Episode Transcript
Interviewer: TMJ, what causes it, how awful it is, and what you can do about it.
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Interviewer: Dr. Gary Lowder is a practicing dentist at the and also a professor there as well. And more importantly he has 30 years of TMJ experience. So, Dr. Lowder, tell me about TMJ.
TMJ or TMD?
Dr. Lowder: TMJ actually refers to the temporomandibular joint. It's the joint located just in front of your ear opening, and you can actually feel its movement as you open and close and put your finger over that area. You can feel the movement of the condyle of the lower jaw or mandible. So in recent years we changed the name to TMD because it actually refers to a disorder in that joint or the system surrounding it.
What Is Temporomandibular Joint Disorder (TMD)?
Dr. Lowder: Temporomandibular disorder usually involves some dysfunction of the joint or the ligaments associated with that joint or the muscles that operate the lower jaw. And that can include headaches and clicking and popping in the jaw joint just in front of your ear. It can include severe facial pain, which is brought about by a muscle spasm in some of those masticatory muscles. And it's essentially like having a Charley horse in your face.
Interviewer: Yeah, so that muscle is constantly just cramping practically. Is that what's going on there?
Dr. Lowder: It is. And it can actually make your bite feel like it has changed. So the teeth position has not changed but the whole jaw position has changed because of the dysfunctional positioning of that muscle. These tensions in the muscle can also create what's known as tension type headache. They usually occur in the temporal region or the temples right behind your eye. It can be one side or both sides. And it often can occur either upon awakening, which can signal that you've been clenching through the night. It can also occur at the end of the day, which indicates again that you may have been clenching during the day. The clenching can also give rise to tooth pain, muscle pain in the face and can also cause wear and breakdown of the supporting bone of the teeth or the periodontal bone.
What Causes TMD?
Interviewer: How did I get here? How does somebody get to that point where it's so dysfunctional and causing so many bad things?
Dr. Lowder: Well, usually our body has a built in mechanism that protects us from too much stress. But after awhile, if you have stress over a long period of time, then things do not repair as efficiently as they normally should. And so I would count gum chewing, excessive clenching or stretching of your jaw, anything that causes your jaw to go beyond a comfortable position, has the potential over time to create a problem we call TMJ problems.
Interviewer: Is it a comfortable position or just overuse, like using any other muscle more than you really should?
Dr. Lowder: It can be both. It depends on the individual's personal body resistance to function. So some persons can chew meat jerky, for instance, and never even notice a problem. And others, if they did that for five minutes, would have severe pain in their face or up by their ear as a response to overworking that system.
How to Treat TMD
Interviewer: So what can I do about it? Stop clenching, right? Stop chewing gum.
Dr. Lowder: It's easy to say but if it's happening in your sleep, then you can't really control it. So what dentists do, usually, is make what's called a night guard or occlusal splint. And that creates a buffer between your teeth, first of all, to protect the teeth from further wear due to abrasion. Or it also can give the dentist an opportunity to create an ideal artificial bite for your muscles and your joint to relate to.
Often the discrepancy in the way the teeth mesh or the occlusion will lead to strain on the joint or surrounding ligaments and muscles. And these appliances or splints can help to reduce that or eliminate it by eliminating artificially, at least, that imbalance in the bite. It should be pointed out though not all headaches and not all jaw pain is related to TMJ issue or clenching. It can come from other sources like sinus infections and tooth abscesses. So those things should be tested very carefully before pursuing advanced temporomandibular disorder treatment.
Interviewer: So the TMD treatment, does it generally always work, if that's the condition? The mouth guard?
Dr. Lowder: It generally does help. It may not always solve it. Some people are true bruxers. These are people who actually grind their teeth. And they will grind the mouth guard. Now the good news is they're not grinding the enamel of their teeth.
Interviewer: Yeah.
Dr. Lowder: So it doesn't compromise those.
What to Do If TMD Treatment Isn't Working
Interviewer: How many people are in the situation where this is something they're going to have to live with?
Dr. Lowder: I would guess maybe 10 to 15% of the TMD population.
Interviewer: There's just nothing they can do?
Dr. Lowder: They seem to have to use medication to control pain. And that can include muscle relaxants. And it can include anti-inflammatory medications like Motrin or Tylenol. Rarely do we have to go as far as using narcotic type medications and muscle relaxants, but those can be used early on in an acute case of TMD.
Interviewer: But if I stopped the chewing the gum and I tried to be more mindful about the clenching of the teeth, maybe stop eating hard foods. That can give some relief to just about everybody.
Dr. Lowder: It certainly can. You need to think of this as a joint. And if you were to sprain your ankle you wouldn't go running a race or go bowling or something like that. You'd be very careful with that ankle until it got its normal function and comfort restored.
I think it's important that your dentist knows how to properly adjust the splint so that he's not creating a new malocclusion with the way the bite fits on the plastic. It needs to fit in a comfortable position where all of the teeth are hitting together at the same time and with the same amount of force so that the joints and the muscles are comfortable and they like that relief.
Interviewer: So for most people with TMJ or TMD, if you want to be technical, there is some relief.
Dr. Lowder: There is. If it's true TMD, it is something that can be helped.
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updated: September 11, 2018
originally published: April 6, 2015