 |
 |
 |
|
Alternative Names: Temporomandibular Disorder, TMD.
"TMJ" stands for temporomandibular joint, or the jaw joint. The TMJs are the small joints in front of each ear that attach the lower jaw (mandible) to the skull. They allow you to perform such functions as opening and closing your mouth, chewing, speaking, swallowing, etc.
TMJ disorder is collection of symptoms which result when the chewing muscles and jaw joints do not work together correctly.
TMJ diseases and disorders refer to a complex and poorly understood set of conditions, manifested by pain the the area of the jaw and associated muscles and limitations in the ability to make the normal movements of speech, facial expression, eating, chewing, and swallowing. Conditions that routinely affect other joints in the body, such as arthritis and trauma, also affect the TM joint.
Incidence; Causes & Development
The National Institute of Dental and Craniofacial Research of the National Institutes of Health estimates that 10.8 million people in the United States suffer from TMJ problems at any given time. Although both men and women experience TMJ problems, 90% of those seeking treatment are women in their childbearing years.
When normal relationships between the condyle, the disc, the fossa and the eminence are altered or distracted for whatever reason, the result is called "internal joint derangement". Internal derangement includes cartilage disc displacements, clicking, popping, stretched or torn ligaments, perforated discs, infection/ inflammation of the capsule or tissues, and adhesions of the cartilage to the socket of the jawbone.
Medical research has not yet defined all the causes of the various TMJ diseases/disorders. Some patients report having TMJ symptoms following dental procedures, the insertion of a breathing tube prior to surgery, trauma, or oral habits such as clenching or grinding the teeth. Conditions that occur in other joints in the body, such as arthritis, can also precipitate or aggravate TMJ pain and dysfunction.
Signs & Symptoms
TMJ symptoms vary widely from patient to patient and may wax and wane within an individual. The most common symptoms experienced by people with TMJ diseases include:- facial pain
- pain in the jaw joint and surrounding tissues, including the ear
- jaw locking while open or closed
- limited opening or inability to open the mouth comfortably
- headaches
- bite that feels uncomfortable, "off", or as if it is continually changing
- neck, shoulder and back pain
- swelling on the side of the face
When a problem is related to the muscle disorders, this is called myalgia/myofascial pain (pain from sore muscles). Pain is usually due to persistent contraction of the muscle as they attempt to keep the lower jaw from excessive movement. This causes pain to the jaw, face, head, neck and eventually translating to the shoulder, arm, back, hip, knee and foot.
Pain lasting for a week or less may not require medical/dental attention. Popping and clicking sounds in the joint have been considered symptoms of a TMJ problem; however experts observe that many perfectly healthy joints make noise. Jaw noises unaccompanied by pain or decreased mobility do not mean you have a TMJ problem.
Those with the symptoms listed above often report additional ones as well, such as ringing in the ears, ear pain, diminished hearing, dizziness or vertigo, and visual disturbances. These symptoms may be a facet of TMJ disease or a different disease process occurring simultaneously.
People with TMJ implants are a subgroup of patients whose jaw problems led to surgery to replace all or part of the jaw joint. The devices failed in a large number of these patients who then experienced serious complications requiring further treatments and often additional surgeries. These patients have reported a variety of signs, symptoms and other medical problems, which may be related to their jaw implants and some of which may have occurred independently. The TMJ Association lists these symptoms because TMJ implant patients frequently report them:- resorption or degeneration at the end of the jaw bone (the condyle) and the part of the skull where the jaw bone is inserted (the fossa); the mandibular, or jaw, bone described as "melting" or "soft"; skull penetration (holes in the skull)
- disfigurement or deformity of the face
- pain and dysfunction in the facial muscles
- sleep disturbance
- flu-like symptoms such as low-grade fever, malaise and fatigue
- weakness and/or diminished muscle strength
- lack of coordination
- nausea with or without vomiting
- visual disturbances, including reading problems, snow blindness, blurred vision, blindness
- memory loss, confusion, inability to think clearly
- seizures and/or blackouts
- swollen lymph nodes/glands (e.g., neck, behind ears, under arms, groin)
- abnormalities of the parotid glands (the salivary glands, located below and in front of each ear)
- abnormal thyroid function
- skin rashes, dry skin, itching, and sensitivity to the sun
- Sjögren's Syndrome (dry eyes, dry mouth and dry mucous membranes)
- changes in skin color and texture, such as hardening, thickening, or shining
- allergies or similar sensitivities to chemicals and drugs
- cold hands and feet
- intolerance to heat and/or cold
- dry, unproductive cough; chronic or episodic hoarseness
- swallowing difficulties
- chronic respiratory, urinary tract, pelvic, or gastrointestinal infections
- benign tumors or granulomas in various parts of the body (e.g., breast tumors, fibrocystic breast disease, fibroid tumors)
One of the most common TMJ disorder symptoms is headache. Over 90% of all chronic headaches, however painful, arise primarily from muscle contraction, most of which originate in the neck. The pain of muscle contraction headache usually starts in the forehead, temples or back of the head and spreads over the neck and shoulders. When neck muscles are dysfunctional or tight, this compresses the occipital nerves, one of the common nerves causing headaches. When there is additional stress, mostly bad bite, that causes TMJ dysfunction, it makes them tighter, and compressing on nerves, blood vessels, and lymphatic channels within the joint spaces. This combination of process can lead to the development of various kinds of headaches; migraine, tension-type, cluster-type.
