TMJ Dysfunction

Temporomandibular joint dysfunction or disorder (TMD) is a general term used for a group of conditions that cause pain in the temporomandibular joint the structures associated with it. TMD is often referred to as TMJ; however this is the name of the joint itself and has been incorrectly used for this group of conditions. TMD can affect a person’s ability to do everyday tasks such as eating (chewing and swallowing), speaking and also sometimes breathing. The majority of patients suffering from TMD are treated by dentists or oral surgeons. Even though both men and women can suffer from TMD the majority of cases are found to be pregnant women.

Symptoms

Due to the wide range of possible ailments affecting the different structures associated with the TMJ there can be all kinds of different symptoms. However, pain is the most common symptom, but it is not a sure way of identifying that the patient is suffering from TMD. Other symptoms include:

• Trismus (limited jaw movement)
• Clicking or popping sounds from the joint
• Locking of the jaw
• Headaches
• Neck/Shoulder/Back pain
• Swelling of the face near the joint.
• Hearing problems
• Problems with eyesight

TMD is easily misdiagnosed due to the symptoms caused being very similar to many other disorders.

Causes

A large number of people believed or even diagnosed to have TMD may be suffering from other conditions which could be confused for TMD due to the large array of symptoms. Some of the known causes of TMD are:

• Physical damage to mandible or muscles associated with TMJ - A heavy blow can cause displacement of the articular disc, bone fractures in the joint, damage to the ligaments, muscles and even nerves.
• Infections/Auto-immune diseases
• Gender - TMD is much more common in women than men. Almost 90% of all cases are female. It is theorised that this could be due to structural differences and also due to hormones in the body (especially sex hormones).
• Age - Osteoarthritis is a very common cause of TMD and 33% of people over 50 have been reported to have some form of arthritis in their TMJ.
• Bad habits - Grinding teeth, clicking jaw, chewing gum, biting fingernails etc.
• Bruxism - grinding of the teeth often involuntarily while sleeping. This can lead on to many harmful conditions such as TMD.

These causes result in a range of different levels of pain. Bad habits for example usually will only cause mild forms of TMD, which most of the time will go away without any treatment. Some of the more serious consequences of these causes can be neoplasms which mimic the symptoms of TMD.

Diagnosis

Diagnosis of TMD can be very difficult as pain is very subjective and also numerous disorders and dysfunctions can cause facial pain. So at present the most common way of diagnosis is with a complete physical examination of the head and neck along with taking a detailed patient history. No singular test is available to directly diagnose TMD. There are however, a few tests that will allow the physician to rule out some of the other possibilities. Imaging studies, such as X-rays, CT scans (Computed Tomography scans) and MRIs (Magnetic resonance Imaging), can be used to get a more detailed look at the joint and its surrounding structures.

Treatment

The treatment for TMD has one objective, which is to alleviate the pain induced by the dysfunction. Luckily the majority of cases of TMD are mild and can be treated fairly simply. However, there is no empirical evidence to show one treatment works better than any other so many self-care treatments are recommended. Some of the treatments for mild TMD are:

• Eating soft foods
• Moist Heat
• Ice packs
• Jaw exercises
• Relaxation techniques
• Avoiding excessive movement of the jaw
• Over the counter pain medicines can also be helpful
• Avoiding any dental surgery.
• Stabilization splint (nightguard or biteplate in order to prevent any abnormal jaw movement whilst sleeping)

In more serious cases and with severe pain, surgery can be an option, but only as a last resort. Some of the operations are:

• TMJ implants
• Reconstructive dentistry
• Surgical repositioning 

Any surgery has risks, however when operating on the face it is even more dangerous due to the fact that many of the important structures (nerves, arteries etc.) are very superficial. Also due to the lack of knowledge on the subject, often the underlying cause is not rectified. Instead the immediate problems are dealt so the condition will persist. Due to the poor understanding and the difficulty in diagnosing TMD, surgery is extremely risky strategy and therefore is only used in extreme circumstances.