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TMJ/TMD

Temporomandibular Joint Disorders 

     TMD is not just one disorder, but a group of conditions, often painful, that affect the jaw joint or temporomandibular joint or TMJ and the muscles that control chewing.

     Women are twice as likely to have it than men.

     Usually, discomfort from TMD/TMJ is occasional and temporary, often occurring in cycles,

*

In most people, discomfort from TMD/TMJ will eventually go away whether treated or not. 

What is TMD?

     The temporomandibular joint connects the lower jaw, called the mandible, to the temporal bone at the side of the head. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of your head. 

     Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. Muscles attached to and surrounding the jaw joint control its position and movement.

     When we open our mouths, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft disc lies between the condyle and the temporal bone. This disc absorbs shocks to the TMJ from chewing and other movements.

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Temporomandibular disorders fall into three main categories:

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Myofascial pain, the most common form of TMD, which is discomfort or pain in the muscles that control jaw function and the neck and shoulder muscles;

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Internal derangement of the joint, meaning a dislocated jaw or displaced disc, or injury to the condyle;

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Degenerative joint disease, such as osteoarthritis or rheumatoid arthritis in the jaw joint.

(A person may have one or more of these conditions at the same time.)

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TMD Is Caused By:

  1. Severe injury to the jaw or temporomandibular joint.

  2. Arthritis in the jaw joint.

  3. Bad bite (malocclusion), this theory is in dispute.

  4. Orthodontic treatment (braces) however studies now show that this is unlikely.

  5. Displaced disc, disc is not in a normal position, however if there is no pain or problems with jaw movement, no treatment is needed.

  6. Stress causing clenching or grinding of teeth at night can tire the jaw muscles and lead to pain.

  7. Jaw clicking, however if there is not other symptoms like pain or the jaw locking than jaw clicking alone may not need treatment.

Avoid, if at all possible, treatments that cause permanent changes in the bite or jaw. 

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Symptoms:

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Pain in the chewing muscles and/or jaw joint.

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Limited movement or locking of the jaw

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Radiating pain in the face, neck or shoulders

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Painful clicking, popping or grating sounds in the jaw joint when opening or closing the mouth.

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Sudden, major change in the way the upper and lower teeth fit together.

     It is important to keep in mind, however, that occasional discomfort in the jaw joint or chewing muscles is quite common and is generally not a cause for concern. 

Often just the simple act of chewing food can become painful~

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TMJD Self Test

Jaw Locked known as "acute trismus "

If your jaw becomes locked open it mean NTI. Also do  not open your mouth greater then the thickness of your thumb for at least 4 weeks with some NSAIDS and Ice ........NO heat. Your dentist may have to manipulate the mandible back into position if the jaw is locked open from dislocating.

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fluorimethane spray and stretch

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ice packs (10 min on, 10 min off, 10 min on) over the joint

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physical therapist

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muscle relaxants **** (for dentists)

 

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TMD/TMJ Updates

NIDCR Launches Study on TMJDs

The National Institute of Dental and Craniofacial Research (NIDCR), part of the National Institutes of Health, has launched a 7-year clinical study that could accelerate research on better pain-controlling treatments for a jaw condition called temporomandibular joint and muscle disorders. Called Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA), the $19.1 million project is the first-ever large, prospective clinical study to identify risk factors that contribute to developing a TMJ disorder. Scientists will track 3,200 health volunteers from 3-5 years to see how many develop the disorder. Then Dr. William Maixner, the study’s principal investigator and scientist at the University of North Carolina in Chapel Hill, said that for those who develop TMJ problems, the study will “open a window on the early stages of the disorder, pointing at genes and other biologic factors that might contribute to pain sensitivity.” TMJ disorders occur in 5-15% of Americans. www.nidcr.nih.gov

 

Routine dental care more difficult for patients with TMD, they report that their discomfort creates more difficulty with daily oral health care as compared with the general dentistry patient population, The results also indicated that TMD patients felt their discomfort had created more difficulty performing basic daily oral care, such as brushing their teeth, because of the presence of pain and the limited ability to open their mouths. Flossing also presented problems for the TMD patients. This study confirmed what clinicians hear frequently from patients who have TMD pain with or without limited opening: the limitations of this disorder make it difficult for patients to continue with daily oral health care at home and make it difficult to continue with routine professional care. 
Journal of Orofacial Pain, Vol. 16, No. 2.The study, conducted at the Orofacial Pain Center at the University of Kentucky College of Dentistry

Estrogen replacement therapy does NOT place women at increased risk for developing TMDs.
JADA, Vol 132, March 2001 pg 319-326.

*American Academy of Otolarynology.
~NTI

***trigger point injections of the lateral pterygoid on the affected side of plain lido or carbocaine with no vasoconstrictor

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February 06, 2008

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