What is TMD?

Temporomandibular disorders (TMD) are common disorders that affect the temporomandibular joint (the jaw joint also known as TMJ) and the muscles that open and close the jaw.

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What causes TMD?

Many different things can cause TMD. Trauma (car accidents, overstretching of the jaw etc) is one. Abnormal habits such as clenching and grinding your teeth (bruxism) lip biting, and fingernail biting which cause abnormal jaw positioning can be a second. Malocclusion, which refers to the abnormal way your teeth bite and fit together, is a third. Another factor may be the abuse of certain prescription medications, which affects the central nervous system and the muscles that contribute to TMD.

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TMD Symptoms

TMD symptoms include pain or discomfort in or around the ear, jaw joint, and/or muscles of the jaw, face temples and neck on one or both sides. The pain may arise suddenly and progress with fluctuating frequency and intensity over months to years. Clicking, popping, grating, locking, limited opening or deviating jaw movement, chewing difficulties, and headache are also associated with TMD.

Occasional discomfort in your jaw or muscles is quite normal and usually not a cause for alarm.

Call our office if you:

  • Experience radiating pain in your shoulders, neck or face.
  • You have a painful clicking sound in your jaw joint when you open or close
  • Your jaws suddenly don’t line up correctly
  • You have difficulty opening and closing your jaw or you get locked in one position.

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TMD Treatment

Because there is no known “cure” for TMD, management of patients with TMD symptoms is similar to management of patients with other orthopedic or rheumatologic disorders. The goals of TMD management include decrease in pain, decrease in adverse pressure on the jaw joints, and restoration of function of the jaw and normal daily activities.

Treatment of TMD is generally very conservative. Dr. Simmons uses management techniques such as behavior modification (stress management), physical therapy, medications, jaw exercises and orthopedic appliances. These practices have proven to be safe and effective in the majority of TMD cases. Most patients suffering from TMD achieve good long-term relief with these conservative and reversible therapies.

There are also some treatments that patients should practice at home.

  • Limit jaw opening (yawning, etc.).
  • Rest of the jaw by avoiding heavy chewing (gum, bagels, tough meat)
  • Avoid grinding and clenching of teeth by keeping the teeth slightly apart and the jaw relaxed
  • Avoid leaning on or sleeping on the jaw
  • Avoid tongue thrusting and chewing non-food items (fingernails, pens, pencils, etc.)
  • Avoid playing wind, brass and string musical instruments that stress, retrude or strain the jaw
  • Massage of the affected muscles
  • Perform gentle range-of-motion exercise of the jaw as directed by your doctor or therapist

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Orofacial Pain Disorders

Orofacial Pain Disorders usually arise from the brain and nerves and affect the head/neck area. They are also often chronic and difficult to diagnose. Some of the many Orofacial Pain Conditions we see regularly in our office include Trigeminal Neuralgia (TN), which is a neuropathic disorder that often appears suddenly as a sharp, shooting pain lasting a few seconds and can be triggered by a touch or a slight movement in a specific area and TMD (also known as TMJ). Other Orofacial Pain Conditions Dr. Simmons treats include Muscle Movement disorders, toothaches without dental causes (Phantom Tooth Pain), neuralgias and more.

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What to Expect at a TMD/Orofacial Pain Appointment

Patients with TMD or Orofacial pain often visit many doctors and undergo many tests, most of which are negative. An Orofacial pain specialist should evaluate patients with persistent pain. Dr. Simmons will perform a comprehensive evaluation, which includes a thorough history, examination, and diagnostic tests. The history will include recording the exact nature of the pain and other symptoms you may have, the history leading up to the persistent pain, previous doctors seen, past treatments and their results, and a list of medications taken with their effectiveness and/or side effects.

Dr. Simmons’ examination will consist of touching different areas of the head, neck and inside the mouth, measurements and evaluation of the jaw, head and neck, and gentle provoking of the pain. This can be with light touches, heavier touches cold or heat. Dr. Simmons may also perform some simple neurological tests. Psychological tests may also be appropriate since anxiety and depression often accompany persistent pain. Depending on the complexity of the problem, Dr. Simmons will decide which of the diagnostic tests are appropriate. After piecing together the results of the history, examination, and diagnostic tests, Dr. Simmons will make a diagnosis and recommend a treatment strategy. Usually, treatment is done on a trial basis and sometimes several treatments may be attempted before an effective approach is found. Treatment of pain disorders may require considerable patience to eventually control the pain. The first, or even the second method of treatment may not be successful but try to avoid being discouraged if you do not get results immediately. Maintain close communication with your doctor in a cooperative manner in an effort to obtain the most effective results.

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