Temporomandibular Disorder (TMD) is a general term that describes a multitude of conditions. All TMD involves some amount of acute or chronic pain resulting from inflammation either in the temporomandibular joint which connects the lower jaw to the skull, or in the collection of several muscles that control jaw movements, called the muscles of mastication. TMD can be quite localized with few symptoms. However, if not addressed at an early stage, TMD can become a very complex musculo-skeletal condition involving significant pain. These more advanced cases are often difficult to resolve successfully and may require one or more treatment approaches including medication, physical therapy, splint therapy, steroid injections, dental reconstruction, or jaw surgery.
Fortunately, we screen all our patients for symptoms of TMD, and we are normally successful in significantly reducing or eliminating TMD symptoms using non-invasive therapies.
Symptoms of TMD include:
- A clicking, popping, or grinding sound or feeling when opening or closing
- Discomfort during function, meaning chewing or talking for prolonged periods
- Frequent headaches
- Migraine headaches (particularly in the morning)
- Ear pain
- Ringing in the ear, or hearing loss
- Facial aching, or a sensation of fatigue in the face or jaw
- Restricted jaw motion, or a shifting of the jaw to one side when opening wide
- Neck and shoulder pain
- Non-restful nights of sleep
- Waking with a tired or fatigued feeling in the face or jaw
- Awareness of clenching teeth together during times of stress, tension, or concentration
Causes: TMD is most often caused by an activity that either overstrains the jaw joint (hyperfunction) or forces the jaw to function in damaging ways (parafunction). The causative force may be a single event or a long history of repetitive parafunction. Emotional or physical stress may be, but is not always a contributing factor. In fewer cases, TMD may be associated with any of the many conditions that can affect any body joint, including ankylosis, arthritis, trauma, dislocations, developmental defects, tumors, and neuralgias.
Hyper- and parafunction: TMD’s causes include the following:
- Clenching due to stress or concentration
- Dysfunctional alignment of the upper and lower teeth
- Exaggerated opening of the mouth such as when eating large bites of chewy foods, wide yawning, or during a difficult wisdom tooth removal surgery
- A behavior known as “jaw thrusting”
- Bruxism (Please see our section on Bruxism)
- Collapse of the vertical “height of occlusion” usually in patients over forty, caused by years of wear that have worn down the biting surfaces of front or back teeth
- Parafunction other than bruxism, such as excessive gum chewing, nail biting, eating very hard foods, ice chewing, etc.
- Degenerative joint diseases
- Myofacial Pain Syndrome
Early Intervention. Occlusal Guard Therapy.
The great majority of TMD in our practice is treated using minimally invasive or completely non-invasive techniques. An oral appliance made out of acrylic, and called an occlusal guard, bite splint, or night splint is worn over some or all of the teeth in one arch (usually the upper arch) during sleep or at selected times throughout the day. During introduction of this appliance, Dr. Osborne may place the patient on a short-term course of anti-inflammatory and muscle relaxant medications. This, combined with a short term course of home therapy, such as moist heat application and temporary reduced jaw function, often achieves significant reduction in the painful symptoms of TMD. After home care and medicine regimens are complete, the occlusal guard’s use is continued indefinitely. Treatment for TMD in our office usually involves no irreversible changes to your teeth or facial structures, and is normally accomplished in a matter of weeks. For more advances cases, or cases that do not respond to conventional therapy, Dr. Osborne may refer the patient to an oral surgeon, pathologist, or physical therapist to determine if more elaborate therapies are needed.
Over-the-counter night guards can sometimes be effective in alleviating TMD symptoms. However, TMD is a very complex disorder, and the causes may be due to multiple factors. One-size-fits-all therapies are not appropriate in the treatment of TMD, and using OTC (over the counter) appliances risks aggravating the condition. Dr. Osborne strongly recommends consulting with a dentist or oral pathologist prior to self-treating with publicly marketed devices. For very minor cases or symptom-free cases, Dr. Osborne may recommend OTC appliances.