July 21, 2018
TMD is complex, but it's worth learning about it and understanding its nuances because TMD doesn't go away or get better on its own. In fact -- it will almost always get worse with time.
By the way, your dental insurance will not cover treatment of TMD.
What is TMD exactly?
The best definition of TMD is a broad one: TMD disorder is a condition involving pain or tenderness in the muscles and/or joint that control jaw movement (this joint is referred to as the TMJ, or temperomandibular joint) with the pain sometimes referring beyond these areas. This pain includes jaw pain, jaw popping or clicking, or pain in the face, eyes, neck, head, and pain when you chew or open wide. So everyone has the joint, "TMJ", but only some people have the pain associated with it, called TMD
Even though TMD is very common -- between 10 and 30 million Americans are affected -- it's generally treated inadequately. Many doctors don't fully understand the disorder, and many dentists can identify TMD, but have not been trained to treat it. Since TMD symptoms can involve the jaw, ear, nose, throat, face, neck, upper back, and even eyes, dentists and ENT doctors often pass TMD patients back and forth, misinterpreting their symptoms and passing on the diagnosis.
The TMJ is in a class of its own since it's both a hinging and a sliding joint. This is unique and accounts for the circular movement that is required to properly chew food. There is no other joint in the body like it. This movement allows the teeth to come together like a mortar and pestle does and efficiently initiates the beginning of the proper digestion of food.
You may not have noticed this before, but when you chew, you chew in a circular motion -- not just up and down -- and that's thanks to the translational movement of the temperomandibular joint. That circular chewing motion, I think, may have evolved to help humans digest our food better and give us more variation in spoken voice. It's not a simple hinging movement, it's more of a three dimensional (circular) movement, and because of that complexity, it can lead to problems or misalignment.
How do I know if I have TMD?
Try this test right now:
Place a finger over the joint in front of your ear.
Open your jaw slightly.
Then open wide until you can feel the joint move.
If you hear a grating, clicking, or crackling noise, or if it's tender when you press, you may have a temperomandibular joint disorder (TMD).
You might also have TMD if you have any of these symptoms:
Jaw pain under the ear
Pain in the face, jaw or neck
Stiffness in the jaw muscle
Not being able to open your jaw all the way, or your jaw getting "locked" open or closed
Some of the symptoms -- headache and ear pain, for example -- can be mistaken for migraines or ear infections, hence all the confusion among professionals.
Most of the time, you can find relief by reducing the amount of wear and tear to the joint. Stop chewing gum, eat softer foods, keep your dental appointments as short as possible, and wear a nightguard to give your jaw a break during the day and prevent clenching at night. Some people find relief with muscle relaxation techniques. Treat this condition as you would a muscle injury.
How is TMD diagnosed?
Because the exact causes and symptoms aren't clear, there isn't a standard test to diagnose TMD. ENT doctors and dentists are typically the ones to make a diagnosis, based on traditional symptoms, especially jaw pain.
No one dentist has the same approach, which is why it's very important to understand your treatment options and get a second opinion.
What causes TMD?
Experts aren't completely sure what causes the problem, but here are some of the possible causes:
Clenching or grinding of teeth
Trauma to the jaw. For example, a root canal (when you have to keep your mouth open wide for an extended period), getting hit in the head, or whiplash.
Arthritis can play a part
Growing up with an improper bite from a young age, which puts wear and tear on the jaw joint over time
The key with TMD is to understand the disorder and your treatment options as much as you can. The longer you live with this condition, the less likely it is you'll be able to reverse the damage to the joint.
The car analogy
Think of it like the tires on your car. If the wheel alignment of your car is off, then your tires will wear unevenly and the car will not steer properly down the road.
Occasionally, jaw pain doesn't indicate anything seriously wrong and the pain usually goes away with little or no treatment. A lot of dentists and doctors shy away from treating TMD because the treatment is not predictable and is highly litigious.
Dr. Coambs has completed advanced training to treat TMD through Occlusal Equilibration (bite balancing) and splint therapy.
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