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Take a bite out of TMD pain

I've been having a problem with pain and clicking in my jaw. A friend suggested I see my dentist, because I might have a problem with my TM joint. What is the TM joint, and what conditions are associated with it?

TM stands for temporomandibular, a joint that connects the lower jaw to the rest of the skull. It has two connection points on either side of the head, just in front of the ears. The TM joint is flexible and can move up, down, and side-to-side, allowing us to talk, chew, and yawn. The muscles surrounding the joint control the position and movement of the lower jaw.

According to John Guarente, D.M.D., an assistant clinical professor at Boston University's Goldman School of Dental Medicine, a dental care provider can diagnose TM disorder (TMD). "What's important," says Guarente, "is that the condition is properly diagnosed and appropriate treatment is prescribed early on in order to prevent the disorder from becoming more severe."

Symptoms of TMD include limited jaw movement, painful clicking, popping, or grating sounds in the jaw when opening or closing the mouth, pain that radiates along the face, neck, or shoulders, headache, and in some cases, a sudden major change in the way upper and lower teeth fit together.

According to Guarente, TMD is associated with three specific conditions, including myofascial pain. "Discomfort in the jaw muscles, neck, and sometimes the upper shoulders falls into this category," he says. The second condition is a skeletal condition with internal derangement of the joint, meaning that the TM joint or disc has been dislocated, or that there has been injury to the rounded end of the joint, known as the condyle. "The other condition contributing to TMD," Guarente adds, "is usually a systemic joint disease, such as osteoarthritis or rheumatoid arthritis in the joint."

Specific causes of TMD, however, remain unclear. Some experts maintain that emotional stress and jaw clenching or grinding one's teeth may contribute to the disorder. "The stress connection may be a catch-22," says Guarente. "Severe emotional stress may lead to grinding or clenching, which leads to pain or discomfort, which leads to more stress. Certainly attaining a stress-free life would not only aid in TMD but also other disease entities."

Because the exact cause and the symptoms of TMD differ from person to person, diagnosis can be difficult. There is no standard way to diagnose one of the disorders, but regular dental checkups and the careful evaluation of the patient's medical and dental history are important. "If a patient suspects he or she might have TMD, it is vital to communicate those concerns to a dentist," says Guarente. "Careful examination of the TM joint, observation of movement patterns, and a review of dental records can all be helpful in diagnosing a TM disorder." Dental X rays are not particularly helpful in diagnosing TMD, and other three-dimensional techniques such as CAT scans, MRIs, or Commcat imaging should be used only when joint disease is suspected.

Treatment for TMD often consists of noninvasive self-care practices. "Applying moist heat to the muscles of the jaw, gentle muscle stretching, relaxation exercises, and physical therapy are all good ways to begin treating TMD that does not originate from degenerative disease," says Guarente. Some dentists may also prescribe a bite-guard or splint. "These are usually plastic plates, worn at night, that help reduce clenching and grinding," he says. "The guards can help reduce stress and tension in the TM muscles."

If your dentist immediately suggests a surgical treatment, Guarente cautions that you should seek a second opinion. When treating TMD, he says, dentists try to be as conservative and noninvasive as possible, particularly with people who are not experiencing significant pain. "We're still researching the disorder, and we hope to find some definitive treatments soon," he says. "In the meantime, the key words for treatment are conservative and noninvasive whenever possible."

"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information on alternative medicine or other health matters, call 617-638-6767.

26 October 2001
Boston University
Office of University Relations