Temporomandibular Disorder (TMD)

About Temporomandibular Disorder (TMD)

This condition is also sometimes called Temporomandibular Joint and Muscle Disorder (TMJMD) or may be erroneously referred to as TMJ.

TMD is a common condition although the exact prevalence in the community is not known. It is estimated that TMD may affect up to 25% of the population.

What is TMD?

This disorder involves the jaw joints (temporomandibular joints - TMJ) the muscles of mastication (those muscles used for chewing), as well as other muscles and soft tissues of the head and neck. Symptoms are felt or referred around the jaw joints and diffusely around the head and neck.

TMD is clinically challenging and it is unusual because of the very wide range of signs and symptoms associated with the disorder. Patients may present, for example, with temporal headache as the primary symptom, or inability to chew without pain, or clicking or grinding in the jaw joints, or waking in the morning with jaw or facial pain, or with dizziness. These are just a few of the many symptoms associated with TMD.

A partial list of the signs and symptoms of TMD includes:

• Pain in the face or jaw region
• Neck pain
• Headaches / earaches
• Clicking of the jaw joint(s)
• Muscle tension in the jaw region
• Restricted opening of the jaw
• Difficulty in chewing
• Toothache / tooth sensitivity (without specific tooth disease)
• Dizziness
• Bruxism (grinding of the teeth)
• Sore tongue / gums
• Locking of the jaw
• Tinnitus (ringing in the ears)

What this means is that patients with TMD may experience one or any number of these signs and symptoms and because of the diverse nature of these symptoms, will consult an equally diverse range of health care professionals in order to try to address the problem.
Patients will consult their GP, dentist, orthodontist, neurologist, osteopath, physiotherapist, chiropractor, pain specialist, maxillofacial surgeon, rheumatologist, orthopaedic surgeon, acupuncturist, psychologist, psychiatrist, audiologist, ENT specialist and others.

This makes it very confusing for the TMD sufferer because practitioners tend to view problems through the lens of their own specialty. This means that the patient gets a huge range of opinion about the cause of the problem and the best way to manage it.

What causes TMD?

For many people with TMD the cause is unknown. There are however some identifiable causes of TMD. These include:

• Problems of the jaw joint (TMJ):
  • - Direct injury such as a blow or impact to the jaw joints.
  • - Damage or displacement of the disc within the TMJ.
  • - Arthritis of the TMJ.
  • - Misalignment or uneven movement of the TMJ.
• Bruxism:
  • - Involuntary, habitual grinding of the teeth.
• Stress:
  • - Stress may be a causal factor, or the chronic nature of pain in TMD may produce stress symptoms.
• Posture:
  • - Carriage of the head and the habitual pattern of posture can be a significant contributor to TMD.
• - Alignment problems of the teeth. Orthodontic interventions.

While there are many interventions that have been shown to be helpful in TMD treatment, there is unfortunately no single evidence-based strategy that has been shown to be effective in the management of TMD. Much of the reason for this is that the factors that contribute to the disorder are generally different for each person.
Each TMD sufferer is unique.

This is the assumption I start with in the treatment and management of TMD. Each patient is assessed to determine firstly if their symptoms are associated with TMD, and if so, what factors can be addressed to manage the problem.

I use a range of clinical interventions to treat TMD. These include:

• Manual soft tissue treatment:
  • - Massage, inhibition, acupressure applied directly to muscles around the jaw, head and neck.
• Joint mobilisation:
  • - Techniques applied to the temporomandibular joints and the cervical spine to try to normalise the range and quality of movement.
• Acupuncture:
  • - This has been shown to be a useful intervention in the management of TMD.
• Muscle Energy Technique (MET):
  • - This is an osteopathic technique that involves a combination of controlled contraction and relaxation of muscles to improve range and quality of movement.
• Low level laser therapy:
  • - I use a 904 nM wavelength cold laser. LLLT has been shown in clinical trials to be useful in the management of pain associated with TMD.
• Remedial exercises:
  • - Patients are frequently prescribed strengthening, stretching or mobilising exercises to help to manage this problem.
• Meditation and stress management strategies:
  • - For many patients, stress management is an integral part of clinical management of this disorder. Simple relaxation and/or meditation techniques are often prescribed.
• Orthoses or Splints:
  • - Many patients with TMD suffer from bruxism or grinding of the teeth. These people are often prescribed dental orthoses or mouthguard-like splints by their dentists and orthodontists. For some this is a very effective intervention especially as it protects the teeth from excessive wear or cracking and may reduce symptoms of TMD. The splints may also exacerbate the symptoms of TMD because the involuntary clenching or grinding at night may increase when something to bite into is provided. Assessment of the impact of a splint on TMD symptoms is essential. A number of alternatives may be suggested or prescribed where appropriate.

Effective management of the complex problem of TMD often involves collaboration between a number of different health care professionals. Referral for investigations, or for the opinions, expertise or treatment interventions of other health care providers may be necessary.