TM Disorders
TMJ is not a disease or syndrome, but rather an anatomic part (temporomandibular
joint). As all humans have two TMJs, we need only concern ourselves with
malfunctioning jaws that are associated with pain or mechanical disability. In reality, TM disorders represent only one of many entities that can
produce the complaint of facial pain.
When occurring, TM disorders are typically characterized by the complaint
of episodic or constant pains in the ears, face, teeth, jaw and neck,
occurring independent of, or during functional activities. In addition,
the complaints of altered/variable jaw range of motion, TM joint noises,
bite inconsistency, ringing/stuffiness in the ears, headaches, fullness
in the sinuses, and generalized jaw/neck muscle tension are often heard. Typically these complaints are associated with local tissue injury, and/or
physiologic mechanisms capable of producing referred or spreading pain. It is therefore quite common for a patient's perceived pain to have its
origin at a distant, unsuspected site.
Though the majority of patients seeking care for TM disorders are adult
females, increasing numbers of children and the elderly are being seen
on a frequent basis. It appears that within each of these groups there
exists multiple risk factors that predispose to the onset of jaw pain
and dysfunction once tissue injury has been initiated. These risk factors
include past and/or ongoing, trauma (one major event or repetitive small
events), over-utilization activities involving the jaw or neck (tooth
clenching/grinding, nail/cutical biting, phone cradling, work postures,
overstretching of muscles resulting in spasm/inflammation (excessive mouth
opening or singing) and commonplace life tensions and conflicts.
A clear understanding of TM disorders reveals that symptoms are experienced
once tissue injury has been sustained. Local tissue injury frequently
develops in the muscle, ligaments, tendons, and bones that support and
move the jaw apparatus. Most of these injuries are reversible and occur
most predominantly in muscle tissue. Inquiries within the temporomandibular
joints, however, do occur frequently and are typically more difficult
to manage. At times, surgery is required to stabilize ligament and cartilage
problems, if in fact, the jaw becomes locked and incapable of sustaining
daily functions. In addition, degenerative arthritis may affect the TMJ
requiring surgical management.
When diagnosed, TM problems can be managed by dietary modifications,
habit-breaking strategies, medication, physiotherapy, exercise, dental
biteplates, surgery and/or stress management techniques. The ultimate
goal of these treatment modalities is twofold:
- To provide an environment to foster healing and adaptation of already
injured tissue.
- To control all future reinjuring factors.
Although multidisciplinary interactions are often required to reach these
goals, the vast majority of those suffering from TM disorders are ultimately
managed successfully.
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