Conditions that Affect TMJ Disorder and Other Comorbidities
With many TMJ disorders, there oftentimes exist other problems that add to the mix – these are called comorbidities. When understanding a TMJ disorder, it is often wise to figure out if the person might also have other medical conditions. A few great examples are EDS, POTS, and/or MCAS. Let’s review each of these and how they might affect the temporomandibular joints and their associated discs.
EDS (Ehlers Danlos Syndrome) is a group of somewhat rare inherited conditions that affect the connective tissue in the body. This can include increased range of joint movement, skin that is too “stretchy” or even fragile. So, when a person has EDS, their temporomandibular joints and discs can be adversely affected – that little disc is more likely to pop out of the socket and make TMJ treatment more difficult. Depending on the type of EDS, there could be a different situation with the TM joints. There could simply be a disc that will not stay in place, so it “slips and slides” around in the socket. Or there could be blood vessel damage that will cause pain or pressure in the joints.
With POTS (Postural Orthostatic Tachycardia Syndrome) there can be lightheadedness, brain fog, fatigue, headaches, blurry vision, tremor, and/or palpitations caused by standing up from a reclined or supine position. All these symptoms can also correlate with slipped discs in the TM joints as well, so dealing with one requires dealing with the other.
In patients with MCAS (Mast Cell Activation Syndrome) this is when mast cells release too much substance causing a reaction like that of an allergy. The TMJ specialist must pay attention to any adverse reaction that appliances might initiate. If the patient is allergic to some of the acrylics or metals used in the treatment of TMD, the practitioner must be aware of this. A patient who reacts strongly to acrylics, for example, might present with tachycardia, shortness of breath, or other symptoms that could be potentially life-threatening. Skin related symptoms like itching, angioedema and skin flushing could be caused by metal or acrylic reactions.
Because more and more people are presenting with EDS, POTS, and or MCAS, it is important to pay attention to their needs. The dental appliances required in treating TMJ disorder need time for the patient to become accustomed to wearing it. The practitioner must tailor the treatment carefully, to avoid excessive problems. Therefore, the ALF appliance has become useful for patients experiencing multiple symptoms.
The bottom line is the doctors all need to work together when a patient has multiple conditions that intersect with other conditions. It’s a team approach. The person who has comorbidities must be addressed in a multidisciplinary approach. Each doctor on the team – and there must be a team – needs to be aware of what the other one is doing. It is important that the physician work closely with the TMJ specialist and any other providers on the team.