TMD

Temporomandibular Disorders

What is TMD?

TMD (temporomandibular disorders) refers to a group of conditions, often painful, that affects the jaw joint (temporomandibular joint or tmj) and the associated muscles used in movement of the jaw and neck.

Discomfort from TMD is usually temporary and often occurs in cycles. Most of the time the pain goes away with little or no treatment. A small percentage of people develops significant, long-term symptoms.

Signs and symptoms of TMD

Pain in the muscles of mastication (jaw muscles) and pain in the temporomandibular joint (jaw joint) are the most common symptoms. Pain can also be referred from other sources such as the neck and teeth. Other symptoms include:

: Limited movement or locking of the jaw
: Radiating pain in the face, neck, or shoulders
: Painful clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth
: A sudden, major change in the way the upper and lower teeth fit together
: Unexplained headaches or facial pain including dull, aching, constant pain

Occasional discomfort in the joint and muscles is common and is not usually a cause for concern.

What causes TMD?

When muscles and joints do not work properly, the muscles will often go into a spasm. This spasm can become part of a cycle that results in tissue damage, pain, muscle tenderness and more spasm.

Some of the possible causes of TMD are:

: Direct trauma due to a car accident, a blow, or a fall
: Whiplash type injuries
: Unconscious habits such as bruxism (clenching and grinding of the teeth)
: Unusual stress
: Diseases such as arthritis

While many of the above factors are believed to contribute to TMD, the exact cause is unknown and sometimes it is not possible to determine the cause of the symptoms.

Diagnosis

Diagnosis of TMD can be confusing because the exact causes and symptoms are not clear. The examination includes feeling the joint and muscles for tenderness and pain, listening for clicking and grating sounds during the movement of the jaw, and identifying limited opening or locking of the jaw during movement. X-rays and other imaging procedures are usually not needed unless a condition such as arthritis is present or the pain persists over time and symptoms do not improve with treatment.

Treatment

Because most patients do not have severe, degenerative TMD, conservative treatment modalities should always be the initial form of treatment. Conservative treatment is simple and reversible treatment that does not cause permanent changes in the jaw or teeth.

Because most TMD problems are temporary and do not get worse, simple treatment is all that is needed to relieve discomfort. Eating soft foods, applying moist heat, and avoiding extreme jaw movements can ease symptoms and allow the body to heal. Gentle muscle stretching, relaxing exercises, and the short term use of muscle relaxants and anti-inflammatory drugs can be helpful. Because stress is often a contributing factor, a stress management program might be considered.

An occlusal mouthguard can help reduce clenching and grinding, reducing muscle tension.

Less conservative treatment might be needed for the small percentage of people that doesn't respond to conservative and simple treatment.

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