TEMPOROMANDIBULAR JOINT DISORDERS (TMD): A Brief Overview
*There are 12 common TMD. These include:
1. Arthralgia
Painful joint affected by movement, function, or parafunction (any habitual use of the mouth that is not related to normal function use, i.e., speaking, eating or drinking). This pain is reproducible by joint testing.
2 i) Myalgia
Muscle pain affected by movement, function, or parafunction. This pain is reproducible by muscle testing of the masticatory (chewing) muscles. This can be further differentiated into three different types:
ii) Local myalgia:
Muscle pain as described above. Pain is localized only to where the muscle is palpated on muscle testing.
iii) Myofascial pain:
Muscle pain as described above. Pain spreads beyond the site of palpation but is contained within the muscle tested.
iv) Myofascial pain with referral:
Muscle pain as described above. Pain is referred beyond the muscle boundaries. Pain may also be spreading.
3. Disc Displacement Disorders
These are biomechanical disorders within the joint capsule which involve the condyle-disc relationship. When the mouth is closed, the disc is in a position anterior to the head of the condyle. There are four forms of disc displacement disorders:
i) Disc displacement with reduction:
On mouth opening, the disc reduces, i.e., gets back into position. The disc may also displace sideways. Disc reduction may occur with clicking, popping, or snapping noises.
ii) Disc displacement with reduction with intermittent locking:
On mouth opening, the disc reduces intermittently. Limited mouth opening occurs when the disc fails to reduce with mouth opening. When this happens, the jaw may be unlocked by a therapeutic maneouver. The disc may also displace sideways. Disc reduction may occur with clicking, popping, or snapping noises.
iii) Disc displacement without reduction with limited opening:
On mouth opening, the disc does not reduce and may also displace sideways. Therapeutic or manipulative maneouvers are not usually effective in reducing the limited mouth opening that is persistent in this disorder. This is also known as a "closed lock".
iv) Disc displacement without reduction without limited opening:
On mouth opening, the disc does not reduce and may also displace sideways. Mouth opening is not limited in this disorder.
4. Degenerative Joint Disease:
Deterioration of articular (joint) tissue characterizes this degenerative disorder. There are also accompanying bony changes in the condyle and/or articular eminence. The joint is "creaky" and this can be felt in an examination by palpation during opening, closing, sideways movements or protrusive movements (drawing the lower jaw forward).
5. Subluxation:
This is a hypermobility disorder also known as an "open lock", in which the disc-condyle complex, which is in an anterior position to the articular eminence in the open mouth position, requires a maneouver to return it to a normal closed mouth position. This dislocation, which lasts for varying lengths of time, is usually self-reduced. When it cannot be self-reduced, it is termed a "luxation".
6. Headache attributed to TMD:
This refers to a headache that is reproducible by jaw muscle or jaw joint testing. This pain is usually located in the temple area and arises from pain-related TMD. Jaw movement, function or parafunction affect this pain.
*J Oral Facial Pain Headache 2014;28:6-27.
One or more of these conditions may be experienced at the same time. Other health problems may co-exist with TMD, such as chronic fatigue syndrome, sleep disturbances or fibromyalgia, a painful condition that affects muscles and other soft tissues throughout the body. These disorders share some common symptoms, which suggests that they may share similar underlying mechanisms of disease. However, it is not known whether they have a common cause. Studies are also underway to establish a link between TMD and Parkinson’s Disease as well as Multiple Sclerosis.
If you think you may have any of these disorders, please Contact Us or Book An Appointment so we can help.
If you are physician or dental staff, please find the referral form download at the bottom of this page.
*There are 12 common TMD. These include:
1. Arthralgia
Painful joint affected by movement, function, or parafunction (any habitual use of the mouth that is not related to normal function use, i.e., speaking, eating or drinking). This pain is reproducible by joint testing.
2 i) Myalgia
Muscle pain affected by movement, function, or parafunction. This pain is reproducible by muscle testing of the masticatory (chewing) muscles. This can be further differentiated into three different types:
ii) Local myalgia:
Muscle pain as described above. Pain is localized only to where the muscle is palpated on muscle testing.
iii) Myofascial pain:
Muscle pain as described above. Pain spreads beyond the site of palpation but is contained within the muscle tested.
iv) Myofascial pain with referral:
Muscle pain as described above. Pain is referred beyond the muscle boundaries. Pain may also be spreading.
3. Disc Displacement Disorders
These are biomechanical disorders within the joint capsule which involve the condyle-disc relationship. When the mouth is closed, the disc is in a position anterior to the head of the condyle. There are four forms of disc displacement disorders:
i) Disc displacement with reduction:
On mouth opening, the disc reduces, i.e., gets back into position. The disc may also displace sideways. Disc reduction may occur with clicking, popping, or snapping noises.
ii) Disc displacement with reduction with intermittent locking:
On mouth opening, the disc reduces intermittently. Limited mouth opening occurs when the disc fails to reduce with mouth opening. When this happens, the jaw may be unlocked by a therapeutic maneouver. The disc may also displace sideways. Disc reduction may occur with clicking, popping, or snapping noises.
iii) Disc displacement without reduction with limited opening:
On mouth opening, the disc does not reduce and may also displace sideways. Therapeutic or manipulative maneouvers are not usually effective in reducing the limited mouth opening that is persistent in this disorder. This is also known as a "closed lock".
iv) Disc displacement without reduction without limited opening:
On mouth opening, the disc does not reduce and may also displace sideways. Mouth opening is not limited in this disorder.
4. Degenerative Joint Disease:
Deterioration of articular (joint) tissue characterizes this degenerative disorder. There are also accompanying bony changes in the condyle and/or articular eminence. The joint is "creaky" and this can be felt in an examination by palpation during opening, closing, sideways movements or protrusive movements (drawing the lower jaw forward).
5. Subluxation:
This is a hypermobility disorder also known as an "open lock", in which the disc-condyle complex, which is in an anterior position to the articular eminence in the open mouth position, requires a maneouver to return it to a normal closed mouth position. This dislocation, which lasts for varying lengths of time, is usually self-reduced. When it cannot be self-reduced, it is termed a "luxation".
6. Headache attributed to TMD:
This refers to a headache that is reproducible by jaw muscle or jaw joint testing. This pain is usually located in the temple area and arises from pain-related TMD. Jaw movement, function or parafunction affect this pain.
*J Oral Facial Pain Headache 2014;28:6-27.
One or more of these conditions may be experienced at the same time. Other health problems may co-exist with TMD, such as chronic fatigue syndrome, sleep disturbances or fibromyalgia, a painful condition that affects muscles and other soft tissues throughout the body. These disorders share some common symptoms, which suggests that they may share similar underlying mechanisms of disease. However, it is not known whether they have a common cause. Studies are also underway to establish a link between TMD and Parkinson’s Disease as well as Multiple Sclerosis.
If you think you may have any of these disorders, please Contact Us or Book An Appointment so we can help.
If you are physician or dental staff, please find the referral form download at the bottom of this page.