7 Things Most Dentists Don’t Understand About TMD
Temporo-Mandibular Disorder (TMD) is a condition that is associated with many different symptoms including jaw pain, clicking or popping, lockjaw, crepitus, tinnitus (ringing in ear), numb fingers, facial pain, neck pain, muscle pain, headaches, and migraines. TMD is a complex disorder and presents differently in every patient. Some patients can have severe symptoms and significant pain even in the early stages of TMD and others have little to none despite showing serious derangement of the joint on scans or MRI. To make things even more complicated, there is much disagreement and debate on not only how to diagnose and treat TMD but also on its etiology.
1. Etiology
One of the areas of confusion and debate among dentists and medical doctors is the etiology of TMD. Many believe that TMD is a neurological condition and treat it with anti-epileptic medications. A large number of TMD patients to come to my office for treatment have been previously prescribed anti-anxiety or antidepressant medications, under the premise that it’s a psychosocial disorder. But what many clinicians don’t identify is how often TMD symptoms are caused by jaw position and the bite or relationship between teeth.
2. Grinding and TMD
Most people, including most dentists and doctors, believe that tooth grinding is just “something people do”. In many cases of grinding, it can go unnoticed and untreated until significant damage has been done to the teeth. Even then, the common treatment is a simple nightguard without diving deeper into the cause of the grinding and its relationship to jaw position. It a patient grinds their teeth in order to achieve an “equilibrium” in jaw position, they may likely have TMD. Asking specific questions that can determine whether or not to pursue further testing for TMD is key to proper diagnosis and treatment of this complicated condition.
3. Nightguard Design
Many TMD patients who receive a nightguard from their dentist complain about it and tend not to wear it. They often comment on the nightguard being uncomfortable or exacerbating their symptoms but they can’t figure out why. But a nightguard highly depends on the design and functionality of it in order to do what it’s supposed to do so simply fabricating a nightguard without the correct design for the condition you are treating may cause or increase symptoms of TMD.
4. TMD patients need an anatomic orthotic
Chronic pain patients that have been suffering for years and even decades must be treated with anatomic orthotics first so that they can experience relief from their symptoms quickly in order to proceed with further therapy. It becomes critical in these cases to achieve results quickly and efficiently so that compliance and resolution of symptoms can follow. This is the first phase of TMD treatment and has to be managed carefully so the patient can begin to appreciate and regain new hope for living a pain-free life.
5. Jaw Position
The antero-posterior and the vertical and frontal dimensions of the jaw joint are critical in TMD patients. The muscles surrounding and supporting the Temporo-Mandibular Joint require a specific “home” when closing. These muscles are ‘happy’ and rested when teeth/occlusion is balanced and in an optimal position in order to resolve symptoms effectively and quickly. When the muscles find an optimal position and teeth connect with each other optimally and stabilize this position, this results in a rested (unstrained) masticatory system and allows spastic muscles to rest in comfort, and TMJ issues can begin to resolve.
6. Chronic TMJ Pain is Debilitating
Victims suffering from chronic pain are often not easy to treat due to their ongoing unresolved issues, lack of tolerance, anxiety, and often depression. When typical medical intervention does not lead to solutions, these patients can find themselves going from one medical practitioner to the next, without ever finding any type of treatment that works. As such, trying yet another option is frustrating and many give up hope. Often, TMJ pain will impact relationships, family, friends, and lead to seclusion and withdrawal, which further compound depression and frustration of this cycle. These patients can come across unhappy, despondent, angry, or laborious, which can cause some clinicians to shy away from digging deeper and asking questions about their condition.
7. Simple to Treat
I ran into a dentist I went to school with years ago recently, and when I told him the focus of my practice is TMD, he said “oh well, those are easy. You just fix the jaw, fix the teeth, open the vertical, and off you go”. Easier said than done. Each TMD patient is different and presents themselves with their own unique set of challenges. Jaw position, tooth position, vertical height, and all the other components that can play a role in their particular situation are the most challenging areas in dentistry to “fix”. TMD is multi-faceted and incredibly challenging to treat. Many cases can be quite complex in nature, and each patient comes with their own unique challenges and limitations. Many of our patients come from all over the country, and are often referred by other health care professionals after trying and failing at many forms of therapy, modality and diagnosis. When I work with a TMD patient, it requires a whole different level of precision, patience, and skill.
About Dr. Agatha Bis
Oakville Dentist, Dr. Agatha Bis, DDS received her Doctor of Dental Surgery degree from University of Western Ontario in 1996. With over 25 years of clinical experience creating beautiful and healthy smiles, Dr. Bis offers a unique approach to dentistry, blending modern dental practices with the use of digital technology to optimize health outcomes. With thousands of hours in post-graduate training, her unique focus and expertise in treating TMD and providing options in restorative dentistry, along with digital technology has led to helping numerous patients resolve chronic and debilitating dental challenges.