Temporomandibular Joint (TMJ) is a term often used to refer to the multi-faceted muscle disorders that can contribute to pain, jaw joint and occlusal problems. TMD refers to temporomandibular joint dysfunction.
According to the layperson the TMJ (Temporomandibular Joint) is a term that is often used to identify a multifaceted multi-etiologic group of problems that involve both medical as well as dental conditions involving the temporomandibular joint, muscles of mastication, the teeth/occlusion as well as the central nervous system (nerves). It is clear that TMD or TMJ problems consist of a complex set of problem that go beyond genetic and bio-psychosocially mediated causes. It is a combination disorder of the teeth, muscles, temporomandibular joints as well affecting the central nervous system in some that cause dysfunctions to the masticatory system as well as the whole postural system of the body. It is not a single cause-related just to a ‘bad bite’ or a ‘malocclusion’ but rather a problem that is multi-faceted in nature affecting all of the above.
“Experts estimate that 75 percent of all headaches are caused by muscle tension, which may be related to the bite.” AGD/Oral Health Resources, Temporomandibular Joint Disorder (TMD), March 30, 2007. Literature also reports that with a frequency of 92%, pain in the temporal muscle was the most common symptom, followed by pain during mouth opening (89%) in both genders. Bagis B, et.al.: Gender Difference in Prevalence of Signs and Symptoms of Temporomandibular Joint Disorders: A Retrospective Study on 243 Consecutive Patients. Int J Med Sci 2012; 9(7):539-544.
Cooper and Kleinberg (April 2008), Haskin (1995), Emshoff (2003), Tasaki (1996), Katzberg, et al (1996) also reported that TMD comprised of the following:
- 70-89% Prevalence of TM Degenerative disease.
- 71.8% had posterior mandibular displacements.
- 53.9% had lateral displacements.
- 82.1% had over-closures (excess vertical freeway space).
- 84.1% were not coincident with the myo-trajectory.
Note: A much smaller percentage of individuals that present with symptoms of temporomandibular joint dysfunction has also been diagnosed by their physicians and health care provides having biochemical imbalances related to nutritional/ vitamin deficiencies and hormonal issues leading to emotional and psychological anxieties and depressions. (Expert help in nutritional and psycho-social counseling may be of great importance to those with these particular needs). These factors should not be ignored!
TMJ is more appropriately called TMD (Temporomandibular Joint Disorder or Dysfunction).
Airway Obstruction: Primary Environmental Factors
Poor arch development, lack of tongue space, facial aesthetics, tooth long axis discrepancies, anterior crowding, and vertical deficiencies are growth and development outcomes of abnormal tongue habits, airway obstruction (breathing), muscle abnormalities, postural abnormalities and facial abnormalities. These are just some of the primary environmental factors that leads to skeletal and neuromuscular problems of any patient with multiple influences.
A comprehensive understanding of the early iatrogenesis of aberrant tongue function is available in the Garry’s monographs on “Early iatrogeneic orofacial muscle, skeletal, and TMJ dysfunction”. Placement of the tongue to maintain a compensatory airway due to nasal obstruction or placement of the tongue between the teeth for compensatory bracing of the mandible may also lead to unstable occlusion.
What Does TMJ Therapy Involve?
There are two prominent philosophies and perspectives to addressing TMD:
- Bio-Psychosocial Perspective
- Bio-Physiologic Neuromuscular Perspective
The National Institute of Dental and Craniofacial Research (NIDCR) ignores that TMD may have not only a muscular component to this disease/dysfunction but that it also may have an occlusal component as well is an over-site which only exemplifies its intent to ignore the bio-physiologic factors of the stomatognathic system and posture of the upper quarter of the bodies systems.
- It suggests that medicine is the solution to TMD problems.
- It suggests that TMD often resolves itself and is self-healing.
- It emphasizes that TMD is a self-limiting disease and occlusal (bite) changes are to be avoided.
- It does not acknowledge that TMD is a major component in the scope of dental practice nor does it recognize that the dentist has a major role in dealing with muscles, joints and teeth as it pertains to temporomandibular joint disorder and all the associated signs and symptoms that relate to the trigeminal system.
Bio-Physiologic Gneuromuscular (GNM) Perspective
This approach focuses on not only the subjective patient complaints, but also on objective assessment of the musculoskeletal occlusal signs and symptoms of TMD.
- Measuring technology and instrumentation are used and include: 1) computerized mandibular tracking, 2) surface electromyography and 3) electrosonography of the TMJ.
- The US Food and Drug Administration (FDA) approved the sale of these devices for these purposes of measuring activity that directly relates to the TMJ. The medical necessity of their use for each patient must be documented by the treating dentist and certainly are non-invasive approaches to document medical necessity.
- These devices have been found to be extremely useful in aiding the clinician to arrive at a diagnosis for conservative treatment. NIDCR fails to even recognize such.
- The use of objective quantifiable diagnostic procedures should be implemented to quantify and qualify a patient’s dysfunction. This certainly adds essential, accurate information in the effective diagnostic and treatment process especially for patients with trauma episodes to the head and neck regions.