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What is TMD?

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 migraine headaches.

What Causes TMD?

There are 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!” That’s not 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?

There are 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 thin bone. 

How Can You Treat TMD?

That depends 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.