Temporomandibular Joint Disorders
Temporomandibular joint disorders are a large area of debate amongst dentists. The temporomandibular joint (TMJ) is one of the most complicated joints in the body, and arguably the one that is most used. So when things go wrong with it, it can lead to serious quality of life issues. Unlike other joints where you can pretty much just avoid use if they flare up, with the TMJ you are forced to continue using it if you want to speak or eat!
Diagnosing these disorders and their causes is an extremely complicated and frustrating area of dentistry. Pain in these cases can be traced to multiple sources like; muscle tissue inflammation, ear infections, neurologic disorders, abnormal or unbalanced bite, arthritis and a number of other more obscure disabilities like diagnosed or undiagnosed traumatic injury, fracture of bones in the area, or fibromyalgia. Common dental dysfunctions that can contribute are bite and alignment disorders, clenching or bruxism (grinding of teeth). Most of the time these flare-up can revolve around times of increased stress or life changes. I always find it interesting/slightly funny when we have an influx of college aged patients with complaints of jaw pain around finals times!
Most people suffering from these types of painful episodes are helped by a medical model of treatment... either NSAID or steroid medications to control pain and inflammation and encouragement to “give it time.” When things flare up, typically it lasts from a couple weeks to a month or more and then complete resolution is realized. In cases that are seemingly from dental sources (bite issues, clenching or bruxism) and it can be verified through clinical observation, a bite guard can help significantly with symptom resolution. Wear facets, fracture or x-ray evidence of bone changes in and around the teeth are good indications that temporomandiblar joint disorders may be of dental origin. Bite guards are worn at night and are balanced so that no specific area of the mouth is bearing more force than another. They also keep the mouth slightly open to give the joint itself time to rest during the overnight hours. This allows for inflammation to leave the joint space and decompress the cushioning pad of the joint.
In rare cases surgical intervention may be needed. For these patients referrals should be made to oral surgery and orthodontics. If a disorder is related to malocclusion and pain is not resolved with the medical (reversible) model of care and has become more chronic in nature surgery can help. The jaw can be reset by an oral surgeon to get to a more ideal bite. Typically orthodontics are then utilized to move the teeth into an ideal position. Then to sure up the bite, a general dentist or prosthodontist can crown certain teeth to even things out. One or more of these treatment options may be employed dependent on the severity of the condition.
The greater the disorder the more involved the treatment becomes. Success rates also go down the more involved the treatment becomes. A conservative approach is ALWAYS the way to start. Antiinflammatory medications like ibuprofen in prescription doses are the way to start. Always consult a dentist or physician before beginning this approach though. Night guards are also a relatively inexpensive and very successful treatment that can be reversed. Do not be tricked into jumping to surgical procedures from the start. Many dentists use crowns essentially as a permanent night guard. These procedures are irreversible and can worsen the condition if not done properly. Many of the dentists that aggressively pursue the more surgical options also claim to be “TMJ specialists” or “Headache dentists/specialists.” Don’t be fooled by these claims... there is no such thing as a TMJ specialist. It is not recognized by the American Dental Association. A team approach (oral surgery, orthodontics and restorative dentistry) with a strong commitment to the medical model of treatment is very important in successful treatment of these disorders.