Symptoms of TMJ/TMD : Why are there so many dissimilar symptoms?
The answer to this question resides in one simple fact. All of the symptoms of TMD (temporomandibular joint disorder) are directly caused by inflammation within the TMJ (temporomandibular joint). The issue of why the joint becomes inflamed is a different issue and will be discussed in a later contribution to this site. But the fact remains, that all of the different, varied, and apparently unrelated symptoms associated with TMD are derived directly from inflammation within the TMJ. This, in part, explains why TMD is so often misdiagnosed as something other that what it is. Most commonly, TMD is misdiagnosed as migraine headaches or orthopedic problems of the neck.
Inflammation is the generic term which describes the bodies response to damage whose main purpose is to begin and carry forward the healing process. Whether you cut your finger, break a leg, burn your hand, sustain a coronary artery occlusion (heart attack), or develop TMD, inflammation is the common denominator at the site of damage. Science has now demonstrated, there are many things we know about inflammation and there are still many things still to be discovered.
One of the more recent discoveries is that besides initiating a cascade of chemical, cellular and humeral events at the site of damage, inflammation initiates a sequence of neural transmissions back to the central nervous system (brain) which trigger neural, muscular and even hormonal changes which help the body deal with the injury at hand. Inflammation of any joint can be shown to have local effects and systemic effects, (effects that effect systems of the body) distant from the site of injury. This is nowhere more evident than in the symptoms associated with TMD.
Let’s break down inflammation of the TMJ into its local effects and systemic effects. Any textbook of pathology will list with florid Latin description the five characteristics of inflammation: 1. Tumor (swelling), 2. Rubor (redness), 3. Calor (increased temperature), 4. Dolor (pain), and 5. Functio Laesa (disfunction). These characteristics explain the local effects of inflammation on the TMJ. Patients will point directly at the joint and comment on the swelling, redness, temperature, pain and limitation of motion. But these localized symptoms are only most likely to show up in a severely damaged TMJ that has been neglected for a long time. It is actually the systemic symptoms, mediated by nerve signals from the joint, which are usually the first signs that the joint is diseased and inflamed. Inflammation triggers the autonomic nerves in the area to signal the brain that the joint is damaged. The brain in turn signals the body not to move that damaged joint. The brain signals the muscles that move the joint to go stiff and not move the joint. This is called muscle trismus. So the five large muscles around the jaw joint get stiff and tight and pull on the bone where they are attached. The pain will be felt where these muscles are attached to the bone mainly on the head, (headache). This is why headache is the most common symptom of TMD. If, after a while, the joint remains damaged and continues to send signals to the brain that the damage persists, the central nervous system, in its wisdom, send out a signal to splint or hold still the entire head in an attempt to decrease the inflammation in the offending TMJ. This is when the patient begins complaining of pain of the neck and upper back where the neck muscles are attached. Neck pain is the second most common symptom of TMD. If the TMJ is not treated to decrease the inflammation after these symptoms show up, the brain continues to receive the signals of inflammation within the joint and finally sends out a reflex response to tighten or hold still the entire upper shoulder area. This is when the patient will complain of pain or tightening of the shoulder and/or arm and once these muscles squeeze the brachial plexus of the arm, complain of arm/hand/ and finger tingling and numbness. Wow! Could anything be more wiered that having tingling in the fingers and hand caused directly from inflammation of the jaw joint… There have even been documented cases of patients thinking they were having a heart attack because the pain of the left shoulder, caused from TMJ inflammation, was so intense.
Ringing in the ears, (tinnitus) fullness in the ears (a feeling like you have been swimming and can’t clear your ears, or a sensation that you cannot hear as well), and dizziness (vertigo) are also common symptoms of TMD. The explanation for these symptoms will be given at another post.
Disorders of the temporomandibular joint have been found to be very common, affecting 45% of females between the ages of 13 and 75. It is seen almost exclusively in females, 95% females, 5% males, and almost exclusively in people who are highly motivated or highly stressed.
98% of patients in my practice are treated successfully with a non-surgical intra oral device and treatment protocol. To date over 2000 patients have been successfully treated.
Dr. Anthony P. Urbanek is a double degree Oral and Maxillofacial Surgeon. Dr. Urbanek received his dental degree from Indiana University and his medical degree from Vanderbilt University. Dr. Urbanek is board certified by the American Board of Oral and Maxillofacial Surgery and has served Williamson and Davidson counties for over 30 years. He currently specializes in treating TMJ/TMD with his non-surgical patented TMJ splint and is also a specialist in Dental Implants and Wisdom Teeth Removal . Learn more at www.drurbanek.com
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