Jaw pain: it's not "just stress"

What's in a name?

There has been a great deal of controversy among clinicians and researchers about the name, definition, symptoms, causes, and treatment of temporomandibular disorders. As a result, many people with TMD have gone to several medical and dental providers before getting a correct diagnosis and treatment.

The temporomandibular joint (TMJ) is the jaw joint. Temporomandibular disorders (TMD) refers to a group of conditions that affect the temporomandibular joint as well as the muscles that control chewing. Although the terms "TMJ" and "TMJ Disorder" are sometimes still used to describe disorders associated with this joint, "TMD" is becoming the accepted term.

Because of a lack of agreement about these disorders, we don?t really know how many people have TMD. Millions of Americans report some TMD symptoms, but in most cases the discomfort is temporary and fluctuates over time. Only a small percentage of people with these symptoms develop serious, long-term problems, and TMD appears to affect twice as many women as men.

Details of the temporomandibular joint

The temporomandibular joint connects your lower jaw (mandible) to the temporal bone on the side of your head. You can feel it on each side of your head by placing your fingers just in front of your ears and opening your mouth or moving your jaw from side to side.

The TMJ is made up of two sections separated by a disc, which absorbs shock to the joint from chewing and other movements. This system, along with the muscles attached to and surrounding the joint, allows the jaw to move up and down, forward, and sideways. This movement enables you to talk, chew, and swallow. Anything that prevents the joints and muscles from working together properly may contribute to TMD.

Contributing factors

Experts feel that TMD is caused by several interacting factors. However, there is disagreement about the specific factors involved and the roles they each play. The factors most commonly considered include:

• Injury to the jaw, such as a heavy blow. This has been scientifically associated with the development of TMD symptoms. Certain lengthy or forceful dental and medical procedures may also contribute.
• Oral habits such as clenching or grinding the teeth, gum chewing, and lip or fingernail biting are often associated with TMD. Although not thought to cause TMD, they can make the symptoms worse.
• Bite problems that affect how the teeth fit together (malocclusion) have historically been seen as a primary cause of TMD. However, recent studies do not confirm this view.
• Diseases of the TMJ such as arthritis in the jaw joints, and diseases that can lead to excessive or uncontrollable jaw movements, such asParkinson's disease, may also be contributing factors.
• Psychological factors such as emotional stress,depression, and/or anxiety are sometimes reported to occur around the time that the TMD symptoms begin or worsen. However, it is not clear whether these problems are present before the start of TMD and contribute to its cause or whether the pain and dysfunction from TMD lead to these problems. Many people increase their tooth grinding and clenching when under stress.

What are the symptoms?

There are a variety of symptoms associated with TMD, including:

• Pain or discomfort in and around the jaw joints, ears, or muscles of the jaw, face, temples, or neck
• Limited movement or locking of the jaw
• Chewing problems
• Painful clicking, popping, or grating sounds when moving the jaw joint

A complex diagnosis

Making the diagnosis can be confusing because of the lack of scientific evidence and the controversies over the disorder. Most cases are diagnosed based on your own description of symptoms, your medical and dental history and a physical examination of the jaw, head, and neck. According to James Fricton, D.D.S., a professor at the University of Minnesota School of Dentistry, "the key to properly diagnosing [TMD] is to understand the patient and the individual contributing factors?medical, dental, emotional, and/or behavioral."

Tailored treatment

Treatment should be tailored to your individual symptoms and contributing factors. Since it is often difficult to "cure," treatment focuses on management of the disorder. Simple treatment to relieve the discomfort and restore proper functioning is often all that is needed. Most clinicians and researchers strongly recommend conservative, reversible treatment that causes no permanent changes in the structure or position of the jaw or teeth.

Self-care practices that often ease TMD symptoms include eating soft foods, applying heat or ice, and avoiding movements that strain the jaw, such as chewing gum and laughing or yawning with your mouth wide open. Other conservative treatments include stress management, physical therapy with exercises you can do at home, and medications to reduce pain and inflammation. Oral appliances, commonly referred to as splints or night guards, can help decrease clenching and grinding and ease the strain on the joints and muscles.

A small percentage of people don?t respond to conservative, reversible treatments. Other options are available to them, including bite adjustment, injections, and surgery. Although these treatments may help in a limited number of cases, they may also cause additional problems. If you?re considering any of them, it?s crucial to get a reliable second opinion.

Getting help

Although many people have been misdiagnosed in the past, clinicians and researchers are actively working to clarify the causes of TMD, the diagnostic criteria, and the most effective treatments. Some doctors and most dentists are able to diagnose TMD and provide the simple treatments. So, if you think you have TMD, talk with your dentist or primary care doctor. If necessary, they will refer you to a dentist who specializes in orofacial pain. If your complaints are shrugged off as 'just stress,' get a second?or even a third?opinion. Or call one of the resources listed below. The chances are good that you can get the relief you need.