TMD is an acronym for temporo mandibular disease
(or disorder). It encompasses many
chronic pain conditions ot the head and neck, most notably jaw joint pain, chronic headache, morning headache, neck and shoulder pain and even some
What Causes TMD?
many causes for chronic head and neck pain. In dentistry we classically think of tooth grinding and
clenching as the cause of this problem.
That is true to a degree.
To the extent that muscles that move the jaws can get tired, the
resulting muscle soreness is described as headache. Think of it this way.
If we spend a day raking leaves in the Autumn and wake up the next day
with a sore back, we easily attribute that soreness to yesterday’s
activity. If we wake up with a
headache, we don’t say, “I have sore muscles of mastication from clenching and
grinding last night.” We say, ”I
have a headache!”
the whole story though. There can
be several reasons for clenching and grinding teeth. Sometimes that activity is due to the teeth not meshing like
gears. If a tooth hits slightly
ahead of the rest, we tend to ‘play’ with that ‘high’ tooth. A more frequent underlying driver for clenching
and grinding the teeth is sleep apnea!
Please note the description of an arousal in the discussion of OSA on
the previous page. During an
arousal there are frequent, short bursts of tooth grinding activity as part of
the effort to open the airway. A
majority of TMD patients have some level of sleep disrupted breathing.
What are the Signs of TMD?
many signs of TMD. The most common
complaint is headache. The pain is
typically at the temples or behind the eyes. Pain can also run down the neck and into the shoulders. Often pain is referred to a distant
area from the actual trigger point. We have seen pain refer to the top of the head or even to a tooth. Sometimes symptoms exhibit as ringing in the ears, called
tinnitus. Ear pain is often the
primary symptom. This pain is
actually in the jaw joint itself. Anatomically the back of the joint is separated from the inner ear by a
How Can You Treat TMD?
on the source of the problem. The simple answer is with a mouth guard (sometimes called a night guard
or splint). There are several
different guards that we use depending on the source of the pain. After a careful history and examination
we can usually determine the source of the problem and define the most likely
solution. It is important to note
that we seldom rely on medication to stop the headache.
Can You Treat Migraines?
Yes and no. True migraine headache is vascular in nature. A migraine sufferer will describe having warning signs (prodromal) thata migraine is coming. These signs can present as an aura, vision or speech changes, a buzzing on one side of the head. Sometimes, though, a‘normal’ headache can precipitate what is perceived as a migraine level headache. We can often minimize the frequency of migraines by treating headaches that arise from muscle pain in the head and neck.