If you have been referred to our office by your dentist or other health care provider, you may have a condition that has traditionally been referred to as “TMJ”. If you have not been referred to us, but you have reason to think that you have this condition, hopefully the information below will help you understand what this is. There is other information on this website that will help you understand how these conditions are treated.
What Is “TMJ”?
The term, “TMJ”, has been commonly used in magazine articles and in television reports and elsewhere as if it designates a distinct, well-defined disorder. This is a misrepresentation. Although innocent, it has led to a certain amount of confusion among the general public. The letters stand for Temporo Mandibular Joint. This term, “TMJ”, actually refers to a broad class of conditions involving the jaw system that may or may not include problems with the temporomandibular (jaw) joints, themselves. They represent some manner of abnormal function (“dysfunction”) of the jaw system The symptoms that may be a part of this condition are not the problem — they are an expression of, are caused by, the dysfunction. Because they involve the jaw system, the dental profession has primary professional responsibility for their management. Other adjunctive treatments may also be helpful in combination with appropriate dental treatment.
The American Dental Association has suggested that “TMD” (for Temporomandibular Disorders) is the more appropriate terminology. Althought this may be a better term for general use, the term “TMJ” will probably continue to be used and may continue to contribute to some confusion in the future.
As a broad group of disorders, “TMJ” or “TMD” represent conditions that have certain common symptoms (see the next category), which occur principally in the muscles and joints of the jaw system. It is because these disorders tend to have certain common symptoms that there is a tendency to think of them as a single disorder.
• The Symptoms That Indicate a “TMJ” Problem
The symptoms that are most commonly associated with temporomandibular disorders include:
• Stiffness, tiredness, and/or pain in the jaw.
• Chronic, recurring headaches.
• Clicking, popping or grating sounds in the jaw joints.
• “Earaches”, which may actually be pain in the jaw joints.
• Pain in the jaw when chewing or opening wide.
• Restricted jaw opening, catching or locking.
• Difficulty or pain when closing the teeth together to a “normal” bite.
• A bite that feels uneven, uncomfortable, strained, painful, or otherwise somehow “off”.
A patient with one of these disorders will typically experience one or more of these symptoms. But the symptoms are not the disorder. And not all of these conditions involve pain – but they all do involve dysfunction. This dysfunction, which is the source of the symptoms, should be the focus of treatment. As with many other conditions, it is always preferable to treat the actual problem, not just the symptoms. Our focus will be to first identify the nature of the dysfunction that is the cause of the symptoms, and then to address that dysfunction.
Often an individual may have lived with a mild form of one of these conditions for many years, perhaps having received no more than treatment for the symptoms. For this reason, they may have experienced having the symptoms improve somewhat and then return chronically. If the dysfunction that is producing the symptoms has not been identified and effectively addressed, the symptoms that are an expression of the dysfunction are very likely to return chronically.
• A Healthy Jaw System
The jaw system, as a functional mechanism, involves not just the teeth and gums, but also the temporomandibular joints and the muscles that control all aspects of jaw function, movement, and positioning. In the entire human body, there is no other joint system that involves such a complex interplay of functional components and complex, coordinated movements as occur in the jaw mechanism.
As long as our bodies are functioning fairly well, most of us tend to take our relative good health pretty much for granted. With respect to the jaw system, most people think of their teeth and gums as the primary structures that need to be maintained in a state of health. People who receive regular dental care and who practice good oral hygiene reasonably assume that their chewing mechanism is being maintained in a relatively healthy state. This may be true; however, there can be changes going on in the chewing mechanism that are not so obvious and that may not be recognized in a routine dental examination.
In a healthy jaw system, the temporomandibular joints, which are the functional foundation of the jaw mechanism, are structurally intact and function without pain. The jaw system functions optimally when the joints are healthy, when the bite supports and protects the joints, and when the muscles are able to function in a relatively relaxed manner. For the jaw system to continue to function in a healthy manner, the teeth must come together in a manner that provides adequate support for the joints and muscles. This means that the fit of the bite must be harmonious with the optimum structural and functional position of the jaw joints and must also allow easy, efficient, coordinated movement by the muscles during normal jaw function. When these conditions exist, the muscles of the jaw system are more able to function in a relaxed manner without excessive muscular activity that may lead to muscle pain.
• Easily Ignored Signs of Trouble
It is a very human trait to live with and tolerate a slightly-abnormal condition until it becomes impossible to ignore. Because these TMD disorders can become progressively more complex if ignored, it is important to identify them in their earliest form and initiate appropriate treatment as early as possible to prevent potential progression.
Because clicking and popping of the jaw joints occurs quite commonly in the general population, and because many people never have any problem from this, these early signs are easily ignored and treatment of these joint sounds is not always necessary. However, even when these sounds have been present for a long time, sometimes there will be a change that indicates that the condition is getting worse. That change may result for an event, such as biting on a hard object, or being hit in the jaw. Even though joint sounds may not have been a problem in the past, when certain changes are noticed, such as louder popping, catching of the joints, or increased pain, this should be carefully evaluated by a knowledgeable dentist as soon as possible, to avoid progression to a more difficult condition. This evaluation should be done by a dentist who has knowledge and experience in the management of these problems. Because of lack of training in dental education, your own dentist may not have that experience. You should feel free to ask for a referral to one who has that greater experience and knowledge of these conditions.
As with many other health issues, if we are able to identify the problem early and make a definitive diagnosis, treatment is nearly always easier and more predictable, involving less cost and usually a much more favorable long-term prognosis.
• Confusion Regarding “TMJ”
The dental profession has primary professional responsibility for treatment of TMDs. The knowledge required to definitively address these disorders has been a development of the past 20-30 years. Unfortunately however, this knowledge is still not being taught in dental schools. As a result, many dentists leave their professional training being confused and uncertain about what these disorders are and how to provide definitive treatment. Many dentists still think of these disorders as no more than a group of symptoms. Therefore, it is still quite common for patients to either have difficulty finding knowledgeable treatment or they may receive well-intended treatment from a dentist who, at most, may provide some symptomatic relief but who will not be able to adequately address the actual problem that is producing the symptoms, the dysfunction.
Our Commitment to Our Patients
Our commitment to our patients is to address the actual disorder (dysfunction), not just the symptoms. If we have an opportunity to evaluate you, we will ask you to complete a lengthy history questionnaire. This will be followed by a thorough examination. In most instances we will then be able to explain to you exactly what is causing your symptoms. Infrequently there may be a need for some specialized imaging to clarify what is occurring. In addition to explaining the treatment that will relieve those symptoms, we will also explain what treatment may be required to minimize the likelihood that those symptoms will return. In other words, we will describe to you what definitive treatment would mean for the actual disorder, not just the symptoms, that caused you to come to our office.
Very few in the health care community have had the opportunity to provide more than limited symptomatic treatment for these disorders. Dr. Higdon’s professional career of over 30 years has been devoted to these disorders and related problems with the jaw system, including the dental occlusion (bite). He has provided definitive treatment for thousands of patients who have reported symptoms similar to what you may be experiencing. His experience in this field is equaled by very few practitioners anywhere in this country or elsewhere. His thorough and comprehensive approach to diagnosis and treatment assures a standard of care that is unmatched.
