• Beware TMJ experts and clinics.
• They can be expensive, long-term habits.
• The best treatment is stress reduction, decreased clenching, decreased bruxing, soft diet and NSAIDS.
• For a few, a conservative dental
  orthotic (nightguard) is benefical.
  

Overview of Temporomandibular Joint Dysfunction

Some call this TMJ, some call it TMD standing for Temporomandibular Dysfunction. This is a problem which is ubiquitous. It is more common in women than men and it has been written that up to 75% of middle age women will have at least one symptom or sign of temporomandibular joint dysfunction. For some this is an episodic acute illness, for others, it is a more chronic malady and for a few, it is an obsession.

The epidemiology of TMJ is hotly debated. It is either multifactorial or associated with some underlying weakness or abnormality which we have not yet recognized. I divide the TMJ illnesses into extrinsic and intrinsic causes. The extrinsic causes are such illness as: osteoarthritis, rheumatoid arthritis, septic arthritis, tumor, trauma etc. The intrinsic causes are by far the most common and seem associated with malocclusion, bruxism, clenching and stress. The pathogenesis of TMJ dysfunction is the same as the pathogenesis of a paraspinal muscle spasm. Something happens which either elicits pain or places the muscles of mastication into spasm. This in turn causes pain, pain causes spasm and a cycle is initiated. Until the cycle is broken or wears itself out, pain and dysfunction ensue.

In the evaluation, it is important to separate the various causes. If an individual has a severe malocclusion, this requires attention before resolution of the TMJ can be anticipated.

If the patient has a habit of clenching their teeth, chewing gum nervously, eating pencils or grinding their teeth at night, a habit which is called bruxism, these practices need to be discontinued. Clenching can be consciously suppressed. Gum chewing should be easy to correct. Bruxism which occurs during sleep is more difficult, and is generally treated with an orthodontic appliance called a night guard or dental orthotic.

If the incipient cause is stress, be that neurosis, situational or otherwise, there is little use to prescriptions, appliances, consultations, etc., when what the individual needs, is focus on stress and its reduction.

Acute TMJ is treated first with cold packs and as symptoms of pain and spasm resolve, with hot packs, nonsteroidal antiinflammatory agents or other analgesics. Most importantly, the joint should be placed at rest and this is done by avoidance of hard chewy foods and alimentation either with full liquids or at least, a very soft diet.

For some temporomandibular joint problems, consultation with a dentist to provide an orthotic is useful. I prefer those which simply put the joint at rest and not those which try to disarticulate and radically reposition the temporomandibular joint.

There are individuals who have made a profession and a fortune out of TMJ. I sometimes wonder if in their treatments and medicaments, they do not create or exacerbate the illness. There are all manners of fancy treatments, joint repositioning orthotics, physical therapy, biofeedback, TENS (which is an electric stimulation), acupuncture, lots of dental visits, MRI, TMJ, arthroscopy and TMJ arthroscopic surgery.

There are a myriad of symptoms which temporomandibular joint dysfunction can cause and the primary care physician should know.

Most patients present with ear pain. Only upon careful history taking can one discuss that the pain is, in fact, in front of the ear and in the jaw joint, not in the ear canal or on the ear itself.

Spasms in one of the muscles of mastication such as the masseter, or temporalis will present as pain, often described as headache. These are often called temple headaches, and undergo complex headache workups, when in fact, they are temporomandibular joint dysfunctions. The jaw joint is very closely related to the ear. One of the tensors of the palate is innervated by the 5th cranial nerve and that muscle, the tensor tympani, also tightens the middle ear ossicles by pulling on the malleus. Spasms in this muscle, which is part of the reflex spasm to all of the 5th cranial nerve muscles, will cause decreased hearing, muffled hearing or a feeling of auricular fullness. There are some cases of vertigo which appear to be TMJ related and while it has been difficult to postulate the connection, it has been seen frequently enough that it must be remembered.