Temporo Mandibular Joint (Jaw) Disorders (TMD)

Constricted airways, sleep apnoea or sleep disordered breathing can cause TMD. To open your airways to achieve optimal oxygen, your body might unconsciously posture the jaw to give rise to TMD.

Untreated airway constriction from enlarged tonsils or adenoids can cause TMD and have other ill effects due to oxygen deprivation.

A single traumatic event such as whiplash injury could cause TMD in the jaw or skull. These can result from a car accident or a fall/blow to the head that wrenches the jaw out of position at such a force that it causes injury to the hard and soft tissue. If a trauma to the joint causes chronic damage, this can result in a TMD problem at a later time.

All joints have limitations to movements and the TMJ is no exception. If you open wide for a long time, or if your mouth is forced open then the ligaments will be torn causing TMD.

Frequently the cause of TMD is structural, biochemical and emotional factors that develop over years and result in TMD. A structural problem is almost always present and leads to over-activation of the jaw, head and neck muscles. Factors related to the teeth and bite are among the most common causes of TMD Disorders.

This is the grinding and clenching of the teeth. It can be while awake but, more often bruxing is done while sleeping. This means you might be waking up with sore, tired jaw muscles and sensitive worn teeth in the morning but may not realise you are a bruxer. The constant grinding of the teeth causes pressure on the TMJ’s and may injure the ligaments. Bruxism is the most common factor found in TMD and is treatable by your dentist.

Malocclusion means ‘bad bite’. When the teeth don’t fit together in harmony with the shape and position of the joints, pressure can be placed on those joints. The chewing muscles suffer from stress and tire, eventually spasming. The spasm causes pain and tissue damage which in turn causes more spasm. This cycle can result in a TMD disorder. Malocclusion may also be produced by: Distorted development of one or both jaws; Underdevelopment of one or both jaws; Airway issues; Loss of teeth without replacement; Over closed bite; High dental restorations; Poor fitting denture or partial denture; Loss of bone in denture patients; Tongue habits; or Orthodontics.

Whilst orthodontics can improve appearance and correct factors leading to TMD some researchers also feel that orthodontic treatment may produce TMJ problems. Proper orthodontic treatment will take into consideration the correct position of the TMJ’s and the skeletal structures as well as the alignment of teeth.

Double jointed people actually suffer ligament laxity. If you are double jointed anywhere in your body there is a strong chance the TMJ will be loose and causing excessive movement. This is a common cause in active young women.

Emotional stress plays an integral role in the development of TMD. Stress increases the severity and duration of bruxism (grinding) whilst asleep. During times of stress many will subconsciously clench and/or grind their teeth more in the daytime too. In times of stress our adaptability goes down. Stress is like throwing petrol onto an existing fire: the fire is a TMJ problem and the petrol is stress. The petrol causes the fire to flair up and burn wildly for a time but the petrol did not produce the fire (or TMJ) it just made it worse.

Various diseases can cause or aggravate TMJ problems. Immune disorders such as rheumatoid arthritis, psoriatic arthritis and systemic Lupus erythematous can produce inflammation in the TMJ. Viral infections such as mononucleosis, mumps, and measles can also cause damage to the surface of the TMJ.

We are just starting to understand the critical role proper nutrition plays in the optimal functioning of our body (including our TMJ), our resistance to stressful situations and our ability to adapt to the challenges within our lives.

In our gravity-based world, our muscles and nerves are designed to keep our head, pelvis and feet level with the ground when standing still or working in balance when under motion. The human body functions best when the skeletal structures are parallel or at right angles to the centre of gravity.

If an area of the system is faulty or injured the body will shift to compensate from its normal balanced posture. This spreads out the forces and allows the injured area to avoid any extra stress on that area. But this compensation now places stress on other, more remote areas to the body and often pain is experienced in these areas. These postural distortions can either contribute to or are the result of TMD problems.

Any activity that causes the head to be held in an unnatural way may intensify TMD problems. Particularly troublesome habits including cradling a telephone between the ear and the shoulders, frequent use of smartphones, carrying a heavy shoulder bag and slumping over a desk to read or type. Playing certain musical instruments and surgery can exacerbate TMD symptoms caused by bad ergonomics.

This disease often won’t result in pain but does cause worn, chipped or broken teeth, broken fillings. Any changes in the position or shape of one’s skull are all indications of TMD disorder and these patients should address these problems sooner rather than later.

The goal of this phase is to reduce and eliminate joint and muscle pain, address structural problems throughout the body and educate the patient as to their role at home. The most common form of treatment at this stage is a splint or orthodontic appliance.

In phase one of treating TMD and TMJ disorders the following steps are normally taken:

1. Investigate possible causes of TMD: This may include doing a sleep test to investigate sleep disordered breathing.
2. A removable appliance helps to keep the lower jaw in an optimum rest position.Construct a removable appliance: This is done using the relaxed position of the muscles of the head and neck (with help from the TENS) to place the lower jaw in an optimum physiological rest position
3. Reduce and eliminate TMJ problems and symptoms
4. Correct postural distortions
5. Educate the patient as to how they can help themselves. This part of the treatment will usually include exercises, medications, lifestyle changes and stress management.
6. There are many types of occlusal splints or orthotics. We will advise you what is the most appropriate splint for your particular needs.

This second stage involves correcting body irregularities that are the cause of the patient’s TMD dysfunction.

The goal of this phase is to maintain support of the TMJ joint by the teeth, ensuring they stay in a pain free position.

Depending on where the pain free position of the jaw lies several different types of therapy are available in Phase 3 including:

• Long term splint use
• Bite adjustment
• Dental reconstruction
• Orthodontics
• TMJ surgery

Often treatment may include a combination of these therapies.