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What to call it?
Currently, the health care and research community call this disease/disorder
TMD. The press and public are familiar with this disease/disorder under the
name "TMJ". Depending who is discussing this disease; it can be called any
number of names. In fact, the confusion regarding what to call this is not
just a reflection of the chaos in the field but also a contributing factor.
We, as patient advocates, have chosen to use "TMJ" as the abbreviation for
these temporomandibular diseases/disorders. This is what the patients and
public relate to.
What is "TMJ''?
According to the National Institute of Health Temporomandibular Disorders
refer to a collection of medical and dental conditions affecting the temporomandibular
joint and/or the muscles of mastication (chewing muscles), as well as related
tissue components.
The TMJs are the two tiny joints in the front of the ears that attach the
lower jaw (mandible) to the skull (fossa). Not only do the jaw joints rotate
as other
ball-and-socket joints, they translate (move down and forward). The disk
is a wafer thin piece of tissue acting as a buffer between the skull and
the condyle (top of the mandible).
When intact, they are the only joints in the human body that work together
as a unit. These joints allow us to perform such taken for granted functions
as opening and
closing the mouth, chewing, swallowing, breathing, kissing, talking, etc.
Problems that can occur with the temporomandibular joint are arthritis, trauma,
tumors,
tearing or dislocation of the disk. Another component of this temporomandibular
diseases/disorders is a painful muscle malady often diagnosed as Fibromyalgia
or
Myofascial Pain Dysfunction. You may experience joint problems, muscle problems
or both.
"TMJ" as we know it runs the gamut from a clicking or popping jaw and mild
discomfort to complete jaw dysfunction and severe and intractable pain. It
is important
to remember that the majority of TMJ patients experience temporary discomfort
and gradually get better with or without treatment.
However, for many others, it can be the beginning of a nightmare in which lives are destroyed, dreams shattered, families torn apart and people left bankrupt, desperate and without hope. If you have TMJ, you may have spent years of your life and thousands of dollars being referred from one doctor to another hoping for relief. These doctors may have told you that you are crazy or need to better handle your stress. They may have told you that you don't have pain. They may even have abandoned you, saying there is nothing more to be done for you...that is, after you have spent thousands or hundreds of thousands of dollars on treatments.
If this sounds familiar, you are not alone. You are not crazy and you are
not to blame if you haven't gotten better. It is possible that you have received
one or many of
the over 49 treatments being recommended to TMJ patients in this country,
most being sold on the basis of the doctor's preference, not scientific evidence
of safety or effectiveness. The treatment may, in fact, be making you worse.
You may feel caught in a quagmire. Your personal experience may be that there
is a great deal of
disagreement among professionals about most aspects of temporomandibular joint
diseases/disorders.
How many people have "TMJ"? Who gets it?
According to the National Institutes of Health, over ten million Americans
suffer from TMJ Diseases/Disorders. This is the most conservative estimate
we have seen.
Both males and females can get TMJ diseases/disorders. However, 90% of
those seeking treatment for TMJ are women, most between puberty and menopause.
Recent research has focused attention on the relationship between sex hormones
and pain. A study conducted by Dr. Linda LeResche, University of Washington
in
Seattle, demonstrated that women on hormone replacement therapy were 77%
more likely to seek treatment for jaw pain than those not undergoing such
treatment.
Also, women on oral contraceptive therapy were 19% more likely to seek treatment.
Evidence is emerging in support of a biological explanation for why there
are more women suffering from TMJ pain.
A study done by Dr. Peter Waite, University of Alabama at Birmingham "demonstrates a high incidence of TMJ dysfunction among Mitral Valve Prolapse patients and leads to a suspicion of a common connective tissue disorder." In an unrelated survey conducted by the Society for Mitral Valve Prolapse Syndrome, of 240 patients surveyed 51% had also been diagnosed with TMJ.
Symptoms
The symptoms most commonly cited are as follows.
• Facial pain
• Jaw joint pain
• Neck, shoulder, and/or back pain
• Pain in the joint(s) or face when
opening or closing the mouth, yawning, or chewing
• Headaches (tension type)
• Swelling on the side of the face and/or
mouth
• A bite that feels uncomfortable, "off,"
or as if it is continually changing
• A limited opening or inability to
open the mouth comfortably
• Deviation of the jaw to one side
• The jaw locking open or closed
• Ringing in the ears, ear pain, diminished
hearing, and/ or hyperaccusis
• Dizziness or vertigo
• Visual Disturbances
A recent study conducted by Dr. J.C. Turp found that among a great percentage of TMJ patients the pain distribution was more widespread than commonly assumed. "Evidence suggests a significant overlap between temporomandibular disorder states and pain conditions in other parts of the body".
