Understanding what causes a sore or painful jaw. (TMD) Temporomandibular Joint Disorder

Understanding Temporomandibular Joint Disorders (TMD): Causes, Management, and Relief

Temporomandibular Joint Disorder (TMD) is often referred to as TMJ disorder. They refer to the same condition of a sore or painful jaw. The correct and technical term is TMD, as this refers to the condition of the joint. TMJ is actually the name of the temporomandibular joint.

TMD encompass a range of painful conditions affecting the jaw joints and muscles. These disorders are categorised as orofacial pain disorders. They are often divided into joint conditions (intracapsular disorders) and muscular conditions (extracapsular disorders), which can involve the muscles of mastication or the neck and shoulders. In this blog, we'll explore the complexities of TMD, emphasising the importance of early intervention, conservative therapy, and addressing multifactorial causes for effective management and relief.

Understanding TMD Categories

TMD symptoms can manifest in various ways, including jaw pain, clicking or popping sounds, headaches, earaches, and difficulty in opening and closing the mouth. To better manage these conditions, it's crucial to classify them correctly. TMD conditions are broadly categorised into two types:

1. Joint Conditions (Intracapsular Disorders): These conditions primarily affect the temporomandibular joint itself. They often result from joint inflammation, disc displacement, or structural abnormalities within the joint.

2. Muscular Conditions (Extracapsular Disorders): Muscular TMDs involve the muscles of mastication (used for chewing) and can also affect the muscles of the neck and shoulders. These conditions may result from muscle tension, overuse, or stress-related factors.

The Role of Duration in TMD Management

The duration of TMD symptoms plays a crucial role in the management of these disorders. Acute conditions, which are of short duration, are generally easier to manage compared to chronic conditions that persist for more extended periods. Research indicates that individuals suffering from TMD for over six months may face more challenges in finding relief.

Chronic TMD conditions can lead to a cascade of complications, making them harder to resolve. Therefore, it's essential to seek prompt treatment and not delay seeking professional help if you suspect you have TMD symptoms.

Conservative Therapy: The First Line of Defence

When it comes to managing TMD, healthcare providers often recommend conservative therapy as the initial approach. This includes non-invasive, non-surgical methods aimed at alleviating symptoms and promoting healing. The good news is that conservative therapy has the potential to resolve up to 90% of TMD conditions.

Conservative Therapies for TMD Management:

1. Physical Self-Management Techniques: These techniques may involve exercises and stretches that help reduce muscle tension, improve jaw function, and alleviate pain. Patients can learn to manage their symptoms through self-care practices.

2. Oral Appliances: Custom-made oral appliances, also known as dental splints, can play a significant role in TMD management. These devices are designed to reposition the jaw, relieving pressure on the affected joints and muscles.

3. Pain Management: Non-prescription pain relievers, moist heat or cold packs, and muscle relaxants may be combined with other therapies to control pain and discomfort.

4. Stress Management: Stress can exacerbate TMD symptoms. Techniques like relaxation exercises, meditation, and counselling may help individuals manage stress and reduce its impact on TMD.

The Multifactorial Nature of TMD

TMD disorders are rarely caused by a single factor; instead, they typically have a multifactorial aetiology. This means multiple factors contribute to the development and persistence of TMD symptoms. Experienced clinicians need to identify and address these underlying issues to provide effective therapy and make appropriate referrals.

Common Factors Contributing to TMD:

• Trauma or injury to the jaw or head.

• Bruxism (teeth grinding or clenching). 

• Parafunctional habits (clenching and bruxism)

• Malocclusion (improper bite alignment).

• Arthritis or joint degeneration.

• Muscle tension or imbalances.

• Poor sleep hygiene and stomach sleeping 

• Forward head posture and cervical neck issues. 

• Airway issues and obstructive sleep apnoea 

• Psychological stress and anxiety.

The Power of Conservative Therapy and Self-Management

Research evidence shows that conservative therapy, combined with physical self-management techniques and the use of the right oral appliance, can significantly control TMD symptoms. These approaches relieve pain and reduce the loading on affected joints and muscles, promoting repair and healing.

In conclusion, TMD is a complex condition with various contributing factors. Early intervention, conservative therapy, and addressing the multifactorial nature of TMD are crucial for effective management and relief. If you suspect you have TMD symptoms, seek professional evaluation and guidance to start your journey towards a pain-free and improved quality of life.

References: 

• Okeson, J. P. (2019). Management of temporomandibular disorders and occlusion. St. Louis: Mosby, 8th ed

• Curran SL, Carlson CR, Okeson JP: Emotional and physiologic responses to laboratory challenges: patients with temporomandibular disorders versus matched control subjects, J Orofac Pain 10(2):141–150, 1996.

• Ohrbach R, editor. Diagnostic Criteria for Temporomandibular Disorders: Assessment Instruments. Version 15May2016. www.rdc-tmdinternational.org Accessed on November 24, 2020 

• Olmos et al. The effect of condyle fossa relationships on head posture. Cranio; 2005 Jan;23(1):48-52

• Wright EF, Anderson GC, Schulte JK A randomized clinical trial of intraoral soft splints and palliative treatment for masticatory muscle pain. J Orofacial Pain 1995;9:116-30. 

• Hodges JM. Managing temporomandibular joint syndrome. Laryngoscope 1990;100:60-6.

• Carlson C, Bertrand P, Ehrlich A, Maxwell A, Burton RG: Physical self-regulation training for the management of temporomandibular disorders, J Orofacial Pain 15:47–55, 2001