Temporomandibular Joint Dysfunction (TMD)

Temporomandibular joint(TMJ)dysfunction can mimic many other diseases, and therefore is often misdiagnosed or overlooked. Common symptoms include dull aching pain around the ear, often radiating into the face, neck, back of the head, and shoulders.
  • certain types of headaches, sometimes of migraine proportions.
  • ringing in the ears, hearing loss, "plugged" ears, ear pain.
  • tenderness of the jaw muscles.
  • clicking or popping noises when opening or closing the mouth.
  • difficulty opening the mouth or chewing, locking of jaws open or closed.

The temporomandibular joints are the hinges located on either side of the face that connect the lower jaw to the skull. Each temporomandibular joint has two sections that permit the hinge and gliding actions needed to open the mouth widely.

The joints work in concert with the facial bones and five pairs of muscles to allow opening and closing of the mouth and forward, backward, and side-to-side movements of the lower jaw. Any disturbance of this facial symphony can trigger the cycle characteristic of TMJ dysfunctions: muscles and joints not working together correctly, causing muscle spasm, resulting in pain, muscle tenderness, and tissue damage.

  • What causes temporomandibular joint dysfunction (TMD)?

    TMD has many causative factors the more common of which are malocclusion or problems in the way the teeth fit together, a blow to the jaw or head, clenching or grinding of the teeth, arthritis of the jaw, poorly fitting dentures, yawning for prolonged periods with the mouth open too wide, recent dental work, accidents that damage facial bones or the jaw, extraction of teeth or missing back teeth, birth trauma due to delivery complications, and traction involving the head, jaws, and neck.

    The most common TMJ dysfunction originates in the jaw muscles and is called myofascial pain dysfunction (MPD). MPD strikes three times as many women as men - usually those between 20 and 40 years old - and results from a tendency to deal with tension and stress by clenching or grinding the teeth. These habits can tire the muscles and trigger spasms, producing pain, more spasms and, eventually, a TMJ dysfunction. MPD sufferers may or may not have problems with their bite.

    Because this dysfunction mimics so many other conditions, diagnosis may be complicated. Many people may spend a great deal of time and money searching for the source of their symptoms. If your physician cannot find any underlying conditions, he could consider the possibility of TMJ dysfunction and recommend that you consult a dentist with a special interest in the diagnosis and treatment of TMJ dysfunctions.

  • TMD: mimics other conditions

    Chronic recurrent headaches as well as facial and neck pain are a common occurrence in millions of people. In addition, people frequently suffer from ear symptoms including pain, ringing, buzzing, loss of hearing or clicking or locking of the jaw which can make chewing, speaking or moving the jaw painful or difficult.

    Until recently these symptoms, apparently unrelated, were frequently undiagnosed or misdiagnosed as migraine, tension headache, neuritis, neuralgia, or stress. When standard treatment remedies for these types of dysfunctions proved unsuccessful, patients were frequently labeled as hypochondriacs, "it's all in your head", or neurotic.

    Today, it is well recognized by certain practitioners within the Health Care Community that these often unexplained, undiagnosed and therefore untreated symptoms are related to a group of problems called, Temporomandibular dysfunctions (TMD). Practitioners with proper training and diagnostic skills, are able to pinpoint the cause of these symptoms and provide relief of symptoms which may have been present for years.

    If you suffer from one or all of these symptoms, this web site contains information about your dysfunction which can help guide you in the selection of a health care professional who has received advanced training in the diagnosis and treatment of head, neck, facial pain and temporomandibular joint dysfunctions.

  • A closer look at TMD

    A question that is frequently asked is what exactly is TMD? TMD or Temporomandibular dysfunctions are a group of maladies which can affect the temporomandibular joints, (the jaw joints located immediately in front of your ears), the associated muscles of the jaw, face and neck, as well as related neurological and vascular structures.

    Problems within this complex can produce a myriad of symptoms which, at first glance, might appear to be totally unrelated to the jaw complex. These symptoms can include headaches (over the eye, in the temples, behind the eyes, and at the base of the skull), generalized facial pain as well as more specific pain directly in front of the ears, ear symptoms including ringing, buzzing, congestion, as well as pain. In addition neck and shoulder pain as well as clicking or grating noises of the jaw joint with movement, locking of the jaw or pain in the jaw with function are frequently encountered.

    Craniomandibular Dysfunction is a term used to describe a collection of symptoms which occur when the chewing muscles and jaw joints do not function together correctly. "TMJ/TMD" is a popular term commonly used to describe the same group of symptoms. TMJ stands for Temporomandibular Joints. These are the two joints that connect your jaw to your skull. When these joints are out of place, they can cause many problems, such as:

    • Clicking or popping of the jaw joints.
    • Pain in or around the jaw joints.
    • Locking or limited opening of your mouth.

    Muscle spasm goes hand-in-hand with displaced jaw joints. Because the nerves and muscles are so complex in this area, when these muscles are in spasm the problems can be far-reaching. People suffer from symptoms they would never think to associate with their bite, such as:

    • Headaches.
    • Pain behind the eyes.
    • Dizziness, nausea.
    • Earaches or ringing of the ears (Tinnitus).
    • Clenching or grinding of the teeth.
    • Neck, shoulder, or back pain.
    • Numbness, or tingling of the fingers.
    • Hearing loss.

    Such symptoms may relate to your bite and can often be successfully treated by a practitioner who has received the appropriate training.

    The primary problem can be within the joints themselves, the muscles of the face and jaw, or a combination of these. Since the symptoms masquerade as so many other conditions, many people travel from doctor to doctor in search of a cure.

  • What Causes Craniomandibular Dysfunction?

    The structures that make it possible to open and close your mouth include the bones, joints, muscles and ligaments. All these elements must work together whenever you chew, speak or swallow. The lower jaw is connected to the facial skeleton via the tm joints by muscles and ligaments. Any problem which prevents the complex system of muscles, bones and joints from working together in harmony may lead to TMJ dysfunction.

  • Jaw Joint Displacement

    Each jaw joint is a ball and socket joint. When functioning properly, the ball and socket do not actually touch because a thin disc of cartilage rides between them. The disc acts as a cushion and allows the joint to move smoothly. Each disc is held in place and guided by muscle. If your bite is not right, the joint is pulled out of alignment. Typically the disc is pulled forward. Since it no longer serves as a cushion, the joint itself now rubs against the bony socket and presses on pain fibers. Mild displacements cause a clicking or popping sound in the jaw joint; more severe displacements can be very painful and eventually lead to permanent joint damage associated with arthritis and a grinding noise known as crepitus.

  • Muscle Spasm

    Your upper and lower teeth must come together firmly each time you swallow. This happens over 2000 times each day and night! When your bite is unstable your muscles must work extra hard. This extra work makes them shortened and stiff. Eventually this strain makes them feel painful. A vicious cycle begins of increased tissue damage, muscle tenderness and pain. The pain makes you feel tense and uptight. This worsens the muscle spasm which in turn increases the pain.

Mr. Patrick Grossmann B.D.S. D. Orth. R.C.S. GDC No. 48080
Flat 1 Lister House, 11-12 Wimpole Street, London W1G 9ST.
Orthodontic Specialist & Treatment
of Temporomandibular dysfunctions.   Private practice only