Definition
TMJ, TMD and orofacial pain are similar terms. These refer to pain
or dysfunction in the jaw joints and/or its surrounding structures.
This can include the entire head, neck and shoulders since these areas
can refer pain to the TMJ. (TMJ=temporomandibular joints
and TMD=temporomandibular dysfunction). TMJ problems are considered
musculoskeletal in nature and not dental.

Common Signs and Symptoms
Headaches
Swallowing difficulties
Facial pain
Neck and Shoulder pain
Ringing in the ears
Clicking or popping jaw joints
Earaches
Bruxing (grinding or clenching teeth)
Limited mouth opening
Dizziness

Etiologies
Factors Associated with TMD
Contributing factors may include: trauma, hormonal problems,
parafunctional habits, occlusion (deep overbite, over 5 missing
back teeth, crossbite, etc.), psychological factors, systemic diseases,
medications, lack of restorative sleep, poor posture, whiplash, etc.

Evaluation
A comprehensive evaluation is needed to discover not only what is wrong
but why. The exam includes an evaluation of the jaw, teeth, cervical areas, muscle and nerve function. Evaluations also include medical history, medications (OTC, prescriptions and herbals),
workplace ergonomics, sleep and diet.

Treatment
Treatment ranges from "self help" to bite guards, minor stabilizing
and functional equilibration, physical therapy, medications (pharmacy
and botanicals), education, elimination of parafunctional habits, counseling
on work and sleep posture and others as needed. Coordination therapy
with physicians, chiropractors, physical and neuromuscular massage
therapists, etc. may be necessary.

Orthodontics is not a treatment for TMJ. If orthodontics is being
considered, it should wait until all TMJ and orofacial pain/problems
have been resolved.

TMJ surgery is rarely needed (mostly to remove tumors, free fibrosed joints,
etc.) Joint rinses (lavage or arthrocentesis) are excellent procedures
that an oral surgeon can do in the few cases where TMJ pain
does not resolve with the appropriate therapy.

Most dentists have limited training in TMJ, head, neck and orofacial pain.
Too often the patient receives a splint that is either inappropriate
or lacks the other modalities that go with treatment. The health provider
most qualified to help with appropriate therapy is usually
a dentist with specific training in orofacial pain.

Radiographs/MRI's
Radiographs are to help confirm a diagnosis, not make one. Uniqueness
of the TMJ allows for a clinical exam that is usually more revealing than
x-ray. Panographs help rule out other pathology. They are poor for TMJ imaging. MRI's are expensive and are normally needed only when surgery
is being contemplated.

Headaches
Headaches are the most common head pain. Over 80% of patients
report headaches when reporting jaw and/or TMJ pain. Migraines
and muscle tension-type are the most frequent.

Nerves from the cervical area or neck hitch rides on the cranial nerve that
goes to the TMJ's, eyes, teeth, sinuses, arteries of the head and brain coverings. Therefore, a pain in the neck often translates into head pain. Muscles from the neck and shoulder commonly
refer pain to the TMJ's, ears, face, etc. and is the cause of many
headaches. Headaches are fairly easy to eliminate if the source
is found and the appropriate (usually not medicine) therapy is performed.