What is Temporomandibular Joint Disorder (TMJ/TMD) and Symptoms

T-M-J is the first letters of the three anatomic parts of the head. T= Temporal bone (skull), M= Mandible (lower jaw) and J= Joint, which connects two bones together. Between temporal bone of the skull and condyle of the mandible is a disc similar to the ones between your backbones. This disc acts as a third bone within the joint, and is made of a dense fibrous connective tissue, which has repair potential. TMJs are held together by a group of ligaments, similar to the knee, hip, or shoulder joints. These ligaments can be damaged, and the disc can become displaced; which we call TMJ disorder (TMD). If one TM joint is injured, the other joint will usually become affected in the future.

Temporomandibular joint (TMJ) is the most complex joint in the human body. It has hinge movement, circular movement and sliding movement in the same socket, and its function is dictated by the teeth. It has dense anatomy of nerves, muscles, blood vessels, ligaments, and tendons within a small area. If you have disorder in such complexity of neuromuscular compact, it reveals various signs and symptoms to the entire body, from head to toe, through neuromusculoskeletal system.

TMJ is probably the most commonly used joint in the body next to the heart. It moves each time when we chew, talk, sing, breath, yawn, swallow, walk or move. Average person uses TMJ 2000-2500 times a day and if you talk or chew a lot, you may use it 5000 times or even 10000 times a day. However, TMJ is less honorable part of the body because of lack of knowledge of its importance, functions, mysterious anatomic structures, and complicated movements.

Medical research has not yet defined all the causes of the various TMJ disorders. There is no single cause for TMJ Disorders. There are multiple causes such as: Malocclusion (a bad bite, crooked teeth, poorly aligned teeth), missing teeth, broken teeth, under developed dental arch, bruxism (grinding teeth), para-functional habit, post surgery, scar tissue, falls/injury, automobile accident, whiplash, trauma (macro and micro), structural imbalance (short leg, short arm), mal-alignment of cervical spine, chronic stress, arthritis, emotional/psychological disorder, internal organ dysfunction, nutritional imbalance, job related poor postures, and long-term repetitive movement are all could be causative factors.



The jaw is literally one end of the skeletal chain. The ligaments, tendons and muscles that are holding Jaw/TMJ are very small and even minor distress placed upon them chronically, can disturb normal TMJ functions. When muscles and joints are distracted over the limit, it will often go into a spasm (cramp). This spasm can become part of a cycle that results in tissue damage, pain, muscle tenderness and more spasm.

If you have a well balanced and maintained TM joint, you may not notice any signs or symptoms. Balance of the TMJ is directly related with the balance of the bite, and this bite could be influenced by even 1/1000 of an inch of interference. Bite changes during the lifetime and so does the TMJ balance.

Temporomandibular Joint Disorder (TMJ/TMD) Symptoms

TEMPOROMANDIBULAR DISORDER (TMJ/TMD): TMJ disorder is collection of symptoms which result when the chewing muscles and jaw joints do not work together correctly. When normal relationships between the condyle, the disc, the fossa and the eminence are altered or distracted for whatever reason, the result is called "internal joint derangement". Internal derangement includes cartilage disc displacements, clicking, popping, stretched or torn ligaments, perforated discs, infection/ inflammation of the capsule or tissues, and adhesions of the cartilage to the socket of the jawbone. 

When a problem is related to the muscle disorders, this is called myalgia/myofascial pain (pain from sore muscles). Pain is usually due to persistent contraction of the muscle as they attempt to keep the lower jaw from excessive movement. This causes pain to the jaw, face, head, neck and eventually translating to the shoulder, arm, back, hip, knee and foot.

HEADACHES: One of the most common TMJ disorder symptoms is headache. Over 90 percent of all chronic headaches, however painful, arise primarily from muscle contraction, most of which originate in the neck. The pain of muscle contraction headache usually starts in the forehead, temples or back of the head and spreads over the neck and shoulders. When neck muscles are dysfunctional or tight, this compresses the occipital nerves, one of the common nerves causing headaches. When there is additional stress, mostly bad bite, that causes TMJ dysfunction, it makes them tighter, and compressing on nerves, blood vessels, and lymphatic channels within the joint spaces. This combination of process can lead to the development of various kinds of headaches; migraine, tension-type, cluster-type.

