As you will likely know, temporomandibular disorders (TMDs) are a selection of conditions that impact the temporomandibular joint (TMJ), masticatory muscles and associated structures of the face and neck. The conditions are estimated to affect around 25-33% of the population, , though a much smaller percentage of people will experience severe enough symptoms to report the problem. Symptoms can range from pain around the jaw, ear and temple to clicking or grinding sounds upon jaw movement, headaches, restricted jaw motion and jaw locking.
In terms of unmodifiable risk factors, incidence of TMDs is reportedly higher in females than males. Interestingly, one review of the literature found that most symptoms presented in patients aged between 20 and 50-years-old. The wide age range affected may well contradict the traditional view that TMDs are degenerative conditions.
TMDs have a multifactorial aetiology, although the exact mechanisms of disorder onset and development are not well understood. In turn, this makes diagnosis and management difficult for healthcare professionals.
There are several potential causes of TMDs, which include bruxism. Some studies have found a strong relationship between bruxism and TMDs, with one associating the sheer force placed on the TMJ – especially during sustained clenching – with the development of TMDs. This is logical when you consider the stress placed on the TMJ and masticatory muscles. Another paper linked parafunction and its influence on joint loading with osteoarthritis of the TMJ. However, as found in a 2008 review, the lack of a universal definition for ‘bruxism’ makes it difficult to definitively confirm a causal relationship between this and TMDs.
Another potential cause of TMDs is an injury to the face or neck. For example, a heavy blow to the face could result in a broken or fractured TMJ and lead to a TMD. There is also some evidence to suggest that whiplash can lead to TMDs, with one American study concluding that one in every three people who experience whiplash are at risk of delayed TMD symptoms. However, other authors have highlighted some conflicting results in this particular area of study and so more research is needed.
Malocclusion is an alternative possible culprit. Indeed, much of the patient-facing literature – including the NHS websiteiii – lists an uneven bite as a potential cause of TMDs. Many clinical papers also elude to the association between malocclusion and the development of TMDs. However, it has more recently been postulated that malocclusion is secondary to joint or muscle disorders. This highlights the importance of a thorough investigation into potential TMD signs and symptoms before any treatment that could adjust the patient’s occlusion is delivered. This could include orthodontics, as well as the provision of restorations and prosthetics within a comprehensive treatment plan.
Finally, specific diseases have been found to increase the chance of TMD development. For instance, rheumatoid arthritis has been associated with a high risk of TMDs, making regular TMJ assessments an essential part of on-going care for individuals with the condition. Patients with fibromyalgia may also be predisposed to TMJ problems. In addition, some evidence exists linking TMDs with chronic diseases such as asthma, osteoarthritis and thyroid dysfunction.
Due to the unspecified aetiology of TMDs, treatment of symptoms can be wide ranging. GDPs should look to implement solutions in order of invasiveness so patients are not submitted to major procedures unnecessarily. In cases of minor TMDs, resolution of symptoms may be provided through simple exercises that the patient can perform at home. These can help to stretch and mobilise the TMJ, improving mobility and reducing discomfort. Botulinum toxin injections have also been shown to provide long-term relief.
Furthermore, a product like the OraStretch Press Jaw Motion Rehab System, available in the UK from Incito Medtech, may improve the patient’s condition. It is an easy-to-use, hand-operated device that gently stretches the TMJ, improves jaw and joint function, and reduces pain and swelling. With diligent use, a patient could gain up to 1-2mm in range of motion per week.
Where TMDs are more serious, complex treatments might be indicated. For any cases beyond the remit of the GDP, patients should be referred to the local maxillofacial surgeon who provides TMJ-related therapies.
Despite the uncertainty that exists around the causes and development of TMDs, even among the healthcare profession, it’s essential to keep the patient’s best interests at heart. Facial and jaw pain that can result from TMDs have a significant impact on someone’s quality of life. Therefore, finding a safe and effective solution is essential.
For more information please email rosiebh@incitomedtech.co.uk or visit http://incitomedtech.co.uk or call 07796 058128