TMD
What is TMD?
TMD stands for Temporomandibular Joint Dysfunction which refers to a dysfunction or a problem with the Temporomandibular Joint (TMJ) which is the jaw joint. So if someone says they have TMJ, they are not wrong, we all have a TMJ, but they might actually mean that they have TMD.
TMJ Anatomy
The term Temporomandibular joint is coined from the names of the 2 bones that form this joint; temporal (2 paired bones of your skull positioned at the sides of your head just above your ears) and mandible (the bone that forms your chin and supports your bottom teeth). The joint has an articular disc that sits within the joint between the top and bottom bone, allowing the joint to open and close smoothly. There are also muscles that attach to the joint helping it to open and close and move side to side.
Common TMD presentation
TMD may result from issues directly related to the TMJ or related to the TMJ musculature. Under that category of joint related issues or “arthralgias” we can have the following:
Anterior Disc Displacement; the articular disc migrates forward within the joint. This can start with joint sounds like popping and clicking as the joint pops over the disc during movement. It can progress to decreased mouth opening when the disc completely blocks the opening and then progresses to the disc moving forward entirely, no longer stopping the joint from opening.
Arthritis
Joint degeneration
Joint Hyperlaxity; Increased movement of the joint with eventually irritates and damages the joint
We also have TMD resulting from the TMJ musculature or “myalgia” that can result from;
Poor muscle coordination
Muscle Hyperactivity; Increased muscle activity, most often from stress and anxiety
Both of these categories can produces localized pain and refer pain to the head and neck.
TMD is more common in females than males and symptoms of these disorders tend to arise during adolescence or adulthood.
They can often arise in conjunction with other chronic illnesses such as fibromyalgia or myofascial pain syndrome
Common TMD Symptoms
pain and/or clicking in the TMJ
difficulty eating/chewing
pain with yawning
headaches that are typically temporal (located in the sides of the head)
dizziness/fatigue.
Here is a Link to the TMD Pain Screener to help you identify if you have TMD, a score of 3 or greater indicates that you likely have TMD
I think I have TMD, what should I do?
The first thing you should do is discuss it with your primary doctor. Print out the TMD Pain Screener (link above) and bring it to your appointment to discuss and share your results with them. This will allow them to correctly screen you for any need (urgent or not) to consult with other specialists in order to rule out any more serious underlying pathology since many TMD symptoms are also symptoms of other illnesses. They may ask that you get a TMJ or cervical spine X ray or other imaging, that you see an ENT or neurologist for your dizziness or other related symptoms. Since this process may take weeks or even months, it may be unwise to go without any form of treatment during this process. It is usually advised to undergo some form of conservative (meaning non-surgical) treatment ASAP in order to prevent aggravation of symptoms but it is important to verify with your doctor if starting conservative treatment is right in your specific case.
It you have already consulted with specialists and all more serious pathologies have been ruled out, specialized physical therapy should be your next stop. Depending on your location and your provider’s familiarity with TMD, you may have to be a strong advocate for conservative treatment as not all providers know that physical therapists can treat TMD. That being said, finding a physical therapist with the right training and experience is not always easy, a great place to start is the PTBCCT member directory.
It’s time to take your health into your own hands and consult a physical therapist who specializes in TMD.
The longer you have lived with the pain the harder it may be to treat so early intervention is key.
