Temporomandibular Dysfunction (TMD): A pain in the jaw

TMD: A pain in the jaw

We often forget that our jaws function like any other joint. They have a ball and a socket, and a disc in between. They have ligaments and muscles which work together to open and close our mouths when we chew, yawn, speak, laugh and even kiss.

And, just like any other joint, our jaws can experience problems. Much like our hips, our jaws can get rickety, clicking and popping when they move, causing extreme discomfort.

This degeneration has a name: Temporomandibular Dysfunction (TMD).

What is TMD?

Some patients experience pain or discomfort in their jaw, and come up with their own diagnosis of TMD. As well as causing discomfort, TMD limits the range of motion in our jaw. Our ability to open, close and move our mouths sideways is regulated by how far our muscles can stretch. The tighter the muscles, the tighter the joint and the less movement we have.

What are the symptoms of TMD?

The symptoms and severity of TMD vary from person to person. Some people’s jaws will lock open every time they yawn: they’ll come racing in as an emergency because they have to have their jaw relocated into its socket.

Others may have limited movement due to tightness in their jaw or teeth overcrowding. This has a lot to do with the ‘relationship’ between the top jaw and bottom jaw: if your bite forms unsymmetrically, you inevitably suffer for it.

It’s just like any bad relationship: disharmony causes problems.

As teeth are brought together, the lower jaw closes very tightly against the top teeth, leaving very little room for movement at the front of the mouth. Overcrowding exacerbates the issue, limiting movement even more and placing increased pressure on our jaw joints.

How is TMD diagnosed and treated?

Despite being aware they have TMD, very few patients actually understand what it is and that it can, in most cases, be corrected.

In the case of jaw tightness and overcrowding, a multidisciplinary treatment is commonly suggested.  An orthodontist is used to assess a patient’s bite and determine if teeth can successfully be straightened and rearranged, relieving pressure between the upper and lower jaw.

In some cases an oral surgeon may also need to be visited. Surgery is used to re-align the entire jaw and ensure all muscles start working in unison. This will stop any muscles spasms as teeth will no longer be at odd positions.

Letting the dominos fall

Our muscles are commonly treated as isolated entities when, in reality, they all work together. Like dominos, if the back or shoulder muscle is injured, then the neck and facial muscles also feel the strain. This can lead to the development of TMD, causing acute jaw pain and stiffness.

Patients who suffer from muscular spasms, such as athletes or individuals with a history of muscular trauma, are recommended physiotherapy treatment.

The treatment, known as trigger point therapy, works by the same logic: by relaxing back, shoulder and neck muscles, facial muscles are also eventually relaxed.

One domino falls, then the next and the next.

What do we look for?

The same metaphor can be applied to the diagnosis of TMD. As the symptoms and cause of TMD vary from case to case, the disorder is notoriously difficult to diagnose. But, by using a process of elimination, an answer can be found.

I always make sure to do a good medical and dental history check and ask all possible questions:

  • Have you had undergone orthodontic procedures?
  • Have you experienced any trauma or injury? A car accident? Whiplash?
  • Do you have any persistent pains?

Often TMD exists as a chronic background issue which goes relatively unnoticed. The symptoms are annoying at most, but they do exist.

It’s simply about finding the clues bit by bit and letting the dominos fall.