The forte of the Resultant Force Vector Technique is the unique ability to reduce abnormal muscle tension and to restore balance within the body by correcting bite and establishing physiological function of TMJ. Through this technique, stress-related headaches have been relieved 90-95 percent of the time in the absence of complicating medical problems. If you, or people you know, suffer from weekly or daily headaches, and are taking medications without knowing when the headaches will cease, something is wrong and it would be worthwhile to be evaluated.
  
MUSCULOSKELETAL DISORDER: The musculoskeletal system is the master system in our body. It controls posture, breathing, gait, and body movement. If you have a TMJ musculoskeletal disorder, you may experience unbalanced walking, discomfort standing/sitting, muscle pain on neck/shoulder/low back, difficulty taking deep breaths, limited range of movement, Chronic fatigue, indigestion etc.

If the force of occlusion is changed according to the direction of muscular movement and bio-mechanical movement, this can eliminate the pain and improve function faster than taking pills or any exercise.

FIBROMYALGIA: This is one of the most prevalent rheumatic disorders affecting women between the ages of 25 and 55. Most FM patients complain of generalized pain that is difficult to pinpoint and often state "it hurts all over."

Hundreds of prominent researchers and clinicians have spent their time, effort and multi-million dollars (maybe multi-billions around the world), to find the cause of FM and pain mechanisms. So far, they recognized the following as possible causes of fibromyalgia: physical trauma, chronic pain conditions, arthritis, chronic mechanical stress, psychological distress, significant emotional stress, repetitive environmental stimuli, genetically decreased threshold, mechanical stress in the spine, automobile accident, infection, sleep deprivation, psychosocial factors, stress, depression, anxiety, childhood trauma, irritable bowl syndrome, headaches (migraine, tension type), restless legs syndrome, periodic limb movement disorder, temporomandibular pain and dysfunction, myofascial pain syndrome, primary dysmenorrnea, chronic fatigue syndrome, female urethral syndrome, neuroendocrine dysfunction, central sensitization (sensitive central nervous system caused by continuous irritation of chemical, heat, touch etc). WOW! WHO COULD NOT POSSIBLY HAVE FIBROMYALGIA? Researchers can talk of all kinds of clever things, but do they actually translate into anything meaningful or helpful? 

What are you going to do and whom are you going to seek to help you? Are you going to visit every single healthcare professionals or are you going to treat each individual symptoms one after another or are you just going to take all kinds of pain pills? What are you going to do the side effect from the medications?  Now, think and  ask yourself.    

AT TMJ, Head & Neck Pain Center, we treat fibromyalgia as one of the "Dental Distress Syndromes".  Fibromyalgia is not a disease, but a symptom of autonomic nerve dysfunction, which influences to the neuromusculoskeletal system. Whatever causative factors are applied to the body, it distresses the bite, TMJ and autonomic nervous system. Teeth are very closely related to the autonomic nervous system, and if we could remove the causative dental distress from the scenario and re-establish physiological functions to the TMJ, patients can alleviate pain within a few weeks without medication, painful stretching exercise or any unfavorable treatment, as the body balance re-establishes. 

OCCIPITAL NEURALGIA is the most common cervical nerve disorder. Common cause is after motor vehicle accident (whiplash), striking the back of the head during a fall, during a surgical procedure which patient's head rotated or neck hyper-extended, repetitive long term abnormal posture, chronic dental distress. Symptoms are: pain of the back or front of the head; pressure behind the eye; light sensitivity; nausea; pain radiation into the ear, shoulder and arm.

NICO (Neuralgia-Inducing Cavitational Osteonecrosis): Many patients who have been diagnosed with trigeminal neuralgia turn out to actually be having neuralgia pain from NICO lesions. Most NICO lesions are found in the alveolar arches where teeth have been extracted. If your teeth have been extracted, there may be unhealed, necrotic lesions in your jawbone.

Diagnosis and treatment of neuralgia is difficult and complicated. Ineffective or inappropriate treatment might lead to worse and patients may wander from neurologist, anesthesiologist to dentist without relieving pain.

Neuralgia in the face and jaw area, is related with trigeminal nerve and facial nerve, which are directly related to TEETH and TMJ. Among the TMJ practitioners, neuralgia is well known symptom and could be controlled by proper medication, balancing dental occlusion and normalizing TMJ relationship. 

