Patients customarily seek professional care for temporomandibular joint disorders due to pain or limitation of mandibular function. The condition has a variety of nomenclatures, such as temporomandibular pain, myofacial pain dysfunction, or is currently referred to as temporomandibular dysfunction (disorder) -- TMD.
One of the least understood maladies in medicine, TMD is often misdiagnosed, mistreated or ignored. Patients who experience symptoms of TMD should seek a diagnosis from a qualified medical professional. Warning signs may be headaches; pain around the ears or head and neck; "tightness" of the jaw muscles (especially when awakening); limitation of motion of the mandible (lower jaw); ringing in the ears (tinnitus); "clicking" of the temporomandibular joints; and loose teeth or frequently broken teeth or persistent dental pain.
The most common cause of TMD is bruxism, a gnashing or clenching of the teeth, usually while asleep. The condition is generally associated with stress -- psychological and physiologic -- a quintessential malady of modern life. It tends to be episodic, running a course of days, weeks, months or years, with intermittent periods of quiescence. As there is considerable controversy in the diagnosis and treatment of the temporomandibular joint (TMJ), therapy should be cautious and palliative. A differential diagnosis may be indicated to rule out other medical problems such as rheumatoid or degenerative arthritis, infection, fracture, tumor, and congenital and developmental anomalies.
A few physicians still question the existence of TMD, and many insurance companies will not reimburse for diagnosis or treatment. Chiropractic care generally affords temporary relief of symptoms at best. Relaxation techniques, stress control and other psychotherapy by caring professionals may offer immeasurable therapeutic value.
Since there is frequently a direct correlation between TMD, stress and bruxism, long-term approaches to TMD should be deferred to dentists experienced in the management of non-orthodontic malocclusions (bite irregularities). Occlusal discrepancies are often viable factors in this equation. If bruxism is suspected as the cause of TMD, the most effective, economically efficient treatment is the fabrication of a bruxism splint, also known as an oral orthotic or night guard. The device functions as a diagnostic aid, and as effective therapy for pain management, often providing relief within days of its use. While there is no consensus of opinion in the dental community on design and materials, most practitioners who successfully treat TMD utilize hard plastic orthotics with flat biting surfaces. The appliance may be fitted to cover the upper or lower teeth. Non steroidal anti-inflammatory drugs (NSAIDs) are often effective during the acute phase of therapy.
Orthodontic treatment of a patient who experiences TMD must be gradual, cautious and conservative. Rather than ameliorate the condition, injudicious movement of the teeth may exacerbate TMJ symptoms. A bite plate used in conjunction with orthodontics may be necessary.
Should a simple approach fail to resolve the symptoms, more complete evaluations such as X-ray tomography, arthrography, magnetic resonance imaging (MRI), or injections into the joint may be in order. Surgical intervention should always be a last resort, unless a clear identification of a problem, correctable by surgery, is established. Second opinions are not unreasonable.
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