Ann-Marie DePalma, CDA, RDH, MEd
Imagine waking up one morning with pain emanating from your both sides of your jaw and the inability to open wide? Never experiencing this before you become panic stricken and fear the worse. Contacting your dentist, you are given an emergency appointment, and the examination reveals that you have an anterior displaced disc and muscle involvement. Treatment is rendered and you begin to experience relief. But what happened, why and what more treatment is needed?
For patients who suffer from Temporomandibular Disorders (TMDs), this is a common occurrence. Yet many dental professionals don’t understand the Temporomandibular Joint (TMJ) and its structure, function and treatment. Often patients are dismissed as the pain is “all in their head ”when there is an actual physical cause to the problem. Yes, mental health does play a role in TMD, but understanding the physical components of the joint, etiology of disease and evaluation methods can direct the oral healthcare professional, and ultimately the patient, to understanding the condition.
TMDs are caused by a variety of factors, have a variety of signs and symptoms and there is no one specific cause or treatment for the disorders. A TMD can be an anatomical joint structural problem or a muscle of masticationorhead/neck muscular problemor a combination joint and muscle problem.Depending on the actual diagnosis, treatments vary considerably.TheNational Institute of Dental and Craniofacial Research classifies TMD by the following:
- Myofascial pain. This is them ost common form of TMD. It results in discomfort or pain in the fascia and muscles of mastication or that control neck and shoulder function.
- Internal derangement of the joint. This involves a dislocated jaw or displaced disc(meniscus), or injury to the condyle
- Degenerative joint disease. This includes osteoarthritis or rheumatoid arthritis in the jaw joint.2A TMD patient can exhibit one or several of the classifications at any time.
The actual cause of TMD may not be evident. Trauma to the jaw, head, neck, stress/psychological, hormonal, postural and airway considerations area few of the etiological factors. Arthritis and other autoimmune disorders have also been implicated. Evaluation methods and treatments vary depending on the cause and can range from less invasive to more intensive and invasive therapies. Clinical observations, imaging, occlusal analysis, sound auscultation, electromyography, and injections are some methods of evaluating a TMD patient. Instituting a soft diet, ice/heat therapy, physical or chiropractic therapy, medications and appliance therapy often are the first line of treatment with the more invasive injections and surgical options available if relief is not accomplished with the first-line therapies.
For patients who are undergoing TMD treatment providing support, products and education are critical to achieving positive outcomes. The TMJ is the most complex joint in the body. The variety of signs, symptoms and treatments can be a frustrating and confusing experience for the patient. As oral healthcare professionals we can assist the patient by calming fears, explaining treatments, being a listening ear and educating ourselves about the complexities of the disorders.
Beyond the Bite 