TMJ Disorders

“I’ve got TMJ”.  This is a common complaint of patients with head and neck pain.  Often, the temperomandibular joint (TMJ) is blamed for the patient’s pain while it is often only a small component or none of the problem.   It all begins with stress.

All humans have stress.  Being highly intelligent and social, humans suffer from more stress than any other animal, worrying about family, health, jobs and even the future.  Humans can anticipate that something unfavorable is about to happen to them and can have a stress response prior to the event, which could help them cope.  Over long time periods, this can lead to chronic stress.

In many patients, stress manifests itself in the form of clenching or grinding of the teeth.  Very often, patients are unaware that this is occurring, likely because it happens most commonly during sleep.  Due to the relentless use of the clenching and grinding muscles of the head and neck, chronic pain and fatigue develops in the muscles.  An analogy would be a runner that ran a marathon (21.6 miles) every day.  The runner would shortly develop significantly muscle fatigue and significant muscle pain.  This would only be relieved with the proper rest and recovery.  Both the runner and the chlencher/grinder are suffering from Myofascial Pain Dysfunction. 

MPD is a fairly common but misunderstood condition characterized by pain in the head (headaches), face, neck, shoulders, and other structures. To be accurate, what is generally referred to as “TMJ” is in fact MPD, a disorder of the muscles, tooth contact and joint.  90 to 95% of all people who complain of “TMJ” actually have MPD without an actual joint issue. 

Myofascial Pain Dysfunction as well as TMJ dysfunction can be present in early teens, as well as in adult men and women, with women experiencing it more often. Stress is the greatest contributing factor to MPD, whether it is high exposure to stress or low threshold for stress.     

The temperomandibular joint does not have a blood vessel inside of it to directly deliver nutrition and remove waste; the joint uses diffusion to perform these actions.  As the mouth opens and closes, nutrition and waste exchange, similar to the ebb and flow of waves on the beach.  When a patient chronically clenches or grinds, as in myofacial pain disorder, the joint is compressed constantly and the diffusion process is limited.  Limited nutrition and a buildup of waste results in a destructive inflammatory state, called degenerative joint disease. 

The general term "degenerative joint disease" may lead to defects in the shape of the tissues of the joint, limitation of function (e.g. restricted mandibular movements), and joint pain.

Note, the TMJ has a disc, much like the knee joint.  Popping and clicking are signs of articular disc disorder.  However, if the lower jaw has full range of motion in addition to painless popping and clicking, no treatment is necessary.

If you feel that you have a MPD and/or a TMJ problem, please contact Dr. Medel to schedule a comprehensive evaluation.