A First Principle Primer Explaining TMJ & MPD
The temporomandibular joint (TMJ) is the joint located between the jaw line (the mandible) and the skull, just in front of the ear. Placing a finger on the face just in front of the ear, and opening and closing the jaw, will demonstrate the location of the temporomandibular joint, and will elicit the movement of the mandibular bone.
To be accurate, what is generally referred to as TMJ is in fact, Myofascial Pain Dysfunction (MPD). Myofascial Pain is a disorder of the muscles, tooth contact and clenching. Although, its treatment always involves the temporomandibular joint.
True TMJ dysfunction (sometimes called internal derangement of the joint), involves a breakdown of the structural components of the joint. This tends to be more serious and difficult to treat than MPD. Fortunately, most cases presenting to the dentist are MPD, in spite of being called TMJ.
While TMJ dysfunction and MPD are distinctly different disorders, they have many features in common. Both disorders occur at any age from teens to later in life in both men and women, but predominately in women. Because the symptoms of MPD and TMJ dysfunction may mimic other disorders, they are known in medical circles as “The Great Impostor”. True TMJ and MPD are often associated with fibromyalgia. When TMJ/MPD are successfully treated, the associated fibromyalgia symptoms frequently improve.
Some of the causes of MPD and TMJ are:
- Trauma to the head or face, for example, whiplash
- Pathology or trauma to the joint itself, for example, arthritis
- Hormonal imbalances, for example, growth spurts in teens, menstrual cycle and menopause
- Medications, which may have the side effect of clenching
- Malocclusion (jaws which do not line up correctly), for example, after orthodontics, after wisdom tooth extraction, or teeth which interfere with correct closure of the jaw
- Stress (the greatest contributing factor) – whether it is a high exposure to stress, or a low threshold for stress
- Trigger points in the neck and shoulder regions
Symptoms may be one or a combination of the following:
- Headaches: Typically, patients wake in the morning with a throbbing headache or develop one later in the morning. Often, they have been told they suffer from migraines.
- Shoulder Pain (which can mimic a rotator cuff injury)
- Stiff, sore neck upon waking, with painful, limited movement of the head
- Tingling fingers and arm pain
- Pain along the shoulders and upper back
- Restricted jaw opening with associated pain and sometimes clicking joints
- Inability to smile or facial pain when attempting to smile
- Clicking, popping or grinding in the jaw joints when opening or closing the jaw
- Locking jaws (the inability to open or close the mouth)
- Dentition related factors: fractured teeth, sensitivity to temperature changes, teeth that are worn down, requiring root canal treatment in the absence of decay, and teeth with clefts at the gum line
- Ear pain with no infection, ringing, buzzing, rushing water sounds, and other unusual ear noises
- Clenching the teeth during sleep, with disturbed sleep patterns
- Light-headedness when walking
- Symptoms of a collapsed or plugged eustachian tube, as when flying in a plane, popping, stuffy ears
- Snoring (with a negative sleep apnea diagnosis)
- Shooting or throbbing pain behind the eyes (usually affecting one eye)
- Difficulty swallowing or constantly choking on food when eating
- Exacerbation of symptoms when wearing a non-customized splint (night guard) over the teeth during the night
Your overall health can be adversely affected by MPD or TMJ dysfunction. Lack of sleep and pain negatively affect most aspects of life. Chronic use of pain medication can adversely affect the liver and kidneys. Clearly, MPD and TMJ dysfunction are serious problems requiring specific treatment.
Ideally, the treatment for TMJ or MPD is to prevent clenching and to correct the occlusion (bite), allowing the teeth to come together (without any interference), into a comfortable, complete closure of the jaws (known as a peaceful neuromusculature). To prevent clenching, a customized splint (night guard) must be fabricated, to the individual’s mouth and jaw. This will allow the jaws to close so that the muscles that close the jaw are relaxed and at rest.
The primary reasons for clenching at night or during the day are stress-related. Everyone’s life is, to some degree, stressful. The extent of stress and the ways in which people experience and work with their stress are major factors in the development of TMJ/MPD.
The following are some useful tools in dealing with stress:
- Yoga
- Biofeedback
- Hypnosis
- Acupuncture
- Meditation
- Exercise
I will not elaborate on the success of the treatment, suffice it to say: “Consistently, successful clinical outcomes support the fact that the diagnosis and treatment are correct.”
If you feel that you may have a TMJ or MPD problem, see your family physician to rule out pathology. If the findings are negative, see your dentist for assessment and treatment if he/she is knowledgeable in this aspect of dentistry.
If you have any questions or concerns, please contact Dr. Sidney Fleisher at 204-786-6617.