Diagnosis & Tests
At this time, no formally established diagnostic criteria exist for TMJ diseases.
Treatment & Prevention
Non-surgical treatment can restore function of the TMJ (Tempero-mandibular joint) with surprising results. Clinicians who have treated individuals with TMD (Tempero-mandibular dysfunction) have noted that related conditions such as tinnitus have been improved and, in many cases, eliminated. Non-surgical treatment is appropriate in cases where the symptoms are related to mild joint damage, muscle hyperactivity and/or dental-skeletal malalignments.
These interventions include application of heat and cold, prolotherapy, injections of a local anesthetic into muscle trigger points, passive and active jaw exercises, medications such as muscle relaxants and anti-inflammatories, multivitamins, neuromuscular orthotics, biofeedback and acupuncture, transcutaneous electrical neural stimulation, coronoplasty, and cortisone injections.
Sometimes TMJ problems resolve over time with patients taking mild pain-relieving drugs and using heat, cold or other palliative measures. At present, there are more than 50 treatments in use ranging from very conservative, reversible therapies to more aggressive, invasive approaches. None of the surgical treatments for severe cases have been proven effective in long-term controlled clinical trials.
The Resultant Force Vector Technique is able to reduce abnormal muscle tension and to restore balance within the body by correcting bite and establishing physiological function of TMJ. Through this technique it is claimed that stress-related headaches have been relieved 90-95% of the time in the absence of complicating medical problems. Those suffering from weekly or daily headaches, who are also taking medications without knowing when the headaches will cease, should evaluate such alternatives.
Dr. Wesley Shankland, Past President of the American Academy of Craniofacial Pain recommends three criteria be satisfied before TM Joint surgery is tried. The criteria are:- All conservative treatment has failed. If splint therapy has failed once, it should be repeated, with a different splint design, or by a different doctor.
- There is a demonstrable physical or structural explanation for the patient's complaints. A physical problem can be seen with an MRI, X-rays, or with dye injections into the joint (arthograms). Make certain that this is not an exploratory surgery or that the surgeon "thinks" this surgery will help.
- The Patient must be suffering so much that they must take strong pain medication, and their life-style is greatly altered. In other words, the patient must be desperate and at the "end of their rope" before surgery is attempted.
Don't permit the doctor to proceed with any invasive or irreversible procedure too soon, and insist on a referral to other practitioners who are trained to listen to symptoms, observe signs, and place these findings into neat packages to determine a diagnosis and treatment into a conservative non-invasive modality.
Prognosis
Various surgical methods and techniques have been developed for TMJ surgery since the 1980s. Surgery was one of the most popular treatment modalities for patients whose symptoms could not be relieved by splint therapy or other conservative treatments.
Despite some patients experiencing symptomatic relief, others have suffered more after surgery. The procedure was irreversible and there was nothing much to do except medicate to control the pain. Because of the severity of pain and the side-effects of drugs, both patients and doctors struggled.
These days, better non-surgical techniques and drugs have been developed, and both surgeons and non-surgeons consider surgery as the last treatment modality option.
