Temporomandibular Disorders (TMD)

Temporomandibular disorders (TMD) are a family of facial pain disorders, often incorrectly referred to as “TMJ”.  TMJ stands for the temporomandibular joint, which is the name for each joint (right and left) that connects your jaw to your skull.  If you have had symptoms like jaw pain, headaches or a “clicking” sound, you’ll be glad to know that these problems are more easily diagnosed and treated than they were in the past.  There are two basic types of TMD:  muscle generated pain and jaw joint generated pain, however long standing pain from either one becomes a problem of nerves and parts of the brain the process pain.

Trouble With Your Face and Jaw?

TMD develops for many reasons and is believed to result from several factors acting together. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. You may have a damaged jaw joint due to injury or disease.  Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. The disk, which is made of cartilage and functions as the “cushion” of the jaw joint, can slip out of position. Whatever the cause, the results may include a misaligned bite, pain, clicking, or grating noise when you open your mouth, trouble opening your mouth wide and headaches.  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.

Do You Have a Temporomandibular Disorder?

  • Are you aware of grinding or clenching your teeth?
  • Do you wake up with sore, stiff muscles around your jaws?
  • Do you have frequent headaches or neck aches?
  • Does stress make your clenching and pain worse?
  • Does your jaw click, pop, grate, catch, or lock when you open your mouth?
  • Is it difficult or painful to open your mouth, eat, or yawn?
  • Have you ever injured your neck, head, or jaws?
  • Do you have teeth that no longer touch when you bite?
  • Are your teeth sensitive, loose, broken or worn?

Treatment

Once an evaluation confirms a diagnosis of a TMD, our team of providers will determine the proper course of treatment.  This is done by identifying all contributing factors and implementing a targeted management program.   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 factors.  It is important to note that treatment always works best with a team approach of self-care joined with professional care of a number of different providers and specialists.

Conservative management techniques have proven to be safe and effective in the majority of TMD cases.  The initial goals are to relieve the muscle and/or joint pain.  This is usually accomplished with medications (e.g.:  pain reliever, anti-inflammatory, or muscle relaxant.)  Self-care treatment, behavior modification and jaw exercises can be effective as well.

Stress management or rehabilitative techniques such as biofeedback or physical therapy may also be recommended.  A plastic orthopedic appliance (or a splint or nightguard) fits over your top or bottom teeth and helps keep your teeth apart. There are different types of appliances used for different purposes (i.e.:  discouraging clenching and grinding, positioning of jaw).

What About Bite Correction or Surgery?

Even when symptoms are long standing and severe, most patients do not require invasive treatment.  Treatments designed to permanently change the bite or reposition the jaw with orthodontics or dental reconstruction are not usually necessary and should be undertaken with great care.

If your TMD has caused problems with how your teeth fit together, consideration may be made for bite adjustments (equilibration), orthodontics with or without jaw reconstruction, or restorative dental work.  Surgical options such as arthroscopy and open joint repair restructuring are sometimes needed, but are reserved for severe cases, such as when the jaw can’t open, is dislocated and nonreducable, has severe degeneration, or the patient has undergone conservative (non-surgical) treatment unsuccessfully.