Nail Clinic: Temporomandibular Joint Disorder


Millions of people experience pain from jaw conditions. Here’s what you need to know if you suffer from a temporomandibular joint disorder.

In order to speak, sing, smile and chew without pain or discomfort, the temporomandibular joint (TMJ), which attaches your lower jaw to your skull, needs to be in proper working order. It’s a complicated system of bone, cartilage, tissue and muscle that allows you to open and close your mouth and move your jaw from side to side. If you experience tenderness in the jaw, neck and ears, or suffer from regular headaches or migraines, temporomandibular joint disorders (TMD, also called TMJ) could be to blame. TMD is fairly common: An estimated 10 million people (and many more women than men) suffer from the condition. And unfortunately, the complexity of the joint system can make it difficult to figure out what might be causing the pain or discomfort related to it. The good news, however, is that the condition sometimes goes away on its own, and if it doesn’t, simple, noninvasive treatments can help alleviate it. Here’s what you need to know if you think you might be experiencing TMD.

Understanding TMD Symptions

TMD sufferers often experience difficulty or pain while moving the jaw for chewing or yawning, or the jaw might even lock up or become difficult to open or close, says Frank Orlando, DDS, a cosmetic and implant dentist in New York. People with TMD may also notice a clicking sound in the jaw, though if this symptom is experienced on its own, it probably doesn’t require treatment for TMD, according to the National Institutes of Health’s (NIH) National Institute of Dental and Craniofacial Research.

TMD-related symptoms can range from slightly annoying to completely debilitating, says Dr. Orlando. People commonly have several symptoms of TMD at once, and the problem usually has more than one cause. There are three general categories of TMD: discomfort or pain in the muscles that control jaw function; an injury to part of the TMJ that has caused something to be knocked out of proper alignment; and TMD related to arthritis, which causes degeneration and inflammation of joints and other tissues.

Unfortunately, the mere nature of nail techs’ work, which entails focusing intently in a rounded, head-forward posture while doing services, can cause jaw and neck tension that might exacerbate TMD symptoms. That’s why nail techs in particular commonly seek out TMD-related therapy, says Sukie Baxter, a licensed massage therapist in Seattle and the author of Perfect Posture for Life.

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What Causes TMD?

Despite how common TMD is, its causes remain relatively mysterious. Researchers aren’t yet sure how the disorder progresses or why symptoms might come and go. One link they’re studying is the potential role of female hormones: Research suggests that the disorder is nearly twice as prevalent among women, and women make up 80 percent of patients treated for TMD, says Dr. Orlando. The highest prevalence of TMD is in women during their reproductive years, or from 20 to 40 years old.

Some suspected causes of TMD are genetics, injury (a new study looked at the prevalence of TMD among rugby players) and sleep disorders. Chewing gum, “lengthy or forceful” dental work, and head and neck tension might contribute to or exacerbate the problem. Bruxism, or teeth grinding, is a common sleep disorder often associated with TMD, but it’s not a proven cause, as many people grind their teeth yet never develop TMD.

Although the causes of the disorder aren’t crystal-clear, “It’s probably due to a number of factors working in concert—things like teeth grinding, teeth clenching, lip biting, stress, anxiety and abnormalities of the disk in the jaw joint,” says Steven Hausman, PhD, a researcher and former director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Poor sleep, for example, might have a cascading effect on TMD risk; it lowers your ability to cope with stress, which can then lead to teeth grinding and tension headaches, says Hausman. “In addition, some people have sleep disorders with associated breathing problems,” he says. “When this happens, the instinct of the jaw is to clamp down and thrust forward in an attempt to open the airway, and this can result in TMJ.”

Where to Get Help

Those afflicted with TMD should first seek out the advice from their primary care physician or dentist, as there’s no medical specialtist for this condition. Pain clinics in hospitals and medical schools are another good option, because they often offer a team of care providers from various disciplines, such as rheumatology, neurology and pain management, says Hausman. “There’s really no standard test that can diagnose TMJ,” he says. “Rather, your healthcare provider takes a history that describes your symptoms, looks at your detailed medical and dental history, and does a physical examination that may also include imaging studies, such as X-rays or magnetic resonance imaging.”

Doctors and dentists also need to rule out other conditions that cause facial pain, such as sinus or ear infections, some types of headaches and facial pain that’s caused by nerve problems, says Hausman. They should ask about any sleep issues as well, says Marco L. Tironi, DDS, a general dentist in Rochester, Michigan. “The medical and dental communities now know and pay attention to the risks involved with leaving a condition, such as obstructive sleep apnea, untreated,” he says, noting that an estimated three- quarters of people with TMD have a sleep breathing disorder.

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Treating TMD

TMD symptoms sometimes go away on their own, but if they don’t, conservative and reversible treatments might help, including eating soft foods, avoiding opening the mouth too wide when eating and yawning, over-the-counter or prescription pain medications, exercise, physical therapy, and stress relief and relaxation techniques. In addition, your dentist might recommend stabilization splints, such as night guards, although their effectiveness in reducing pain hasn’t been proved, says Hausman, and they should be avoided if they cause pain or affect the way you bite or chew. Applying heat might also help, unless the TMD is related to arthritis, says Baxter, in which case it could make the pain worse.

Surgery is rarely necessary, notes Hausman. It’s also considered risky because it could change the way the top and bottom teeth line up, may affect muscles in the jaw and face, and also has the potential to damage the nerves in the face or ear.

Managing TMD

  • Avoid chewing on anything that isn’t food, including pens, pencils and fingernails.
  • Try not to clench your jaw; keep your teeth slightly apart and your jaw relaxed.
  • Don’t open your jaw more than two fingers wide when chewing or yawning.
  • Keep a log about your TMD management, including pain information and treatment notes, so you can identify what seems to help and what doesn’t.

Source: “Temporomandibular Disorders,” The American Academy of Orofacial Pain.

– by Virginia Pelley


Image: Bigstock]

This story first appeared in the September issue of Nailpro magazine. To receive the magazine, click here to subscribe.

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