Post-surgical symptoms are categorized as "chronic pain symptoms" and must be treated/managed accordingly.
|
|
 |
|
 |
Conditions that suggest TMJ Problems: | | | | | Metabolic |  Tinnitus | The findings of a recent study were very interesting. Of a group of twenty patients with tinnitus, ten tested positive for TMJ dysfunction in all diagnostic tests used. Nine tested positive to one or more of the diagnostic procedures. Only one patient of the twenty had no positive evidence of any jaw joint dysfunction. Dr. Morgan's findings were published in The Journal of Craniomandibular Practice. ["Tinnitus of TMJ Origin: A Preliminary Report," Vol.10, No.2]
Another research project was headed by Richard L. Goode, MD, professor of ENT and Head and Neck surgery at Stanford University's School of Medicine. Drs Morgan and Goode were able to establish the mechanical connection between the ossicles in the middle ear and the capsule and disk of the TMJ. ["The TMJ-Ear Connection", Journal of Craniomandibular Practice, Vol. 13, No.1).]
You may get an idea if the tinnitus is connected to your TMJ in some way, by - Clenching your teeth - does it change the tinnitus in some way? (Get louder/softer, pitch change)
- Pushing in hard on the jaw with your palm. Does the tinnitus change?
- Pushing in hard on the forehead with your hand. Resist with the head. Any changes?
As many as 50% of people using these techniques find a change in their tinnitus and a TMJ correlation they had not known about. |
|
Symptoms - Skeletal |
TMJ problems (confirmed) |
| | | | |
Recommendations and treatments for TMJ Problems:
KEY | | Proven definite or direct link |  | | May do some good |  | | Highly recommended |
GLOSSARY
Acupuncture (Acupuncturist)
A family of procedures that originated in traditional Chinese medicine. Acupuncture is the stimulation of specific points on the body by a variety of techniques, including the insertion of thin metal needles through the skin. It is intended to remove blockages in the flow of qi and restore and maintain health.
Allergy (Allergies)
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Anesthetic
Agent causing loss of sensation by neurological dysfunction or a pharmacological depression of nerve function.
Arthritis (Arthritic)
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Benign
Literally: innocent; not malignant. Often used to refer to cells that are not cancerous; they tend to grow slowly and don't spread (metastasize) like cancer tumors do.
Cartilage
Specialized fibrous connective tissue that forms the skeleton of an embryo and much of the skeleton in an infant. As the child grows, the cartilage becomes bone. In adults, cartilage is present in and around joints and makes up the primary skeletal structure in some parts of the body, such as the ears and the tip of the nose.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Gastrointestinal (GI, GI Tract)
Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.
Gland (Glands)
The glandular system is one of the most important and complicated systems of the body. Gland tissue can be either an organ or general tissue that secretes chemicals and there are two types of gland: exocrine and endocrine. Those glands which secrete chemicals through tubules or ducts are called exocrine and include sweat, tear and salivary glands. Ductless glands - part of the endocrine system - secrete special chemicals (hormones) directly into the blood.
Lymph Nodes (Axillary Nodes, Inguinal Nodes, Lymph Gland, Lymph Glands, Lymph Node, Lymphatic)
Small, bean-shaped nodes at various points throughout the body that function to filter the lymph fluid and attempt to destroy the microorganisms and abnormal cells which collect there. The most common locations are the neck (both sides and front), armpit (axillary) and groin (inguinal), but also under the jaw and behind the ears. Swollen or painful lymph nodes generally result from localized or systemic infection, abscess formation, or malignancy. Other causes of enlarged lymph nodes are extremely rare. Physical examination for lymph nodes includes pressing on them to check for size, texture, warmth, tenderness and mobility. Most lymph nodes can not be felt until they become swollen, and then will only be tender when pressed or massaged. A lymph node that is painful even without touching indicates greater swelling. Lymph nodes can usually be distinguished from other growths because they generally feel small, smooth, round or oval-shaped and somewhat mobile when attempts are made to push them sideways. Because less fat covers the lymph nodes in children, they are easier to feel, even when they are not busy filtering germs or making antibodies. Childrens' nodes enlarge faster, get bigger in response to an infection and stay swollen longer than an adult's. Also known (incorrectly) as lymph glands.
Magnetic Resonance Imaging (MRI)
A technique used in diagnosis that combines radio waves and magnetic forces to produce detailed images of the internal structures of the body.
Malaise
A vague feeling of bodily discomfort, as at the beginning of an illness. A general sense of depression or unease.
