by Clayton A. Chan, DDS, MICCMO
Today, our dental professions diagnostic paradigms are evolving beyond only identification of dental caries, marginal breakdown of old fillings and crowns, root canal lesions, fractured teeth and periodontal breakdown. These basic dental problems are often only indications of a more hidden muscular, occlusal and temporomandibular joint problem that go often undetected, even within the medical and dental profession. TMJ/TMD is a problem that is not easily seen by cursory dental x-ray and intra-oral evaluation. It presents with many signs and symptoms that can mimic other medical and dental problems as vascular disorders, brain tumors, aneurisms, cervical disc disorders, throat and oral cancer, etc.
SIGNS AND SYMPTOMS OF TMJ
Some of the numerous signs and symptoms may include clicking, popping and grating noises of the jaw joints. Consider the tender paining temporal muscles on the side of the head. Tender and sore muscles behind the head and neck (sub-occipital cervical region) as well as upper shoulders can be part of this problem. Muscles under the chin, the facial muscles (side of face), limited mouth opening, loose teeth, clenching/ bruxing, postural problems, paresthesia of fingertips and hands, nervousness, insomnia are just a few of the over 120 different signs and symptoms of TMJ. What about those cases with non-specific facial pain, tenderness on palpation of various sites of the head and neck? Teeth sensitivities and aches, ear congestion feelings, pain behind the eyes, tingling in the arms and fingers, dizziness, ringing in the ears, etc., all relate to the dental aspect of TMJ. Many of these symptoms are related to and are associated with the living tissues that effect the mandibular position and in turn effect upper to lower teeth relationships and vice versa.
- Clicking, popping and grating noises in the jaw joints
- Tender and sore muscles on the side of the head (temporal region)
- Sore and tender muscles under the chin
- Facial soreness and tenderness
- Limited mouth opening
- Loose teeth
- Clenching/ bruxing
- Ear congestion feelings
- Pain behind the eyes
- Postural problems
- Shoulder pain
- Lower back pain
- Tingling in the arms and fingers (Paresthesia of fingertips and hands)
- Insomnia (Difficulty sleeping)
Crowded lower anterior teeth, wear of the lower incisal edges, fractured cusps, narrow arches, vaulted palates, deep curves of Spee, over-closed bites, flared upper anterior teeth, locked upper buccal cusps, facets, cervical erosion (abfractions), receding gums, mobile teeth, open interproximal contacts, loss of molars, cross bites, anterior open bites, anterior tongue thrust, lateral tongue thrust, midline discrepancy, to name some of the intra-oral signs.
- Crowded teeth
- Crooked teeth
- Worn lower anterior incisors
- Narrow V shaped arches
- High vaulted palate
- Deep bite
- Cross bite
- Open bite
- Flaired teeth
- Tongue thrust habits
- Midline discrepancy
- Lower front incisors are taller than back bicuspid and molars
Extra-oral signs as: facial asymmetry bilaterally, short lower third of the face (chin to nose point diminished), chelitis, abnormal lip posture, deep mental crease on chin, dished-out or flat labial profile, facial edema, mandibular torticollis, cervical toricollis, forward head posture (lordosis) elongated lower face (steep mandibular angle), and speech abnormalities, should all be considered as abnormal signs. The human body, which includes the teeth, the muscles of the head and neck, the TM Joints, the neurology that innervates the system of mastication and posturing of the head and neck are all parts of what the dental profession should consider when diagnosing and treating our patients comprehensively.
If you are experiencing such and are not getting better you are not alone. These type of symptoms are signs of temporomandibular joint dysfunction (TMJ) which are a common problem among 10 million people in the USA. Approximately 1 in 27 or 3.68% of all people in USA experience these types of symptoms daily (National Institute for Dental and Craniofacial Research). Many TMJ patients have received numerous listed medical and dental treatments with little to no effective relief of their pain. Many of the treatments have been recommended based on the doctor’s preference and not based on sound objective measured scientific evidence for both safety and effectiveness. Some treatments have been tried, some invasive, irreversible, and made the patient worse, leaving the patient in a dilemma of financial loss, disappointment, depression and despair.
This list of subjective symptoms is by no means exhaustive, but does provide a good idea of the nature of the complaints that are often made by those suffering from TMD.
CAUSES OF OF TMJ
- Airway Obstruction
- Bad Bite (Dental Treatment – poor orthodontics, or poor restorative)
- Developmental Abnormalities
Individuals who mouth breath during the day or night due to upper airway obstruction in the nose are candidates who may experience an increase in some of the TMJ/TMD symptoms. Hypertrophied adenoidal tissue in the back of the nose breathing passages can block normal nose breathing and cause the person to alter his/her breathing patterns and mouth breath. Enlarged tonsils can cause tongue displacement over the teeth and even forward causing and “anterior open bite” malocclusion to develop. This is not normal and can lead to aberrant tongue forces on the teeth which will contribute abnormal swallowing patterns and mal alignment of the teeth.
Trauma episodes to the head and neck region (e.g., high velocity neck jerks, whiplash, ski accidents, slips and falls) can contribute to mis-alignment to the cervical bones effecting the lower jaw relationship to the upper jaw. This change, whether over a period of time or sudden, can cause the bite to be off (mal aligned) resulting in an imbalance of biting forces to your teeth producing some of the signs and symptoms mentioned in this brief article. Teeth that have been orthodontically moved to causes upper jaw restrictions against the lower teeth, or orthodontics that have attempted to corrected teeth crowding, but resulting with no bite or teeth coming together, especially in the posterior regions of the jaw can also contribute to the signs and symptoms mentioned in this article.
Stressors, whether physical stresses to the skeletal and muscular system or biochemical imbalances to the body systems can also result in emotional and psychological stresses. (Compound that with the numerous incidences when medical and dental professionals cannot find a rational cause or reason for some of the patient’s complaints; this furthers the unease, emotional strain and anxiety to the patient, especially when the medical profession often prescribed anti-anxiety depressant medications as a “standard” means pacify the situation). Seeking to address the cause rather than addressing the symptoms is key to treating TMJ/TMD problems.