I used the term "TMJ" because most people say to me "I have TMJ." The correct term "TMD", for temporomandibular disorder. A broad term, it is similar to saying "I have a gastro-intestinal disorder." What does that really tell anyone? It could be so many different symptoms and diagnoses. The first thing a dentist should do is to ask lots of questions.
- Do you have joint noises?
- Does your jaw lock open or closed?
- Have you had a head and neck trauma?
- Do you chew gum?
- Do you wake up with sore muscles?
- When and where do you have pain?
- Do you have headaches?
- Can you eat the foods you want to eat?
- What is the history of your jaw problem?
The above is just a sample of some questions that may be asked. A thorough health and dental history is taken before gloves are even put on. For the extra-oral exam, or the part of your dental exam that is outside your mouth, I start at the front base of your neck. I feel for swellings, lumps and bumps. I am also checking specific muscles and the insertions of where the muscles attach. Some muscles that are palpated are the sternocleidmastoid, masseters, temporalis, and suboccipital among others. I note how tight the muscle is and if there is any pain. Feeling for joint clicking, popping, grinding (called crepitis) or a combination of both is done just below and in front of your ear. At which point the clicking, popping, or crepitus happens during jaw movement is also recorded. The movement of your jaw may be straight, or to one side or in a S shape. We check maximum movement wide and to each side. I check the position of your bite when your teeth are closed together, and also where your jaw bone is fully seated into the concavity of your skull (this position is called Centric Relation.) I document which type of bite (occlusion) you have, because there are different classifications. Noting the presence of tooth wear and recession is documented, as these are often signs of TMD problems. The specific diagnosis is often aided with imaging (x-rays). Your treatment options and recommendations vary so much we cannot list them all here. However, some of the more common treatment options include wearing an occlusal guard (like a night guard) that is custom made, use of moist heat and cold, adjunctive use of chiropractic care and massage, diet change (softer and more healthy), elimination of caffeine and gum and good sleep hygiene.
If you think you have TMD (TMJ) talk to your dentist at your next visit with Life Smiles, a local dental practice in Plymouth, MN.