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TMD

Understanding the Great Imposter

By Dr. Steven B. Syrop

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Treatment of the Common Causes of TMD

Treatment is aimed at relieving the symptoms of pain and discomfort; recommendations include education, heat, mild painkillers, muscle relaxants, soft diet, and simple jaw exercises. The next phase of treatment may include a “bite guard” or some form of appliance therapy. Relaxation training and biofeedback with a licensed therapist in more intractable situations is also helpful. These procedures are “reversible,” that is nothing is done physically that cannot be changed. Commonly a bite guard, an unobtrusive yet rigid plastic horse-shoe shaped appliance that fits over the biting surfaces of the upper teeth is used. It is designed to prevent the lower teeth gritting into the upper teeth and allowing the muscles and therefore the joints to relax. It is commonly worn at night, but can also be worn during the day if clenching and grinding are apparent. It is also re-usable during periods of recurrent stress and symptoms.

In the event that symptoms do not subside with these measures, re-evaluation and a new diagnosis may be needed and should be considered. Treatment recommendations may escalate to include irreversible procedures like bite adjustment or at last resort, surgical treatment. These procedures once applied cannot easily be reversed and are only used after conservative reversible procedures have been exhausted and unsuccessful.

There are four other common diagnoses which can cause TMD:

  • Underlying dental conditions leading to muscle pain.
  • Internal joint derangement.
  • Osteoarthritis.
  • Synovitis.

Once the person is out of pain the dentist is able to more fully diagnose the underlying dental conditions that may have led to TMD, such as bite problems, For example, if a filling is even a little high, it can throw off the bite and cause teeth to make inappropriate contacts. The bite itself may be a problem, excessive wear on individual or groups of teeth may also trigger muscle spasm and TMD. Exactly how the bite is related to TMD symptoms is controversial. In the past, much emphasis was placed on the bite. Today, most researchers agree that the bite is not as important as we once thought. Small discrepancies in the bite are very common and are not always the reason for TMD symptoms. Over 80% of patients with TMD will improve significantly with the conservative treatment described above. Since so many people do well with simple treatment, it's prudent to delay “bite adjustment” until you've tried simpler reversible approaches first.

Other causes of TMD as listed above require more sophisticated tests to ensure proper diagnosis and treatment. These may include head and neck examination, blood tests and joint visualization through x-rays, CT or MRI scans. A dentist will commonly take a panoramic (x-ray) radiograph as a first screening of the temporomandibular joints to rule out arthritis or other bone irregularities. Muscle pain or myalgia is the most common cause of jaw pain. A diagnosis of internal joint derangement or disc displacement, means that the disc in the joint is out of position. A displaced disc may result in “clicking” or “popping” sounds, and/or preventing the jaw from opening fully. This diagnosis requires more judgment in treatment as sounds from the joint can be fairly common without great significance. Osteoarthritis, commonly known as “wear-and-tear” arthritis, means that the joint's cushioning has been lost resulting in a change of shape of the bones. A diagnosis of Synovitis refers to swelling inside of the jaw joint.

Summary

TMD pain varies in character from mild to severe, acute to chronic and in location, all of which give your dentist clues regarding the real culprit, but because the symptoms are similar, diagnosis or pinpointing the real cause can be tricky. Just because of this unfortunately, this common ailment may be initially missed or misdiagnosed, but it doesn't have to be. Inexplicable TMD pain can sometimes be misperceived by patients leading to unnecessary worry. Stress can aggravate the condition actually making it worse. Overall, it's best to avoid self-diagnosis and to seek professional attention to treat existing pain as well as to prevent further problems. Don't delay, if you're having TMD pain, mild moderate or severe don't hesitate to see your dentist, the problem may be quite simple to resolve. If your problem is not easily resolved, your dentist may refer you to a specialist to further diagnose and treat the problem effectively. Remember proper and early diagnosis is critical to successful treatment and relief.



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