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My Jaw Hurts
Temporomandibular Disorders (TMD) are painful conditions that primarily affect the jaw and are related to the spread of pain to the head, face, ears, neck and shoulders. The temporomandibular joint (TMJ-jaw joint) and the associated muscles of mastication (jaw muscles) are responsible for daily functions of opening and closing of the mouth, chewing, talking, yawning, swallowing, breathing and kissing. The American Academy of Orafacial Pain describes two basic types of TMD Myogenous TMD (muscle generated pain) due to jaw/head/neck/shoulder muscle overloading or tension, and Arthrogenous TMD (jaw joint generated pain) due to joint inflammation, degeneration and disc dislocation.
It has been suspected that over 10 million people in the United States suffer from TMD, affecting more women than men. There has been controversy over the cause, diagnosis, and treatment of TMD. Despite the prevalence of TMD cases, further research and specialization is needed by various medical fields to better understand and treat the disorder.
Causes for TMD vary greatly and a single cause is rare. Historically, trauma and disease have generally been accepted as causes. Trauma encompasses injury from direct forces to the jaw, as well as stress to the jaw due to lengthy or forceful dental, medical, and surgical procedures that require opening of the mouth. Diseases that may aggravate the TMJ include osteoarthritis, rheumatoid arthritis, gout, strokes, Parkinsons disease, Lou Gehrigs disease, myasthenia gravis and tetanus (lockjaw). Other notable factors that may precipitate or aggravate the TMJ include systemic hypermobility, poor posture, malocclusion (abnormal bite), head/neck tension, chewing hard foods or gum, poor oral habits (jaw clenching, teeth grinding, lip/gum/nail biting) and psychological stresses.
TMD is a musculoskeletal disorder and diagnosis should be made through a comprehensive clinical examination from a combination of dentists, medical doctors, physical therapists, and psychologists. A comprehensive examination by a physical therapist should include a thorough history and a physical evaluation of the TMJ, muscles of the head and neck, and the cervical spine (neck).
Most TMD symptoms experienced by people are temporary and fluctuate over time, but may develop into chronic conditions requiring professional treatment. Treatment is either conservative (reversible) or surgical (irreversible). Most researchers and clinicians agree that conservative management is the safest and best course of care. Treatment may include physical therapy, behavior modification, medication, and dental appliances. A physical therapist can advise with patient self-care, educate for postural correction, prescribe jaw exercises, use modalities (ice/heat/ultrasound/electrical stimulation) and perform manual mobilization techniques to restore muscle and joint function of the jaw, head and neck. All of these techniques aim to restore muscle/joint function, range of motion, muscle coordination, joint stability and decrease pain and inflammation.
Fifty percent of TMD symptoms can be relieved and/or resolved with conservative management. Successful outcomes will require cooperation between the various medical professional mentioned, due to the complexity and variance of causes and treatment option. The American Academy of Orafacial Pain has made strides in establishing collaboration between the dental and physical therapy communities. Chronic TMD patients do not have to suffer any longer, because there is medical advice and treatment available.