Migraine (Migraine Headache, Migraine Headaches, Migraines)
Not just a headache, but a disorder affecting the whole body, characterized by clearly defined attacks lasting from about 4 to 72 hours, separated by headache-free periods; progresses through five distinct phases. Prodrome: experienced by about 50% of migraineurs and starting up to 24 hours before the headache - changes in mood, sensory perception, food craving, excessive yawning, or speech or memory problems. Aura: experienced by about 15% and starting within an hour before the headache - disruption of vision (flashing lights, shimmering zigzag lines, blind spot) or sensation (numbness or 'pins and needles' around the lips or hand), or difficulty speaking. Headache: usually pulsating and occurring on one side of the head, it may occur on both sides of the head and alternate from side to side. Muscles in the neck and scalp may be tender; there may be nausea and the desire not to eat, move, see or hear. Resolution: the headache disappears and the body returns to normal. Resolution may occur over several hours during sleep or rest; an intense emotional experience or vomiting may also end the headache. Postdrome: After the headache stops, the sufferer feels drained, fatigued and tired. Muscles ache, emotions are volatile and thinking is slow.
Mucous Membranes (Mucosa, Mucous Membrane, Mucus Membranes)
The membranes, such as the mouth, nose, anus, and vagina, that line the cavities and canals of the body which communicate with the air.
Myalgia
Diffuse muscle pain.
Nausea
Symptoms resulting from an inclination to vomit.
Palliative (Palliate, Palliates)
Relieving or soothing the symptoms of a disease or disorder without effecting a cure.
Parotid
A pair of salivary glands tucked into the notch in front of each ear and emptying through parotid ducts by each upper 2nd molar. Although the fluid has some of the thick viscous lubricant nature of saliva from the glands in the floor of the mouth, the parotids secrete high levels of ptyelin and amylase (starch-digesting enzymes) lysozymes (antimicrobial enzymes) and a group of proteins loosely called parotin that stimulate epithelial and nerve cell growth.
Prolotherapy
A single or series of injections that stimulates the body to regrow, tighten, and strengthen ligaments or tendons. It is unequaled for pain relief and restoration of normal function for any body joint where connective tissue is weak or has been damaged.
Saliva (Salivary)
The watery mixture of secretions from the salivary and oral mucous glands that lubricates chewed food and moistens the oral walls.
Seizure (Seizures)
While there are over 40 types of seizure, most are classed as either partial seizures which occur when the excessive electrical activity in the brain is limited to one area or generalized seizures which occur when the excessive electrical activity in the brain encompasses the entire organ. Although there is a wide range of signs, they mainly include such things as falling to the ground; muscle stiffening; jerking and twitching; loss of consciousness; an empty stare; rapid chewing/blinking/breathing. Usually lasting from between a couple of seconds and several minutes, recovery may be immediate or take up to several days.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Tempero-Mandibular Joint (TMJ)
The hinge of the jaw.
Thyroid (Thyroid Gland)
The thyroid gland is an organ with many veins, anchored around the front of the throat near the voice box. It is essential to normal body growth in infancy and childhood. It absorbs iodine from the diet and releases thyroid hormones - iodine-containing compounds that help govern the rate of the body's metabolism (its total life processes), affecting body temperature, and regulating protein, fat and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor. To a high degree, metabolism is regulated by the hormone thyroxine, which can be made by the thyroid if enough organic iodine is available. An enlarged thyroid gland that is not cancer is sometimes called goitre.
Tinnitus (Tinnitis)
A sensation of noise (ringing or roaring) that is caused by a bodily condition and can usually only be heard by the person affected.
TMD
Tempero-mandibular joint dysfunction.
Tumor (Tumors, Tumour, Tumours)
An abnormal growth of tissue resulting from uncontrolled, progressive multiplication of cells and serving no physiological function; a neoplasm. Literally, a swelling; in the past the term has been used in reference to any swelling of the body, no matter what the cause. However, the word is now being used almost exclusively to refer to a neoplastic mass, and the more general usage is being discarded.
Urinary Tract (UT)
The kidneys and the lower urinary tract, which includes the ureters, bladder, and urethra.
Vertigo
The sensation of spinning or whirling; a state in which you or your surroundings seem to whirl dizzily.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: Nov 08, 2009
|
 |
|
|
