Early detection and intervention of TMJ Disorder is needed for the best outcomes. Many people that suffer from TMD have been told that their symptoms aren’t worthy of treatment, that treatment will not help or may even cause worse problems. The truth is there are treatments to rehabilitate the temporomandibular joint, address pain and prevent future damage.
TMD, or Temporomandibular Disorder, describes a variety of symptoms that occur when the jaw joint (temporomandibular joint), the muscles of the face and neck, or the cartilage inside the TMJ is damaged.
You might read or be told that these problems are self-limiting, are stress related, or are naturally occurring and are no cause for alarm. Causes of TMD are often cited to be arthritis, infection, genetic, or hormonal. Please pause and consider this statement by the TMJ Association regarding TMJD. Because upon further consideration…what causes the arthritis? The infection? The hormones present in all women? If that were true, TMJ would be present in virtually everyone because we all have these supposed “causes” in our lives. These are merely other existing factors occurring in patients with TMJ.
Women especially are advised to live with it. This is quite honestly, very troublesome to those of us who treat these orthopedic problems daily. Some websites purporting to have the latest research and advice regarding TMJ problems describe the above “causes” as non-related to TMD. They advise those suffering to engage in stress management and medication, pharmacologic treatment of pain and anxiety. Their approach is focused on psychosocial coping with symptoms and to re-assure sufferers the symptoms will go away. Some do. Many go from joint clicking to muscle pain, headaches, ear pain, neck pain, etc. It’s true for some the initial clicking may go away, but the progressive symptoms are not attributed to the progressive joint dysfunction.
Treatment of joint problems should begin with rest to see if pain subsides. Often, medication is then recommended to suppress pain after a week or two. If either of these approaches eliminates pain, the study is “completed” and the “cure” is considered “rest and medication”. The study doesn’t follow those people over the following months or year(s) to evaluate what other problems develop as a result of that damaged joint – much as a knee problem can lead to a subsequent hip or low back problem from altered biomechanics. The study can conclude that the condition is “self-limiting” and recommends rest and time, in addition to medication as treatment. Those of us treating biomechanical problems can usually relate the sequence of events that occurred leading to the new problem or subsequent re-appearance of pain in the damaged joint and its associated muscles.
What is true is that some people can have damage in the TMJ for many years and never have pain. As one author writing in the Journal of Dental Research about the shortcoming of Evidence Based Research stated, “Absence of evidence is NOT evidence of absence”. Orthopedic and functional-based medical sub-specialties such as Physical Therapy, TMJ, rely on patient’s seeking help for pain or being concerned about loss of function to begin treatment. Typically only athletes seek ongoing correction of biomechanical problems so that the consequences of imbalance don’t affect their performance. Most of us wait until it hurts to seek help. I see this frequently with patients that have had a clicking jaw for months or years, then the clicking goes away because the joint is now dislocated. Then weeks to months later a variety of symptoms cause them to seek help, as described above.
Studies aren’t done that identify biomechanical “abnormalities” and follow those people for a lifetime to document changes in lifestyle because of functional limitations, pain in associated structures and ultimately the onset of systemic diseases or problems such as hypertension or weight gain from loss of activity or joint problems from abnormal movement. All of which may arise from the increasing avoidance of movement. Professional athletes constantly correct and improve biomechanics because their performance depends upon it, but it isn’t studied by an insurance company or considered necessary treatment in them or the average person.
Common sense tells us that arthritis is the result of joint damage, except for some autoimmune arthritis which rarely attack the TMJ, not the cause. Although there are infective forms of arthritis, we don’t catch it like a cold. Our joints typically develop arthritis due to underlying misalignment, excessive, sustained pressure or unnatural use of the joint causing injury. This is also true of the TMJ. Arthritic change to the bone occurs after painless damage to the soft tissues of the joint for a time, such as clicking in the TMJ.
Women may be more prone to joint damage because of estrogen receptors found in their joint tissues. Estrogen alone doesn’t “cause” TMJ any more than it “causes” degenerative back disease. It may be a factor lowering the threshold for all joint injury.
Additionally, direct trauma to the face or neck can damage the ligaments of the TMJ, allowing the disc to become unstable. Micro-trauma can be from excessive or prolonged jaw opening, whiplash. Clicking, popping, or other noises in the TMJ indicate permanent damage that is progressive over time. The rate of progressive damage is dependent on many factors and can proceed over months or years. Once damaged, the TMJ cannot “fix itself”. Strong research supports that TMJ disc displacement is NOT self-limiting. The sooner appropriate joint-based treatment is begun, the better the long term outcome. Untreated, it leads to arthritic deterioration of the joint and facial asymmetry in growing children.
Regardless of the condition, but very important in orthopedic problems of the TMJ, is early detection and intervention. Unfortunately, many are told that their symptoms aren’t worthy of treatment and that treatment won’t help and may cause worse problems. There is hope, there is help.