submitted by Dr. Michael Spadafora, D.D.S.
Last month’s column was about Temperomandibular joint disorder (referred to as TMD) and some of the symptoms that occur in dental patients. It is a topic of such interest that more discussion was warranted.
When a patient arrives in the dental office complaining of symptoms indicative of TMD (such as headaches, jaw pain, locked jaws, swelling), the doctor will take a detailed health history. In the health history, the dentist is looking for recent traumas, increases in stress, the presence of arthritis in other areas of the body and other factors that may contribute to TMD. He is also listening for complaints from the patient (for example, the jaw locks open when the patient yawns, eating is difficult).
A physical exam follows the health history. In the exam, the dentist is listening for sounds from the jaw – clicking, popping, and grating sounds. He will feel the jaw as it opens and closes to determine if the movement is smooth. He will observe the jaw and mouth to determine the range of motion. Finally, the dentist will palpitate the areas around the jaw to identify the specific sites of pain. Occasionally, the dentist will recommend x-rays of the jaw or an MRI.
A good and careful diagnosis of TMD is important because the symptoms are so wide-ranging and can be indicative of other issues (sinus and dental infections).
The diagnosis is the first step in treating TMD. The protocol for treating TMD suggests starting with the most conservative treatments. Lifestyle changes, such as eating softer foods, taking smaller bites, and purposefully keeping the jaw unclenched are recommended. Medication is sometimes prescribed, ranging from NSAIDs (non steroidal anti-inflammatory drugs such as Advil and Naproxen), muscle relaxants, and low dose antidepressants.
Custom fitted night guards often will provide relief from TMD, as well as ice and moist heat.
Finally, treatment options can include physical therapy, corticosteroid injections, and, as a last resort, surgery. Relief is almost always available for patients suffering from TMD. The patient must take the first step and visit his dentist or physician.