temporomandibular

Temporomandibular disorders (TMDs) are a group of more than 30 conditions that affect your temporomandibular joints (TMJs). You have two TMJs; one on each side of your jaw. They connect your lower jaw to your skull.

TMDs can cause problems in your jaw joint and your muscles that control jaw movement. These problems can include pain, stiffness, and trouble chewing.

There are three main types of TMDs:

• Disorders of your jaw joints
• Disorders of the muscles you use for chewing
• Headaches from a TMD

Many TMDs last only a short time and go away on their own. However, in some cases they can become chronic (long lasting)

Sometimes an injury to the jaw or TMJ can cause a TMD. But in most cases, the cause is not known.

Research suggests that certain factors may play a role in why a TMD starts and whether it will be long lasting:

• Genetics
• Psychological and life stressors
• How someone perceives pain

Anyone can develop a TMD, but it is more common in women than in men. It is most common in women between 35 and 44 years old.

The symptoms of TMDs may include:

• Pain in the chewing muscles and/or jaw joint. This is the most common symptom.
• Pain that spreads to the face or neck.
• Jaw stiffness.
• Limited movement or locking of the jaw.
• Painful clicking or popping in your jaw joint when you open or close your mouth. However, clicking or popping without pain is common and is not a sign of a TMD.
• Tinnitus (ringing in the ears), hearing loss, or dizziness.
• A change in the way the upper and lower teeth fit together.

There is no standard test used to diagnose TMDs, and some other conditions can cause some similar symptoms. This can make TMDs hard to diagnose.

To find out if you have a TMD, your health care provider or dentist:

• Will take a detailed medical history, which includes asking about your symptoms. They will want to know:
  • Where the pain is
  • When you have it
  • What makes it better or worse
  • If it stays in one area or spreads to other parts of your body
  • If you have any other pain conditions such as headache or back pain
• Will examine your head, neck, face, and jaw for:
  • Tenderness
  • Jaw clicking or popping
  • Problems moving your jaw
• May order imaging studies such as an x-ray, MRI, or CT

For many people, the symptoms of TMD are temporary. To help you feel better, your provider or dentist may suggest that you:

• Eat soft foods.
• Apply heat or cold to the face and do some exercises to gently stretch and strengthen your jaw muscles.
• Take over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.
• Stop clenching your jaw, chewing gum, and biting your nails.

If those do not help, your provider or dentist may suggest other treatments such as:

• Physical therapy
• Self-management and behavioral health approaches, which can include:
  • Cognitive behavioral therapy (CBT), a type of psychotherapy. It can help you identify negative thoughts and change them. It can also teach you coping skills.
  • Biofeedback, which involves using electronic devices to teach you to control certain body functions, such as your heartbeat, blood pressure, and muscle tension. For example, it can detect when you tighten your jaw muscles. You can learn how to recognize when this happens and then relax your muscles.
• Medicines such as:
  • Anti-anxiety medicines
  • Antidepressants
  • Anti-seizure medicines
  • Prescription pain relievers
• An intraoral appliance, which is a device that fits over your teeth. Types of intraoral appliances include oral splints and mouth guards. If you are going to use one, it's important to:
  • Know that there is not a lot of evidence that they improve TMD pain.
  • Make sure that the appliance you have is not designed to permanently change your bite.
  • Let your provider or dentist know if it makes your pain worse.
• Complementary treatments, which are treatments that are used along with mainstream medical care. There is limited evidence showing that they help with TMD symptoms. But some providers and dentists may recommend acupuncture and transcutaneous electrical stimulation (TENS). TENS involves using a device to send a gentle electric current to your nerves or muscles. It may help treat pain by interrupting or blocking the pain signals.

If you are still having severe symptoms from a TMD, your provider or dentist may suggest surgery, including implant surgery, or another procedure.

It's important to be careful, because sometimes surgery or another procedure may not work or may even make your symptoms worse. Before any surgery or other procedure, it is very important to get opinions from more than one provider and to completely understand the risks. If possible, get an opinion from a surgeon who specializes in treating TMDs.

NIH: National Institute of Dental and Craniofacial Research

Your jaw is a set of bones that holds your teeth. It includes:

• The maxilla, which is the upper part of your jaw. It holds your top teeth in place and doesn't move. It also supports the muscles involved in chewing and facial expressions.
• The mandible, which is the lower part of your jaw. You move it when you talk or chew. It also holds your lower teeth in place.
• The temporomandibular joints (TMJs), which are two joints (one on each side) that connect your mandible to your skull.

