Disorder can be hard to diagnose and treat

Everyone has TMJ two of them, in fact. But not everyone has the pain often associated with the temporomandibular joints.

The disorder that can cause facial pain, headaches and locking jaws is known as temporomandibular joint disorder or TMD, although it’s often mistakenly called TMJ. The confusion often doesn’t stop there, dentists at the Medical College of Georgia say.”TMD is not really a diagnosis,” says Dr. Mark Stevens, chair of the School of Dentistry Department of Oral and Maxillofacial Surgery “Rarely is it one single problem. It’s often the culmination of several symptoms and it requires a multi-faceted approach to diagnosis and treatment.”Symptoms can include migraine headaches combined with oral or facial pain, teeth-grinding or jaw popping.”The question often becomes whether TMD is a syndrome or a symptom,” says Dr. Joseph Konzelman, a professor of oral medicine in the School of Dentistry. “So many of the symptoms can be attributed to other disorders that it becomes a process of ruling out other problems first.”Together with colleagues from the dental school and other specialists from areas such as physical therapy and psychiatry, Drs. Konzelman and Stevens operate the Oral/Facial Pain and TMD Clinic in the MCG School of Dentistry.An estimated 6 percent of the U.S. population suffers from TMD and most are women.”The disorder is often a stress-related problem,” says Dr. Stevens. “It’s not that women have more stress, but they often present it in another way. While men’s stress often manifests itself in problems like hypertension, women start to grind their teeth. Stress seems to manifest in the oral and facial regions for women.”But other common habits can also lead to TMD. “There’s really a shopping list of contributing factors,” Dr. Konzelman says. “Stressful situations can lead to it, but a lot of other things have been linked to TMD.”Common risk factors for the disorder include poor posture, which strains the muscles of the head and neck, inability to relax, poor diet and lack of sleep.The bad news, experts say, is that TMD isn’t always preventable. It can be caused by arthritis, fractures, dislocations and structural problems present at birth, Dr. Stevens says.The problem is often compounded by difficulty diagnosing and treating the disorder.”Part of the enigma of TMD is that it’s often a socially acquired habit that is difficult to interfere with,” Dr. Konzelman says. “Often patients won’t continue with a prescribed treatment and sometimes they can’t.”For example, patients who grind their teeth when stressed or asleep may find it almost impossible to break the habit. TMD caused by a muscular problem may require a set of facial exercises that patients resist.The disorder also is episodic, Dr. Konzelman says, which often leads people to think they’re cured and discontinue treatment. Part of the solution is a multidisciplinary approach.”Some things we can control and some things we can’t,” Dr. Stevens says. “We can make a guard for patients who grind their teeth, but the overlying problem how they manage stress should be treated psychologically.”Treatments vary from muscle massage to diet adjustment. Very few patients require surgery, experts say.”The good news is that people almost always find a treatment that works,” Dr. Stevens says.(Source: Medical College of Georgia: September 2006).