What you need to know about TMD (Part 2)

Temporomandibular Disorders (TMD) are the most common musculoskeletal subgroup of Orofacial Pain (OFP) conditions that occur in the head and neck area. While most symptoms are transient, some are refractory and painful enough as to need attention of a OFP/TMD specialist.  

The three most common TMD’s are: Myalgia (muscle soreness), Arthralgia (painful joint ligament inflammation) and Disc Interference Disorder (closed locked joint). 

Myalgia may have dental or non-dental causes and a trained dentist must be able to rule out whether this is caused by dental problem, for example, an infected tooth or a poorly made dental restoration. Otherwise, real TMD Myalgia may be from muscle trauma from prolonged jaw clenching or tooth grinding (bruxing) behavior. Arthralgia or joint pain, like muscle pain, may also come from low grade trauma like prolonged grinding and clenching  or dental/medical procedures that require prolonged mouth opening or from high impact trauma like being hit on the jaw. In some cases, arthralgia may be a result of poor dental work which a?ects the joint due to an unnatural alteration of a person’s chewing motion. A Disc Interference Disorder is a condition where the soft tissue disc that is in the jaw joint becomes abnormally positioned and interferes with mouth opening.  

In these three forms of TMD, there is a tremendous overlap symptoms and a TMD/OFP specialist’s job is to correctly identify which condition is present, to be able to recommend the most appropriate therapy which will benefit the patient.  

Importantly, whatever approach a specialist uses in managing TMD, it must be based on good scientific evidence. Among these: proper use of pain medications, reversible oral appliance therapy, joint and muscle manipulation techniques, behavioral training exercises or a combination of these. A dentist who  proposes aggressive, irreversible dental procedures like “raising and changing the bite” through braces or crowns, shaving-o?  teeth to “stabilize or centre the joint” to “cure” TMD or other body ailments should be viewed with much caution. These forms of therapy have no scientific basis and are not recommended because TMD symptoms respond well to reversible and conservative treatment procedures. Next installment; why pain medications don’t always work.  

READ: Think you have TMD? Here's what you need to know (Part 1)

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Dr. Ricardo Boncan received his training in TMD and Orofacial Pain at the University of Rochester, Eastman Institute of Oral Health in Rochester NY. He is the current president of the Orofacial Pain Association of the Philippines and the program director of the University of the Philippines College of Dentistry TMD and Orofacial Pain Program.