About TMJ Disorders
Temporomandibular Joint Disorders (TMD), are a common subgroup or orofacial pain disorders, often incorrectly referred to as TMJ. There are two basic types of TMD: muscle pain and jaw joint generated pain.
It is still not clear what causes TMD, however we do know that it involves more than one symptom. It is unusual that TMD is caused by one event. TMD is believed to result from several factors acting together. These include injuries of the jaw and diseases of the jaw joint such as arthritis. Tooth clenching/grinding (bruxism), difficulty sleeping, head/neck muscle tension and emotional stress may be contributing factors in developing TMJ disorders. Identifying and controlling these factors should reduce and manage TMD.
TMD/Orofacial Consultation and Examination
Your initial consultation with our staff and doctor begins with detailed information gathering. All of the information requested on our forms is not only relevant, but also necessary to inform us as to your unique background so we can better serve your needs. The more we know, the more accurate the diagnosis and effective the treatment. The comprehensive history includes your chief complaints, history of your present complaints, past medical and dental history, review of systems and psychosocial history. After the history forms are completed by you and reviewed during the consultation, Dr. Kaspo will ask you about additional details that are important to understand why you have the problem. There are many factors that contribute to and aggravate health and pain disorders.
A comprehensive clinical examination of your jaws, face, ears, nose, mouth, throat, head and neck will follow the history interview. Cranial nerve and oral cancer screenings will also be performed. Additional diagnostic tests such as blood work up may ordered. Diagnostic imaging such as x-rays, CT scans or MRI may also be ordered. In specific cases, previous medical/dental records may be requested and/or conferences held with your previous doctors and therapists. After the doctor has arrived at a diagnosis, it will be thoroughly explained in clear and understandable terms. Contributing and aggravating factors will be identified and explained. Written educational aids and illustrations describing your problem will be supplied whenever possible.
After the diagnosis is established, contributing factors identified and you become familiar with your disorder, all reasonable options of therapy and treatment will be explained. Your options may range from receiving information about avoiding specific activities such as chewing gum or bagels, to alternative therapies such as herbal remedies, over the counter or prescription medication, exercises, behavior modification/biofeedback, counseling, stress management, diet counseling, physical therapy, oral appliances, bite adjustments, TMJ injections/arthrocentesis, and surgery. At Michigan clinic for Facial Pain, PLC we utilize a multidisciplinary approach at all levels and may ask you to see other specialists. When you become a patient, we begin a partnership. Successful treatment is not only dependent on what we offer and deliver, but on your habits, thoughts, actions and commitment. We have a proven track record of success in treatment Orofacial Pain over many years, because we care.
Factors Associated with TMD
- Trauma: Direct trauma to the jaws has been scientifically associated with the onset of TMD symptoms. Direct trauma to the jaws can occur from a blow to the jaw, hyperextension or overstretching of the jaw, and in some cases, compression of the jaw. Lengthy or forceful dental procedures, intubation for general anesthetic and surgical procedures of the mouth, throat, and upper GI track (esophagus and stomach) can traumatize the TMJs.
- Abnormal Habits: Habits such as tooth/jaw clenching, tooth grinding (bruxism), lip biting, fingernail biting, gum chewing and abnormal posturing of the jaws are common and have not been proven to result in TMD. To date, it has not been scientifically established that jaw habits such as tooth grinding cause TMD. Jaw habits are often associated with TMD and may be contributing factors that perpetuate and aggravate ongoing TMD symptoms.
- Occlusion: Dental occlusion refers to the way the teeth fit together or the bite. Historically, the dental profession has viewed malocclusion (abnormal bite) as a primary causative factor in TMD. Recent research studies do not confirm that malocclusion causes TMD. In large population studies, most patients with TMD have normal occlusion and the majority of people with malocclusion do not have TMD.
- Psychological Factors: Many patients with TMD report onset of jaw dysfunction symptoms or aggravation of preexisting TMD symptoms with increases in emotional stress or psychological imbalance such as depression or anxiety. Scientific studies indicate that many TMD patients experience levels of depression and anxiety that are higher than the non-TMD population. To date, it has not been established whether depression or anxiety is present prior to the onset of TMD and contributes to its cause, or whether the chronic pain associated with TMD leads to depression and anxiety. Many patients will increase their level of tooth clenching and grinding when they experience emotional stress, psychological imbalance or pain.
- Diseases of the TMJs: Several types of arthritis may develop in the TMJs like any other joint in the body. It is common for osteoarthritis to be present in the aging population. Many other diseases such as Parkinson’s Disease, Myasthenia Gravis, strokes and Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease) may lead to excessive or uncontrollable jaw movements. Diseases such as Tetanus (lock jaw) may lead to uncontrollable jaw muscle Contracture
- Other Factors: Abuse of drugs and the use of certain prescription medications can affect the central nervous system and muscles to contribute to TMD.
Screening for TMD should be an essential part of a routine dental and medical examination. A brief TMD screening evaluation may include:
- Brief history of jaw pain, headache, neck ache, noises in the TMJ’s, catching/locking of the jaws, injuries to the jaw/head/neck and prior TMD/Orofacial pain treatment.
- A screening exam with measurements of jaw opening and side to side movements, jaw deviation on opening, palpation (feeling) of the TMJ’s/jaw/head/neck muscles to localize painful areas, identify joint noises, evaluation gums, oral soft tissue and teeth noting disease, excessive tooth wear from bruxism and general symmetry of the jaw, face and head. If significant findings for TMD are identified, a more comprehensive history and clinical examination should be conducted.
Comprehensive TMD Evaluation
The comprehensive TMD evaluation may include comprehensive history of all jaw/head/neck symptoms, medical history, dental history, personal history, family history and psychological history.
- Comprehensive physical evaluation of the TMJ’s, cervical spine, muscles of the jaw/head/neck, neurological-neurovascular structures, teeth, gum and soft tissues.
- Psychological evaluation, including a brief interview and testing when indicated.
- Additional tests, including X-rays and diagnostic imaging, biopsies, blood tests, urinalysis, neurological tests and diagnostic injections.
To schedule an appointment with us to discuss your particular situation please call us at any time at (248) 519-1100 or contact us via e-mail.