TM Disorders
Many people suffer from pain in the jaw, face, ears or head when they swallow, yawn, talk or chew. The pain may be sharp and searing or dull and constant. Sometimes a clicking or popping noise occurs during chewing or yawning. These symptoms can often be attributed to a disorder of the temporomandibular joint, referred to as TM disorder.

The temporomandibular joint is located in front of each ear where the mandible (the lower jaw) hinges against the temporal bone of the skull. A disk of cartilage separates these two bones (Fig. A). These two joints work together, making it possible for you to open and close your mouth. This structure is among the most frequently used in the entire body. These joints move every time you chew, talk, swallow or yawn. Each time you bite down, force is put on them as well as on the teeth.

What causes TM disorders?

There are several reasons why TM problems develop although the causes are not completely understood. Constant clenching or grinding the teeth can increase the wear on the cartilage lining which surrounds the joints. Chewing gum can cause wear as does chewing on only one side of the mouth. TM disorders can be caused by damage to the joint due to injury or a disease such as arthritis. Other possible causes include muscle tension, malocclusion (improper bite) and psychological stress.

Fig A

How does the dentist determine the cause of my TM problem?
Your dentist will conduct a careful examination and evaluation in order to determine the cause or causes of your TM disorder. Your medical history will be reviewed as will similar problems that have occurred in your family. Imaging tests such as tomographic or transcranial x-rays may be performed. These can reveal joint damage, fractures or tumors. Another test, magnetic resonance imaging (MRI), may also be ordered. This test produces images of soft tissue and can identify damage to ligaments or disks. (Disks are shock absorbers that allow the upper jaw to glide against the lower jaw.) In some cases, plaster models of the jaws are made to help determine if jaw problems are a result of grinding or an improper bite.

How is TM disorder treated?
There are a variety of treatments for TM disorder. The treatment depends on several factors including the probable cause of the problem and your willingness and ability to follow the treatment program your dentist prescribes.

The recommended treatment may include resting your jaw frequently to help relax muscle tension and take the pressure off the affected joint. Sometimes applications of ice or heat and certain exercises are recommended. To ease pain, your dentist may prescribe medicines containing aspirin, anti-inflammatory drugs, or muscle relaxants. Certain stress management techniques may be suggested to help relieve the symptoms of TM disorder. In some cases, electrical stimulation and ultrasound have been helpful in relieving discomfort.

Sometimes, a splint, a plastic appliance that fits over your top or bottom teeth, may be prescribed. There are different types of splints, each used for a different purpose. A bruxism splint or night guard (Fig. B) is usually worn only when sleeping. It is designed to keep the top teeth separated from the lower teeth thus reducing clenching and grinding. An anterior positioning appliance reduces pressure on certain parts of the jaw by moving the jaw forward. An orthopedic stabilization appliance helps relax muscles and allows joints to move into the proper position.

Fig B

 

Can braces help?
Orthodontics, procedures that include the wearing of braces to reposition teeth, is another treatment that has had good results. Restorative work designed to change the size or shape of teeth to establish a stable bite is another treatment that has helped sufferers of TM disorder. Sometimes there is a TM problem because a missing tooth has pushed teeth out of alignment. In this case, a bridge may be constructed to replace the missing tooth or teeth.

Is surgery ever used to correct TM disorders?
After all other treatments have been explored, surgery may be recommended. Most cases of TM disorders can be corrected through non-surgical techniques. Surgery may be necessary when there is severe joint damage. Arthroscopy lets the surgeon see the muscle of the joint space to diagnose the actual problem. The joint space can be drained of excess fluid. Overstretched ligaments and/or connective tissue can be tightened. The disk can be repositioned to allow the joint to move smoothly.

It may be necessary for patients with arthritis to have joint restructuring. This is indicated when the joints have badly deteriorated from the disease.

What else should I know about TM treatment?
Perhaps the most important part of your treatment and recovery is how you work with your health care team. It is imperative that you follow the step-by-step plan designed especially for you. You should feel free to discuss your TM treatment and concerns with the dentist. By doing this, you can almost certainly expect to attain a healthier, less painful jaw.
If you are interested in learning more about TM disorders and how they can be treated, please call our office, and we will be happy to answer your questions.



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