TemporoMandibular Joint Dysfunction, often called TMJ or TMD, is known as the "great imposter" because so many symptoms that patient complain of can be related to this disorder. The list of possible TMD symptoms include back pain, dizziness, ear congestion, ear pain, eye pain, facial pain, fatigue, headaches, jaw clicking or popping, jaw locking, migraines, muscle twitching, neck pain, ringing in ears, shoulder pain, sinus congestion, and many others.
Acute trauma to the jaw joint will usually result in pain in and around the joint. Most dentists are able to treat this type of trauma with hot and cold compresses, soft diet, jaw exercises, and anti-inflammatory drugs such as ibuprofen. Patients with chronic jaw joint problems, on the other hand, rarely have pain in the joint. Instead, they tend to complain of neckaches, headaches, backaches, ear congestion or pain, and even numbness and tingling in the fingertips. This article will help explain how TMD is related to these seemingly unrelated symptoms.
The nervous system of the human body consists of two parts. The voluntary nervous system is the one you control with your brain. If you want to throw a ball, all you do is think about moving your arm and the necessary muscles work in a coordinated fashion to make it happen. The involuntary nervous system is the part that controls everything else. Most people are aware that it controls things such as your heartbeat, breathing, and digestion, but it also controls all the muscles you don't think about. When you raise your arm to throw a ball, the muscles on the other side of your body also contract to keep you in balance. You don't have to think about it; it just happens.
The main goal of the involuntary nervous system is to keep you alive. This requires placing more importance on certain areas of the body than others. If you fall down, your hands automatically go out to protect your head from hitting the ground. Better to have a broken arm or wrist than a brain injury. Likewise, if you have a splinter in your left foot your body automatically places more weight on your right foot. If you don't remove the splinter, eventually your right foot would start to hurt because it is overcompensating for the injured foot.
Patients with TMD usually have irritated jaw joints, which is similar to having a splinter in your foot. Whether due to a bad bite, a slipped disk, or trauma to the joints, the only way the body can take the pressure off the joints without consciously thinking about it is to change the head position. Try this simple exercise: Open your mouth, look up at the ceiling, then close your mouth and notice which teeth touch first. Next, open your mouth, look at the floor, and close your mouth and notice, which teeth touch first. For most people, it's quite different, and one position is usually more comfortable than the other. Naturally, you can't walk around all day looking at the ceiling or at the floor, but the body can figure out a way to change the bite while your head is level. By holding the head in a different position (usually forward), the bite changes just enough to take the pressure off the irritated jaw joint. In order to do this, however, the neck and shoulder muscles must be constantly contracted to keep the head from falling over. Better to have sore neck muscles than be unable to chew or talk.
The human head weighs about as much as a bowling ball. Imagine holding a bowling ball in the starting position, close to your body with your forearm straight up and down. You could probably hold the ball like this for quite a long time. Now imagine moving the ball about six inches away from your body. How long do you think it would take for your arm muscles to become sore or irritated? Of course, you could use your other arm to hold up the first one, but eventually the other arm would become tired as well. In fact, if you could hold the ball up long enough, your shoulders would start to hurt, your back muscles might cramp, and even your feet may become tired because of the awkward position of your body.
By now you might be starting to connect the dots as to why TMD patients have so many seemingly unrelated symptoms such as headaches, neckaches, backaches, and shoulder pain. Holding the head in the forward position to protect the jaw joint requires a lot of tension in the neck and back muscles. This constant tension also compresses the nerves that pass through these muscles, so some TMD patients also suffer from shoulder pain and even numbness or tingling in the fingers. In order to maintain balance and not fall forward, the body may also compensate by rotating the hips, resulting in lower back pain, and flaring the feet out, resulting in foot pain.
Sometimes holding the head forward is not possible or is not enough to change the bite, and the joint remains painful as well. In certain cases the jaw position puts pressure on the ears, causing ear pain and even hearing loss. Sometimes the extra stress on the nervous system causes other unrelated problems to flare up, such as allergies, sinus problems, and eyelid twitching. And in many cases, the chronic pain combined with the stress can lead to depression and mood swings.
A dentist trained in TMD treatment that relieves the stress on the jaw joints has the potential to relieve most if not all of the above symptoms. If the symptoms have been long standing, however, other health care providers such as chiropractors, osteopathic physicians, physical therapists, and massage therapists may be needed for complete relief. And in certain cases, the "TMD symptoms" may not be due to the jaw joints at all. Back and neck disorders can also cause the same symptoms as TMD. In these cases, TMD treatment will be of limited benefit and your dentist may be able to refer you to the appropriate health care provider.
If you suffer from any of the symptoms listed in this article, it may be worth your while to have your dentist perform a TMD screening. I speak from personal experience; I suffered from lower back pain and numbness in the fingers for many years, potentially a career ending condition for a dentist. I never believed I had TMD because my jaw joints never hurt. With the proper diagnosis and treatment of my TMD, however, I have now been pain free for over two years, and continue to practice dentistry with no numbness in my fingers.
(Dr. Rogers is a general dentist practicing in Northern Virginia. His practice focuses on helping patients achieve better overall health through advanced dental treatments.)
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