Diagnostics
The NIH Technology Assessment Conference Statement concludes, "there are
significant problems with present diagnostic classifications of TMD, because
these
classifications appear to be based on signs and symptoms rather than on etiology."
They further state that, "...scientifically based guidelines for diagnosis
... are still
unavailable."
The dental community usually diagnoses TMJ based on several things, including
range of motion tests, listening for sounds in the joints, examining the
teeth, and
palpation of the jaw joints as well as the muscles of the face, and head.
Typically the dentist will ask for information about your pain and other
symptoms, injuries, oral habits, and previous medical and dental treatment.
Diagnostic tools
A variety of imaging techniques are used to aid doctors in the diagnosis of
TMD. Some of the most common ones are:
Conventional Radiography (plain x-rays,
including Panorex) is quick, painless, and relatively inexpensive. However,
since they only show just the bony structure
of the joint, they are generally useful for ruling out obvious pathological
changes and disease processes.
Tomography shows "slices" through the joint.
When done properly and interpreted accurately, tomograms give a better view
than plain x-rays. The major
drawbacks with tomography are cost, time, and like plain x-rays, they show
only bone.
Computed Tomography (CT or CAT Scan) provides
superb detail of bone in multiple directional planes, with a minimal dose
of radiation. They are fairly
expensive and provide a somewhat limited view of the disc and soft tissue.
Magnetic Resonance Imaging (MRI) produces
brilliantly detailed and accurate images of bone as well as soft tissue, and
is widely considered the best single
way to study the TMJ. No radiation is used; however, since sophisticated equipment
is needed, MRIs are expensive -- sometimes over a $1,000 for both sides.
Arthrography allows the study of the position
and function of the joint, including the disc. It involves the injection
of contrast dye into the joint, followed by
imaging using plain x-rays, tomograms, videotape, or a combination. A skilled
examiner is a must, and the procedure can be very uncomfortable, but if done
properly, arthrography can be an extremely accurate diagnostic tool.
A variety of other techniques have been developed to diagnose TMJ diseases
and disorders including jaw tracking, surface electromyography, sonography,
thermography, and silent period durations. The NIH Technology Conference included
multiple views of these diagnostic methods. Proponents of these instrumentation
devices say they "are clinically useful and objective methods of quantifying
physical components of "TMDs" in patients screened for treatment." The opponents
say, "none of the instruments can be said to provide more than ancillary
documentation and none have proven diagnostic validity or utility." These
tests can cost several thousand dollars.
Reference: G.F. Carrera, MD, "Diagnostic Imaging of the Temporomandibular Joint," The TMJ Report 2(2): 4-6, May 1992.
We recommend that you first consult with a medical doctor to rule out any disease that may be causing your symptoms and is treated by medical practitioners. If they are unable to find a reason for your problem, and you are referred to a dentist for a TMJ evaluation, we encourage you to then obtain multiple INDEPENDENT opinions on your condition.
To be a truly independent opinion, the medical/dental professional can
not be associated with or working with the medical/dental professional from
whom you have
already received an opinion. Many TMJ patients seek further opinions outside
of their geographical area, without the referral of their original medical/dental
professional.
With the increase of managed care (HMOs), where a primary care physician
is your health care gatekeeper it is mandatory that you, the patient, become
your own
well-informed advocate. You will also need to educate your primary care physician
and all others you encounter within the system about TMJ.
As the Washington Post states in their Health News section on May 7, 1996, this is critical for " ...medical science is so uncertain about how to treat jaw pain because the disorder has not been accurately diagnosed or described - and no one is sure whether it should be treated by doctors or dentists, or both."
This information was developed by the TMJ Association, Ltd. and is herewith used with permission.
TNJ Association, Ltd. The TMJ Association changing the face of TMJ. Available at: http://www.tmj.org/index.html. Accessed October 26, 1999.
The TMJ Association presents the following solely as an information guide.
It does not constitute medical advice, nor is it a substitute for medical
advice. Always
consult with your doctor before starting any treatment. The TMJ Association
does not provide physician referrals and does not endorse any particular health
care
professional or organization.
The information in this document is for general educational purposes only. It is not intended to substitute for personalized professional advice. Although the information was obtained from sources believed to be reliable, Arbor Publishing Corp, its representatives, and the providers of the information do not guarantee its accuracy and disclaim responsibility for adverse consequences resulting from its use. For further information, consult a physician and the organization referred to herein.