Temporomandibular disorders (TMD) are a common subgroup of orofacial pain disorders, often incorrectly referred to as “TMJ”. TMJ is the abbreviation used for the temporomandibular joint or jaw joint.
TMD SYMPTOMS include pain or discomfort in or around the ear, jaw joint, and/or muscles of the jaw, face, temples and neck on one or both sides. The pain may arise suddenly and progress with fluctuating frequency and intensity over months to years. Clicking, popping, grating (crepitus), locking, limited opening or deviating jaw movement, chewing difficulties, and headache are also associated with TMD.
Causes for TMD are unclear as TMD usually involves more than a single symptom and rarely has a single cause. TMD is believed to result from several factors acting together, including jaw injuries (trauma), and joint disease (arthritis). Tooth clenching and grinding (bruxism) and head and neck muscle tension, while not scientifically proven to be a cause of TMD, may perpetuate TMD symptoms and often need to be controlled to reduce and manage TMD. It is important for the TMD patient to understand that the disorder can be chronic in nature and highly dependent upon multiple factors including emotional stability. Because there is no “quick fix” or immediate cure for TMD, the most successful and scientifically supported treatments focus on self-management and control of the aggravating factors.
Treatment Options
OCCLUSAL SPLINTS
It may be recommended that you wear an orthotic (also known as a splint, night guard, bite guard) that fits over either your upper or lower teeth. An orthotic has many different uses and can be worn either full time or part time, depending what your doctor determines is best for you. Generally, orthotics are used to keep the teeth apart, realign the jaw joints and help the jaw muscles relax. The specific design and adjustment of your orthotic will depend upon your condition, how it changes during the time you wear your orthotic, and your overall treatment plan.
STRESS MANAGEMENT
One treatment approach for your TMD problem is to learn to manage your daily stress. Your doctor may recommend several techniques to help you do this. They may include biofeedback, relaxation breathing, guided imagery, and sometimes referral to a therapist.
PHYSICAL THERAPY
Physical therapists are trained professionals who help rehabilitate all types of physical injuries. There are many different techniques that are helpful and the most common include jaw exercises, postural and ergonomic training, ultrasound, electrical stimulation, and mobilization. Your doctor and physical therapist will work together to formulate a plan for your treatment.
OCCLUSAL CORRECTION
Sometimes it is necessary to improve the way your teeth fit together. This can be accomplished in different ways.
Orthodontics, usually with braces, can move your teeth so they fit together better. In some cases, if the jaws themselves are misaligned, the jaws are moved with a combination of orthodontics and oral surgery called orthognathic surgery.
Bite Reconstruction is accomplished through extensive dental work like crowns, bridges and, if indicated, implants. This is done to replace missing teeth or to change the size and shape of the teeth so they fit and function together in a more harmonious manner with the jaw joints and muscles.
Surgery is sometimes done to repair or reconstruct the joints when more conservative treatment has failed to improve comfort and function. While rarely needed, surgery can be performed to eliminate debris that accumulated in the joint, to repair damaged tissues and to even replace entire joints, similar to the replacement of other joints like knees, hips and shoulders.