Dr. Richard Rodgers is a dentist and has answered some common questions that Bizymoms visitors have about TMJ/TMD.
Q. What is TMJ?
A. First a little anatomy lesson, TMJ stands for the Temporomandibular Joint. This is the joint that connects the base of the skull (the Temporal Bone) to the lower jaw (the Mandible). There are two TMJ’s, one on each side. I’ll refer to them as the jaw joints. If you place your fingers on the side of your face just in front of the ears and open and close your mouth you will feel the jaw joints moving.
The term "TMJ" as it is commonly used identifies a specific collection of symptoms or a syndrome describing a malady of the masticatory (chewing) system. The term "TMJ" however is not quite accurate since it involves more than the anatomical structures of the jaw joints. A better term is "TMD" (which stands for Temporomandibular Disorder) which encompasses problems involving the joints, the muscles of the head and neck that move the jaws, or both. "TMJ" can also be called craniomandibular disorder or temporomandibular dysfunction syndrome Now what we know about TMD. The problem is statistically more predominant in females. The mean age of patients with TMD is 35. TMD can be caused by genetic susceptibility to osteoarthritis, trauma to the joint, poor fit between upper and lower teeth, stress, nutritional deficiencies, hormonal stimulation, and certain sleep postures.
The most frequent symptom that patients present with is pain in the chewing muscles. The muscle pain results when muscles are forced to exert extended, atonal contractions. A poor or unbalanced relationship between the upper and lower teeth that requires extra work from the muscles to overcome the imbalance will lead to these atonal contractions. Another, less common cause is aberrant nerve stimulation coming from within the central nervous system and leading to parafunctional muscle activity such as clenching or grinding.
The sequela (complications if left untreated) include muscle spasms, alterations in the ability to open or close the mouth, headaches, damage to the jaw joints and fractured or worn down teeth. The acute presence of TMD might be an indication of potentially larger problems such as pathologic changes to the joint, neurologic disorders or chronic or sudden unacceptable changes to the bite (occasionally developing after major dental treatment).
Q. How do I know if I have TMJ?
A. You will likely have pain in the jaw muscles or temple muscles. And or pain in the jaw joints. And or pain when trying to open or close your mouth. The pain can be mild, moderate, or severe. If may imitate a toothache.
Answering yes to any of the following questions would suggest the TMJ/TMD is part of a larger problem.
• Do you or would you have any problems chewing gum?
• Do you or would you have any problems chewing bagels or other hard foods?
• Have your teeth changed in the last 5 years, become shorter, thinner, or worn?
• Are your teeth crowding or developing spaces?
• Do you have any problems sleeping or wake up with an awareness of your teeth?
• Do you have any problems with your jaw joint? (pain, sounds, limited opening, locking, popping)
• Do you have tension headaches or sore teeth?
Q. Can pain killers help in treating TMJ syndrome?
A. Over the counter pain relievers such as Aspirin or Ibuprofen can be helpful in controlling the pain associated with TMD. They will also help to control inflammation in the muscles or jaw joints if taken for several days in succession. However, this should not be considered as "treating the TMJ syndrome" since the source of the larger problem may cause the TMD to return. Also keep in mind long term use of OTC pain meds carries its own risk of health complications. It is better to identify the true source of the problem and have it treated.
Q. Who is qualified to treat TMD?
A. General dentists with additional training in TMD, Prosthodontists, and Oral Surgeons are most commonly the ones that treat TMD. The ADA has not designated treating TMD as a specialty so any dentist with an interest is allowed to treat TMD. It takes a little digging to find out if a dentist is interested in treating TMD patients. Often it will be listed among the services in their literature, on their website, or in their advertisements.
General Dentists and Prosthodontists will usually only address problems with the teeth and muscles. If the problem requires surgical intervention of the joint then obviously the Oral Surgeon would be best to consult. Fortunately, most TMD problems will not require surgery.
Q. Who needs to have their TMD treated?
A. In the absence of symptoms no treatment is needed, there is no supportable evidence of any benefit to a preventive approach to treatment of TMD. Patients in pain would obviously need treatment. TMD connected to the larger problems previously mentioned can be considered progressive in the sense that whatever has begun to breakdown will continue to worsen without intervention. So worn down teeth will continue to wear down, or partial disc derangements within the joint will become full derangements. In the end the progression leads to debilitation, either functional or cosmetic. Therefore anyone feeling symptoms should be evaluated to find out the severity of their problem as soon as possible.
Q. What should you expect from a TMD doctor?
A. Naturally, you should expect the doctor to be thoroughly knowledgeable of the jaw joints, musculature of the jaws, and the neurological effect of the basal ganglia. The doctor will listen carefully to the description of your problem and then do a thorough diagnostic evaluation. Based on what the doctor finds he or she interprets the signs and symptoms as it might relate to larger issues. You should expect the doctor to diagnose and treat you with kindness and sympathy as well as practical, cost-effective and evidence-based solutions.
The acute symptoms may take several weeks to fully resolve. A nighttime occlusal guard is often used early in treatment to quiet the hyperactive muscles. Once the pain is resolved then a functional analysis should be performed to identify any larger issue. If the analysis points to a larger issue then a plan can be formulated to address the larger issue. The complete treatment of the TMD may involve as little as the continued use of the nighttime appliance or a significant amount of dental treatment in order to provide a stable healthy relationship between the teeth, muscle and jaw joints depending on your individual circumstances.
Q. What results can I expect from surgery?
A. Surgery is not usually indicated for acute TMD symptoms. Sometimes a larger issue of involving pathologic changes or traumatic injury to the jaw joints will require surgical correction. In my opinion when surgery becomes necessary we have stepped beyond what is generally considered TMD. While it is true that TMD is involved with the same anatomical structures, it would be wrong to consider those problems part of a typical TMD case. More to the point of the question, I have not had any personal experience with patients that have undergone joint surgery for any reason, so I do not feel qualified to respond to the specific question on results.
Q. Is TMJ/TMD covered by insurance?
A. Treatment for TMJ/TMD will sometimes be covered by insurance. It depends on the policy that you chose from the options provided by the employer. The policy handbook provided by the insurance company is the best resource to find out if yours covers it.
Q. How can we contact Dr. Rodgers if we have further questions?
A. Call : (404) 577-6620
Email : drrodgers@rodgersdds.com
