What are temporomandibular diseases
and disorders (often abbreviated as "TMJ")?
"TMJ" refers to a collection of
clinical problems involving the temporomandibular joint (TMJ),
the muscles used in chewing (called the muscles of mastication),
or both.
How common are temporomandibular
diseases and disorders?
According to a U.S. National
Institutes of Health (NIH) survey, over 10 million people in the
U.S. report TMJ symptoms at any given time. Women in the
childbearing years slightly outnumber men in reporting symptoms.
When it comes to seeking care, the proportion of women
increases, and in the more severe cases, women patients far
exceed men.
What are the most common signs
and symptoms?
The symptoms of TMJ include pain in
the cheek, near the ear, jaw locking (inability to open or
close) and jaw sounds. Pain is either episodic or persistent.
Symptoms can occur on one or both sides of the face and may
include other body pain. Most people have relatively mild
symptoms, but a sizable minority goes on to develop persistent
pain and severe limitation in jaw motion. These symptoms can
lead to diet restrictions, major disruptions in ability to work
and engage in normal social and family life.
Do we know what causes TM
problems?
Like any other joint, various types
of arthritis as well as damage from intentional or unintentional
injury can affect the TM joint and surrounding tissues. Whether
some patients are more susceptible because of anatomic
variations in the joint or other individual characteristics is
under study, as are the reasons for the preponderance of women
among the more severe cases of TMJ.
What should I do if I
experience symptoms?
Any lasting pain and/or dysfunction
should be properly diagnosed. It is important to rule out
tumors, neurological problems, and other medical conditions that
may be causing the jaw symptoms. As a first step, see your
family physician, who may refer you to a neurologist, a
rheumatologist, or other specialist. If in doubt, seek an
independent second opinion. Jaw sounds and a limited mouth
opening without pain are not indicative of a current or
potential TMJ problem. If you are referred to a dental
professional for treatment, the National Institute of Dental and
Craniofacial Research (NIDCR) recommends avoiding any treatment
that invades the tissues of the face, jaw or joint or that
causes permanent, or irreversible changes in the structure or
position of the jaw or teeth. Remember, most TMJ problems will
resolve over time. |
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How are TM diseases/disorders
diagnosed and treated?
Understanding of TMJ pathology has
not matured to the point where tests such as a tissue biopsy or
blood sample can establish a diagnosis. At this time clinicians
note symptoms, patient history, and may use X-rays. There are at
least 50 different treatments available, often reflecting the
type of provider seen. Most patients who seek care initially
improve with a variety of treatments and may even improve
without treatment. One point is clear: there is no
"one-size-fits-all" approach to managing TMJ. While milder cases
often receive more aggressive treatment than they need,
treatment of cases with severe debilitating pain often appears
inadequate. Experts convened at an NIH Technology Assessment
Conference held in 1996,
http://odp.od.nih.gov/consensus/ta/018/018_statement.htm,
concluded that conservative and reversible approaches are the
treatments of choice, along with adequate measures of pain
relief. The safety and efficacy of jaw surgery, including
implants to replace all or parts of the joint, have not been
demonstrated in clinical trials. Many cases of implant failure
have led to serious complications.
Will my insurance cover TMJ
claims?
Controversy exists over whether TMJ
is a dental or medical condition. Presently, diagnostic criteria
as well as many treatments lack scientific validation. These
factors, along with evidence that some patients' TMJ problems
are made worse following some treatments, have led insurance
companies to question covering them or even decline to cover
diagnostics and treatments of TMJ.
What research needs to be done
on "TMJ"?
In the spring of 2000, the
national patient advocacy group, The TMJ Association,
co-sponsored a workshop, "Moving TMJ Research into the 21st
Century." Key recommendations
included 1) the need for animal, computer, and cell culture
models to study the normal, injured, and diseased joint, 2)
development of a diagnostic classification system, 3) evaluation
of TMJ tissue repair problems and the development of new methods
of tissue reconstruction using gene and protein therapeutic
approaches, and 4) studying the neurological basis of deep
tissue and joint pain in order to develop better means of pain
control. Details of the workshop and extensive information on
TMJ can be found at the group’s Web site,
www.tmj.org. |
