TMJ/TMD Update

One of the most controversial topics in the dental profession is the issue of temporomandibular disorders (TMD’s), also known as temporomandibular joint disorders (TMJ).  Last year the American Association of Dental Research (AADR) issued a revised statement based on a review of the literature. The American Dental Association considers the AADR statement to be the standard of care for TMD/TMJ.  The goal is for patients with TMD to have less risk of inappropriate treatment.

The policy statement recommends that “unless there are specific and justifiable indications to the contrary, treatment of TMD patients initially should be based on the use of conservative, reversible and evidence-based therapeutic modalities.  Studies of the natural history of many TMDs suggest that they tend to improve or resolve over time.  While no specific therapies have been proven to be uniformly effective, many of the conservative modalities have proven to be at least as effective in providing symptomatic relief as most forms of invasive treatment. Because those modalities do not produce irreversible changes they present much less risk of producing harm.  Professional treatment should be augmented with a home care program,  in which patients are taught about their disorder and how to manage their symptoms.”  http://www.iadr.org/i4a/pages/index.cfm?pageid=3465#TMD.

This statement sounds very reasonable to me and yet it caused a firestorm of criticism from some of my colleagues.  But I have successfully treated TMD with noninvasive treatment consisting of exercise of the muscles and bite splints.  I have also on occasion discouraged patients from having surgery of the TMJ – surgeries which are now infrequently performed.

What a misnomer! The TMJ is the temporomandibular joint connecting the mandible, or lower jaw, to the skull. We all have it! Put your fingers in front of your ears and open and close; you will feel the TMJ. The condyle, or tip of the mandible, should rotate and slide evenly and smoothly down the maxillary slope. If the two sides are uneven, if you hear a pop or click, or feel pain, or if your jaw locks at times, you MAY have a disfunction of the joint, or TMJ disfunction. That is the proper terminology! Saying “I have TMJ” is like saying “I have knee,” or “I have shoulder.”

How to treat it? First, you need a very careful diagnosis of the problem. Second, you need to explore the many noninvasive treatment modalities that may alleviate some of the symptoms. I will be happy to see you for a TMJ consultation at my Long Island dental office.