The temporomandibular joint has received much notoriety lately. Although there is a common base level of discomfort and other pathology surrounding the joint, recently there has been an elevation of reported dissatisfaction with symptoms that include pain, along with difficulty eating from limited opening, inability to close or open, or noises such as popping or clicking from the areas surrounding the joints. Consultation with your dental health care professional is advisable when joint problems cause pain or dysfunction.
A correct diagnosis always should precede treatment. A dentist will sort out the symptoms from the causes and begin the process of alleviating the symptoms by treating the cause. In some cases, there can be arthritic changes in the joints or perforation of the capsule or meniscus separating the two bony parts of the joint. In other cases, there can be muscular discomfort from chronic clenching or bruxing. It is important to differentiate the sources of the problem to obtain the correct treatment solution.
Overstressed muscles will cause pain because of inflammation, but prolonged pressure on the bones surrounding the ear can cause tinnitus, a stuffy ear, hearing changes, vertigo, as well as headaches. With enough stress the ligaments that attach the muscles to the bone can stretch and cause the meniscus to lag as the mandible opens and closes, causing popping, clicking, or inability to open or close the mouth.
When this progresses to its furthest extent, surgery may be necessary to correct the stretched ligament or damaged meniscus. That is why a correct diagnosis should be made before assuming only home therapeutics are sufficient. If jaw muscles are the primary source of discomfort, treatment can be assumed to be effective if that is the locus of care. If symptoms are primarily form other sources such as fibromyalgia, posture, skeletal dysplasia’s, or traumatic injuries, then treatment should be focused on those sources and although dental treatments may be helpful, they are secondary resources and may not work, since the source of symptoms are elsewhere.
When presenting with facial pain, often oral appliances such as splints and bite guards are the most common treatment. A study from study by researchers at NYU College of Dentistry evaluating patients with fibromyalgia and facial pain shows that patients with fibromyalgia rate appliances as less helpful than self-care treatments, such as jaw exercises or warm compresses, when the initial symptoms include widespread pain.
A recent study, published in the journal Clinical Oral Investigations, suggests that self-care techniques are better as the first treatment approach for muscle related TMD when widespread pain is present as well as fibromyalgia. The study correctly points out that widespread pain should be a factor in diagnosis and treatment of TMD.
Temporo Mandibular Disorder or TMD (sometimes called TMJ after the temporomandibular joint or joint connecting the lower jaw and the skeletal bones) is a group of common pain conditions that occur in the jaw joint and surrounding muscles. The muscular condition, called myofascial temporomandibular disorder (mTMD), affects over 10 percent of women. Patients with TMD often have other pain (comorbid) conditions. Studies show that up to 18 percent of people with fibromyalgia a condition characterized by widespread pain also meet criteria for TMD.
When the chief complaint is focused on facial or jaw pain, Dentists frequently use a variety of treatments to manage pain, including oral appliances, such as splints and bite guards; pain medications, such as nonsteroidal anti-inflammatory drugs; and self-care techniques, such as jaw exercises and warm compresses.
Although Vivian Santiago, research assistant professor in the Department of Oral and Maxillofacial Pathology, Radiology and Medicine at NYU College of Dentistry and the study’s lead author, states that “Oral appliances are a common first-line treatment for TMD, despite mixed research results regarding their benefit. Even when oral splints have been found to have some benefit, they have not been found as effective for patients who also have widespread pain in the treatment of mTMD,” this does not hold true for other pathologies that are found in jaw disfunctions such as open or closed lock which this study did not examine.
In this study, focusing on fibromyalgia and TMD, the researchers examined what non-medication treatments 125 women with mTMD and fibromyalgia use to manage their pain and how effective patients perceive the treatments to be.
Percentage treatments reported included 59 percent used oral appliances, 54 percent physical therapy, 34 percent at-home jaw exercises, 20 percent acupuncture, 18 percent seeing a chiropractor, 14 percent trigger point injection, 7 percent exercise or yoga, 6 percent meditation or breathing, with most participants using more than one treatment.
84 percent reported best improvement resulted from common self-care activities, including jaw exercises, yoga or exercise, meditation, massage, and warm compresses. At least 64 percent using oral appliances reported a little help. Around 11 percent using oral appliances said their pain was worse.
There are varying types of oral appliances including hard or soft upper- or lower-night guards, splints, MORA appliances, repositioners, or retainers, and over the counter boil and bite, and their application methods differ. The study did not specify which appliances were used or why, when and how they were applied.
The researchers did not find significant differences between the number of treatments reported by women with and without fibromyalgia.
“While fibromyalgia is diagnosed by a physician, usually a rheumatologist, TMD is usually diagnosed and treated by a dentist. Our research suggests that dentists should ask patients with facial pain about whether they also have widespread pain, as this could provide more information to help plan their treatment.” “Although clinical trials are critical for understanding treatment efficacy, our study highlights the importance of listening to people suffering with TMD to understand which treatments are the most beneficial,” said the researchers.