 Chiropractic therapy, physical therapy, massage therapy, acupuncture therapy, etc., may be the possible choice of treatment modalities. However, if symptom remains after certain number of months therapy, the internal force vector of the incident may be perpetuated into the TMJ and remains as a foci of dysfunction of the altered mandibular-cervical relationship, hanged the tone of masticatory muscles. Until the TMJ relationship is corrected, some degree of symptoms may persist despite of  various treatment modalities. 

UN-RESOLVED CHRONIC PAIN: If any pain does not go away in a reasonable period of time (i.e. 3-6 months), it becomes chronic pain, and requires different modalities of treatment. 

Traditional medicine does an excellent job with acute pain, but performs poorly with chronic pain. Pills, physical therapy, surgical intervention, psychiatric evaluation/counseling, and "Learning to live with it" are the standard treatments options for chronic pain patients. 

Chronic symptoms are controlled by the autonomic nervous system, consisting of the sympathetic and parasympathetic nervous system, which may demand long term care without promise for progress or cure. This may force life style changes that were previously enjoyed, and causing one to easily fall into depression.

If muscle tones and posture changes, and/or scar tissue forms, the musculoskeletal system of the body and TMJ relationship changes automatically, and this can cause various chronic symptoms. The relationship between teeth and abnormal muscle tension are frequently ignored by the medical establishment because they cannot over-ride the influence of the teeth on the muscles.

CHRONIC FATIGUE/LACK OF ENERGY: Many people blame their age. Aging may be one of the factors, but there are multifactor, which cause chronic fatigue: improper nutrition, continuous un-resolved stress, chronic illness such as; diabetes, cancer, allergies, hypoglycemia, hypothyroid, poor circulation, taking multiple drugs, all have to be considered as well. If you have dental distress syndrome, which perpetuate into TMJ, it may influence the masticatory, digestive, endocrine, neuromuscular systems causing inadequate energy production and extra energy consumption costs to your body, leading to chronic fatigue. Keeping peak energy condition requires multidisciplinary attention. Balancing the bite and TMJ is one of the most effective proven treatment modalities. 


POST TMJ SURGERY SYMPTOMS:15-20 years ago, various surgical methods and techniques were developed for TMJ surgery. It was one of the most popular treatment modalities for patients whose symptoms would not be relieved by splint therapy or other conservative treatments. However, despite some experiencing symptomatic relief, patients have suffered more after surgery. The procedure was irreversible and there was nothing much to do except medicate to control the pain. Because of the severity of pain and side effects of drugs, both patients and doctors struggled. These days, better non-surgical techniques and drugs have developed, and both surgeons and non-surgeons consider surgery as the last treatment modality option. 

Dr. Wesley Shankland, Past President of the American Academy of Craniofacial Pain recommends three criteria be satisfied before TMJoint surgery is tried. The criteria are:

All conservative treatment was a failure. If splint therapy is a failure once, it should be repeated, with a different splint design, or by a different doctor.

There has to be a demonstrable physical or structural explanation for the patient's complaints. A physical problem can be seen with an MRI, x-rays, or with dye injections into the joint (arthograms). Make certain that this is not an exploratory surgery or that the surgeon "thinks" this surgery will help.
Patients must be suffering so much that they must take strong pain medication, and their life-style is greatly altered. In other words, the patient must be desperate and at the "end of their rope" before surgery is attempted.

Don't permit the doctor to proceed with any invasive or irreversible procedure too soon, and insist on a referral to other practitioners who are trained to listen to symptoms, observe signs, and place these findings into neat packages to determine a diagnosis and treatment into a conservative non-invasive modality. 

OTHER SYMPTOMS:


Most TMJ practitioners believe that many symptoms, that do not seems like dental related, are caused by TEETH/TMJ disorders and calling it "The Great Imposter." Chronic fatigue/lack of energy, stiff neck, dizziness, ringing in the ear, light headedness, blurred vision, pain behind the eye, muscle twitching, numbness or tingling, speaking disorder, swallowing difficulty, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), seizure, could not fall in deep sleep, snoring, difficulty breathing, keep changing position of sleep, nasal stiffness, allergies, unstable walking, fall down often, head forward posture, unparallel shoulder height, un-corrected scoliosis, pain in the hip/leg/foot/heel, restless leg syndrome, carpal tunnel syndrome, Parkinson's disease, irritable bowels,  are part of TMJ disorder symptoms.

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