other conditions cause symptoms similar to those of TMDs, such as migraine headaches and infections.
What Increases Your Risk?
Risk factors for temporomandibular disorders (TMDs) include:
Stress and anxiety, which can cause facial and jaw muscle tension.
Repetitive habits, such as grinding your teeth (bruxism), clenching your teeth, excessive gum chewing, eating hard or chewy foods, and nail biting.
Habits that can cause muscle tension, such as sleeping on one side of your face or with your mouth open, opening your mouth wide when yawning or singing, or holding your head up by cradling your jaw in your hand.
Injury to the jaw or head. TMDs can result from a direct blow to the jaw, chin, or head; whiplash to the head or neck; overstretching the jaw during dental work or surgery; or other injuries that may lead to joint damage or muscle tension.
Age and gender. TMDs are more common in younger adults (ages 20 to 50) and in women.
How is a Temporomandibular Disorder Diagnosed?
Although there is no one way to identify a TMD, your doctor can most likely check your condition with a dental and by asking questions about your past health. In some cases, an X-ray, CT scan, or MRI is also used to check for bone or soft tissue problems related to symptoms of TMD.
How is it Treated?
TMD symptoms usually go away without treatment. Simple home treatment can often relieve mild jaw pain. There are things you can do at first to reduce pain.
· Rest your jaw joint.
· Use medicines for a short time, to reduce swelling or relax muscles.
· Put either an ice pack or a warm, moist cloth on your jaw for 15 minutes several times a day if it makes your jaw feel better. Or you can switch back and forth between moist heat and cold. Gently open and close your mouth while you use the ice pack or heat.
· Eat soft foods. And avoid chewy foods and chewing gum.
Getting physical therapy and learning ways to reduce stress may also help to reduce pain and TM joint problems. Continue to use some of these methods over time to prevent and manage symptoms that might come back. If your pain is chronic or severe or is caused by problems with how the joint is shaped, your doctor may recommend other treatments.
Splints, also called bite plates, are a common dental treatment for TMDs. Splints are usually clear pieces of plastic that fit between the upper and lower teeth. They help reduce grinding and clenching. Splints are used for a short time so that they do not cause permanent changes in the teeth or jaw.
For most people, surgery is not used to treat TMDs. Surgery has few benefits, and there is the chance of causing more serious problems. You and your dentist can carefully weigh a decision to have surgery.
Dental Splints:
Dental splints are the most common dental treatment for temporomandibular disorders (TMDs). These splints are used for short periods of time. They do not cause permanent changes in the teeth or jaw.
Dental splints, also called occlusal splints, include bite plates and mouth guards. They are custom-made by a dentist. They are typically made of clear plastic. They fit between and over the upper and lower teeth.
Dental splints can help ease muscle tension and stabilize the jaw. They do this by preventing grinding and clenching of the jaw (bruxism) that might be causing muscle tension and pain.
Splints are worn mostly at night, because people tend to clench or grind their teeth during sleep. It may not be easy to get used to wearing and caring for your splint, but it is an important treatment that may last for 3 months or more.
In cases of disc displacement and muscle spasm, you may be advised to wear a splint during the day and at night for about 2 weeks, and then only at night during times of stress and pain. This may allow a displaced disc to return to its normal position.
Many people who have TMDs find splint therapy helpful for treating pain and muscle tension.
Physical Therapy For TMD
A physical therapist can develop a program for you that includes learning and practicing techniques for regaining normal jaw movement.
The focus of physical therapy for temporomandibular disorders (TMDs) is relaxation, stretching, and releasing tight muscles and scar tissue. Physical therapy is an especially important part of recovery from TM joint surgery, as it helps minimize scar tissue formation and muscle tightness.
Physical therapy techniques may include:
Jaw exercises to strengthen muscles and improve flexibility and range of motion.
Heat therapy to improve blood circulation in the jaw.
Ice therapy to reduce swelling and relieve pain.
Massage to relieve overall muscle tension.
Training to improve posture and correct jaw alignment.
Transcutaneous electrical nerve stimulation (TENS), which is the application of a mild electrical current to the skin over the jaw joint. This electrical current is thought to interfere with the body's pain signals. TENS relaxes muscles, improves blood circulation, and relieves pain. The effectiveness of TENS varies, but it seems to work for some people.
Movement of the temporomandibular (TM) joint to release scar tissue that restricts muscle movement and to improve range of motion.
Ultrasound therapy, which uses high-frequency sound waves directed to the TM joint, to reduce pain and swelling and improve circulation.
Trigger point management.
Some people with temporomandibular disorder (TMD) have areas of the jaw joint that "trigger" severe pain. Trigger point management includes trigger point compression and trigger point injections.
Trigger point compression is done by a doctor or physical therapist, who applies firm pressure to the jaw muscles with the thumb or knuckle. Trigger point compression works like a deep massage. The pressure may feel tense or uncomfortable at first, but as the pressure continues, the area loosens and discomfort decreases. Stretching and heat applications are applied after trigger point compression.
Trigger point injection involves a shot of local anesthetic into the trigger points of the jaw.
Prevention of TMD
To prevent temporomandibular disorders (TMDs), try to reduce muscle tension in your jaw. You can reduce muscle tension in these ways:
Relax. If you have a lot of stress and anxiety in your life, try relaxation techniques.
Learn to recognize when you are clenching your teeth. Practice keeping your teeth apart, bringing them together only when swallowing or eating. When driving, avoid clenching the wheel with both hands, because often your teeth will be clenched also.
Do not overuse and stress your jaw muscles. Avoid constantly chewing gum, biting your nails, resting your chin on your hand, or cradling the telephone receiver between your shoulder and jaw.
Change your diet. Eat softer foods, and use both sides of your mouth to chew your food. Avoid hard or chewy foods, such as popcorn, apples, carrots, taffy, hard breads, and bagels.
Maintain good posture. Poor posture may disturb the natural alignment of your facial bones and muscles, causing pain.
In the past, various procedures such as dental restoration and orthodontic treatment were used to prevent joint sounds from developing into TMDs. Such measures are not only unneeded but also potentially damaging to a joint that may never become painful on its own.
Home Treatments
If your temporomandibular disorder (TMD) symptoms are mild, try home treatment for at least 2 weeks. If your symptoms don't get better or if they get worse during this time, call your dentist.
Home treatment involves reducing your stress, resting your jaw (by eating only soft or pureed foods), taking steps to reduce pain, and exercising your jaw.
To help relieve pain and restore jaw function:
Try comfort measures such as moist heat, ice, or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen.
Do jaw exercises as prescribed by your doctor or physical therapist. Also, pay attention to your jaw, and relax it when you are tense.
Change your diet to decrease jaw strain. For example, avoid hard or chewy foods.
Manage stress. Many people tend to clench or tighten their muscles when they are under stress of any kind.
Change your body mechanics, such as by using good posture for sitting and standing.
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