Jaw problems can include:

• Fractures (broken bones).
• Dislocations, which are joint injuries that force the ends of your bones out of position.
• Temporomandibular disorders (TMDs), which are conditions that affect your TMJs.
• Osteonecrosis, which happens when the blood flow to part of your bone is disrupted. It can cause the bone to break down.
• Jaw tumors, which can be benign (not cancer) or cancer.
• Jaw defects, which are birth defects in which your jaw could be missing or deformed.

Diagnostic imaging tests are often used to diagnose jaw injuries and disorders. Your treatment will depend on which jaw problem you have.

Fibromyalgia is chronic (long-lasting) condition that causes pain all over the body, fatigue, and other symptoms. There is no cure, but treatments can help with the symptoms.

The exact cause of fibromyalgia is unknown. Studies of the brains of people with fibromyalgia found that they seem to process pain differently than people who don't have it. They may feel pain when others do not, and they may also have a more severe reaction to pain.

Fibromyalgia can run in families, so genetics may also play a role. Other factors may also be involved, such as having certain diseases that cause pain.

Anyone can get fibromyalgia, but it is more common in:

• Women; they are twice as likely to have fibromyalgia
• Middle-aged people; your chance of having it increases as you get older
• People with certain diseases, such as lupus, rheumatoid arthritis, osteoarthritis or ankylosing spondylitis
• People who have a family member with fibromyalgia

The main symptoms of fibromyalgia are:

• Chronic (long-lasting) pain and stiffness all over the body. People often describe it as aching, burning, or throbbing.
• Fatigue and tiredness.
• Trouble sleeping.

Other symptoms may include:

• Problems with thinking, memory, and concentration (sometimes called "fibro fog")
• Muscle and joint stiffness
• Numbness or tingling in the arms and legs
• Sensitivity to light, noise, odors, and temperature

People who have fibromyalgia are also more likely to have certain diseases, including:

• Anxiety
• Depression
• Headaches, including migraines
• Irritable bowel syndrome
• Pain in the face or jaw, including disorders of the jaw know as temporomandibular joint syndrome (TMJ)

Fibromyalgia can be hard to diagnose. It sometimes takes visits to several different health care providers to get a diagnosis. One problem is that there isn't a specific test for it. And the main symptoms, pain and fatigue, are common in many other conditions. Providers have to rule out other causes of the symptoms before making a diagnosis of fibromyalgia. This is called making a differential diagnosis.

To find out if you have fibromyalgia, your provider:

• Will take your medical history, including asking detailed questions about your symptoms
• Will do a physical exam
• May order x-rays and blood tests to rule out other conditions

Not all providers are familiar with fibromyalgia and its treatment. You should see a provider or team of providers who specialize in the treatment of fibromyalgia.

There is no cure for fibromyalgia, so treatment focuses on relieving the symptoms. Providers usually use a combination of treatments, including medicines, lifestyle changes, talk therapy, and complementary therapies:

• Medicines
• Certain antidepressants and anti-seizure medicines, which may help with pain or sleep problems.
• Pain relievers.
• Lifestyle changes
• Getting enough sleep.
• Getting regular physical activity. If you have not already been active, start slowly and gradually increase how much activity you get. You may want to see a physical therapist, who can help you create a plan that is right for you.
• Learning how to manage stress.
• Learning to pace yourself. If you do too much, it can make your symptoms worse. So you need to learn to balance being active with your need for rest.
• Talk therapy, such as cognitive behavioral therapy (CBT), can help you learn strategies to deal with pain, stress, and negative thoughts. If you also have depression along with your fibromyalgia, talk therapy can help with that too.
• Complementary therapies have helped some people with the symptoms of fibromyalgia. But researchers need to do more studies to show which ones are effective. You could consider trying them, but you should check with your provider first. These therapies include:
• Mindfulness meditation.
• Biofeedback, which uses electronic devices to measure body functions such as breathing and heart rate. This teaches you to be more aware of your body functions so you can learn to control them.
• Movement therapies such as yoga and tai chi.
• Massage therapy.
• Acupuncture.