(by Ann-Marie DePalma)
Patients present to dental professionals with a variety of oral-facial pain and conditions. If a patient presented to your practice complaining of muscular pain and limited opening, would you know how to evaluate and refer? Temporomandibular disorders (TMD) are a common reason for pain in the muscles of mastication and limited opening and can be the cause of acute or chronic pain.
TMDs affect millions of Americans, predominately female (or female presented at birth), although many males can also be sufferers. The temporomandibular joint is comprised of the articular bone of the skull, the condyle of the mandible, a meniscus (disc) separating the two bones and a variety of nerves, blood vessels, ligaments and muscles. When an issue arises in any area of the soft or hard tissues of the joint, a temporomandibular disorder can occur. Patients often say they have “TMJ” when denoting the disease, however TMJ refers to the joint and TMD refers to the issues of the joint and surrounding structures. There are several different types of TMDs ranging from disc interference disorders to acute or chronic muscle disorders, to inflammatory and growth disorders. Obtaining an accurate diagnosis is essential in determining the exact nature of the TMD therefore when a patient says they have TMJ or TMD, that is not a true diagnosis.
The cause of TMDs is variable just as there are a variety of symptoms associated with the disorder. TMD is often labeled as an imposter disease since its symptoms can be as varied as the population ranging from joint and muscle pain to ear symptoms to postural concerns. The etiology is also variable with some factors including:
- Cervical dysfunction
- Faulty habits
- Hormones
- Trauma
being implicated in the disorder. Yet there is no one single etiological factor.
Treatments are also varied from:
- Appliance therapy
- Heat/ice/rest
- Analgesics
- Injections including Botox
- Physical therapy or chiropractic therapy and acupuncture
- Surgery (last resort therapy).
Many treatments have been proven successful, while others have not or have caused more harm than good. Dental insurance may or may not provide a benefit for patients while medical insurance coverage can play a role.
As mentioned, obtaining an accurate diagnosis is essential to determining the best treatment for the patient. There are many tools that are available to assist in obtaining that diagnosis. The first diagnostic tool however that all dental professionals should be using is a thorough intra and extra oral evaluation. Palpating the muscles of mastication and the joint can provide clues to direct a diagnosis. All clinicians should be versed in doing the evaluation, not only for TMD but also for signs of oral cancer. All team members, whether administrative or clinical, should have a basic understanding of TMD.
Understanding the diagnosis and treatment for TMD can significantly improve the quality of life for this often-misunderstood disorder. As dental professionals, we are educators of our patients and educating ourselves about TMDs can assist patients in understanding their situation.
For information for your team on TMD/TMJ contact: annmariedepalma@gmail.com or depalmaannmarie.com
Written by Ann-Marie DePalma