What is Temporomandibular Joint Disorder?

While “temporomandibular joint disorder” (or “TMD”) is a mouthful to pronounce, it’s actually a simple concept: it’s a term to describe pain or other difficulties associated with the joints — one on each side of our face — that connect our jawbones to our skulls.

As the image from the Mayo Clinic shows, the temporomandibular joint also connects to numerous muscles and parts of the skull. As a result, TMD can appear as ongoing pain in one or more of the jaw, face, shoulders, temples, ear, or neck. The pain will most often appear when opening or closing the mouth, or chewing. Grinding, popping sounds, or clicking noises might also accompany TMD.

Causes of TMD

With these assorted sites for pain, and other symptoms, it’s no surprise that TMD has a wide variety of possible causes. They can include:

• clenching the jaw repeatedly or for long periods of time
• grinding the upper and lower teeth against each other, often unconsciously or while sleeping
• disease of the temporomandibular joint such as arthritis or soft tissue disease
• misalignment of the teeth, which should fit properly between top and bottom sets
• bad posture that can lead to muscle or joint strain
• repetitive stress
• traumatic injury
• habits of nail biting, pencil chewing, and so on
• poorly fitting dentures or plates
• tooth decay
• psychological stress
• overuse of phone and computer screens that can lead to postural, muscle, and eye strain

Treatments for TMD

Such a wide variety of causes of course requires consideration of a correspondingly wide variety of approaches to treatment. It should be noted that dentists are well positioned to diagnose and treat many (though not all) of these TMD situations arising from these causes.

Diagnosing Causes

Treatment begins with diagnosis. A dentist will conduct an individual assessment to ascertain the cause or causes at play, identifying sites of muscle pain and tenderness, checking dental alignment and bite, assessing the appropriateness of any dental appliances in use, and possibly using radiographs (x-rays) to look for hidden causes.

Treating TMD

The first step is the most immediate and simple: when possible, remove any immediately correctable potential causes. This might be as straightforward as stopping activities that can cause or exacerbate TMD. Nail biting, gum chewing, and controllable clenching should be eliminated.

Often the site of pain will indicate a cause. Shoulder and neck pain are most likely caused by posture or daily activities that can be remedied.

Immediate treatments might include switching to a diet of soft food, taking anti-inflammatory drugs to ease pain in muscles, or taking muscle relaxants to prevent inflammation. However, these immediate treatments are generally treating symptoms, not causes, and further investigation and treatment are usually appropriate. Temporary measures might apply as a response to a sudden injury that will heal in the natural course of time, but will seldom solve underlying chronic problems.

More specific dental causes can be revealed by testing tooth or denture alignment, leading to corrective dental solutions. Braces might assist to correct misaligned teeth; a new filling might need adjustment by removing high points to reshape teeth; old dentures might need alteration to compensate for changes in the gums that occur naturally over time. Inspection or x-rays might reveal tooth decay that transfers pain to the jaw, requiring fillings or root canal treatmemt.

Some causes of TMD are interconnected. The stresses of day-to-day life can lead to behaviours that can cause TMD, such as tooth grinding (also known as “bruxism”) and clenching. A dentist can often recognize that these behaviours are in play by evidence found on the teeth. Should they happen over an extended period of time, grinding and clenching can leave tooth wear or damage. Typical treatments for dealing with tooth grinding and clenching are dental night guards and bite plates (also known as “occlusal splints”).

Dental Night Guards, Bite Plates

When it comes to dealing with TMD caused by grinding or misalignment of the teeth, an excellent solution is a bite plate, or occlusal splint. If teeth are misaligned, the temporomandibular joints have to compensate, leading to muscular and joint pain. An occulusal splint will operate as a compensating adjustment, relieving pain. When grinding of teeth at night occurs, an occusal splint (a “dental night guard”) will both protect the teeth from damaging each other and may also lead to a reduction in the behaviour as well.

Occlusal splints are custom-made by your dentist, who will take a mould of your teeth and create a guard or plate customized to your teeth and the desired correction in bite that it is designed to induce.

Alternative Treatments

A number of other treatments for TMD are also important to consider. Physiotherapy and massage can relieve pain and in some cases, such as directed muscle stretching, might also have preventative value.

One way of dealing with stress and the consequent negative behaviours that can damage teeth and cause TMD is to practice “mindful movements”. Mindful movements are akin to the disciplines of meditation and mindfulness generally, and can train one to recognize and avoid the clenching and grinding that can trigger so many dental problems. Some yoga exercises have also been recognized as relieving TMD.

While outside the scope of this blog post, there is also much to be said for the use of acupuncture and botulinum toxin (Botox) in treating TMD. Acupuncture can have excellent results when the cause of pain is related to nerves and pressure points and therapeutic Botox can also have positive effects on muscles involved in TMD. Both of these approaches require skill and knowledge in application.

While TMD has many causes that can manifest in many problems, your dentist is an excellent resource for treatment. Contact the Sherway Gardens Dental Centre with your questions about TMD you might be experiencing.