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with Rod Moser, PA, PhD

Stories from behind the examining room door, as told by Rod Moser, PA, a primary care physician assistant with more than 35 years of clinical experience.

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Friday, July 27, 2007

Is it TMJ?

Temporomandibular joint pain and dysfunction affects some 10 million people in the U.S. and is a frequent concern of people posting on the WebMD ENT Message Board. One researcher estimated that 75% of the U.S. population will experience one or more symptoms associated with this common joint and connective tissue disorder sometime in their lives. Ninety percent of people who seek a diagnosis or treatment for TMJ are women, mostly of childbearing age.

Although this condition is common, it is not well understood by many primary care clinicians and misdiagnosis is common. Furthermore, TMJ is often blamed for a variety of ear-related disorders without a valid medical investigation. Although an x-ray, CT scan, or MRI are often helpful, the diagnosis of this disorder is often made solely on the patient’s report of symptoms. Consequently, this diagnosis is often wrong.

The most common complaint is pain in the area directly in front of the ear, sometimes radiating to the temples or neck. This pain is triggered by movements in the jaw, such as chewing or speaking, or the psychogenic grinding of the teeth at night (bruxism). Many people experience clicking, snapping, or popping in the temporomandibular joint when the mouth is opened or closed. The jaw can even lock due to muscle spasms.

Because of the nerve pathways, TMJ disorders can cause a plethora of symptoms in other anatomical areas, such as headaches and ear pain. Dizziness, neck pain, shoulder pain, tinnitus (ringing of the ears), swallowing difficulties, and sleep disturbances may also be related to TMJ problems. Since many of these symptoms can also have hundreds of other causes, it is often medically difficult to attribute TMJ as the sole cause of symptoms such as dizziness or tinnitus.

The first step for any person that believes that have a TMJ disorder is to be properly diagnosed. This usually requires the intervention of a specialist, either a dentist or oral surgeon that specializes in TMJ disorders, or a good ENT. Since various forms of arthritis can be involved in TMJ, your primary care medical provider should be intimately involved in your collaborative care. Other than laboratory tests for arthritis, there are no specific lab tests that would determine if you have TMJ or not. X-rays are important, but have their diagnostic limitations. Many specialists will order an MRI or CT scan of the TMJ area. In some cases, a bone scan is helpful.

The next step involves management, with a goal to reduce pain and improve jaw function. A comprehensive approach that may include medications, physical therapy, and possibly intraoral appliances is optimum. Certain lifestyle modifications are often necessary, such as avoiding “chewy” foods, gum chewing, nail-biting, and excessive talking. People who are prone to teeth–clenching and grinding (bruxism) may need a custom mouth guard at night.

Pain and inflammation is often controlled by the use of NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen. In severe cases, short-term steroids are used, as well as muscle relaxants and antianxiety medications. Physical therapy, such as hot/cold compresses, jaw exercises, muscle-stretching, and massage can be very helpful in all cases. If anxiety and stress are underlying issues, this must be addressed, either by relaxation therapy or psychological intervention.

Alternative treatments such as acupuncture, chiropractic, or naturopathic methods have not been shown to be effective and there are few, if any, scientific studies to show they are curative.

Surgery is usually the last resort when conservative treatments fail. Surgery purports a high success rate. Every person and every case of TMJ is different, so surgery is highly individualized. Before undertaking a surgical approach, I often recommend second opinions.

TMJ disorders remain a frustrating problem for the patient and the treating clinician. The best hope appears to be a combination of therapies, coupled by a good attitude. Many things in medicine cannot be cured, but they can be effectively treated.

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Technorati Tags: TMJ, temporomandibular joint pain, jaw pain, health and wellness

Posted by: Rod Moser, PA, PhD at 4:00 pm

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