Temporomandibular joint dysfunction (TMD) is a complex problem for the otherwise healthy patient, but when it is combined
with the multiple symptoms of a patient with fibromyalgia syndrome, it becomes difficult to diagnose and treat effectively
without a team approach involving multiple disciplines. In and of itself, TMD produces a multiplicity of symptoms:
Uncomfortable; patients tend to wince, clench, and grind their teeth in response to stressful, chronic uncomfortable stimuli. This sets up trigger points and painful areas in muscles as a result of referred pain pathways which mask the actual source of the pain and can be quite distant from it. Regardless of the cause of an injury, pain may be referred along reflex pathways far distant from an injured area. When combined with the symptoms of fibromyalgia, the picture of TMD becomes very complex because of the intricate neural pathways in and around the TM joint and reflex referral arcs to far distant areas.
Causes
Causes of TMD are varied and may include trauma (i.e., whiplash accident); loss of teeth; improperly fitted dental appliances; improper orthodontic therapy; a variety of degenerative joint diseases; growth and developmental problems as well as tumors, bruxism (nocturnal grinding), etc. These problems can occur individually or collectively, wreaking havoc with the delicate jaw joint and the neuromuscular balance of the jaw joint, occasionally causing the disc, which separates the lower jaw from the skull, to slip out of place, perforate or break its attachments leading to muscle pain, limited movement, joint noise, and referred pain. If it is left untreated for a long period of time, irrevocable changes occur in muscle, tissue and joint making the problem complicated and chronic in nature and making therapy protracted and less predictable.
Treatment
Treatment ranges from simple appliance therapy (to take the pressure off the inflamed joint and allow healing to occur) along with warm, moist compresses, a soft diet and anti-inflammatory medication to a multi-disciplined approach involving special xrays, computerized measurement of jaw/muscle relationships and function, and very specialized appliances together with physical therapy, rheumatological evaluation, an ear/nose/throat consult, etc. In most cases, a simple acrylic splint will not do. A dentist specializing in TMD or MPD (myofascial pain dysfunction) is necessary to determine the most appropriate therapy for each patient based on the presentation, severity and dimensions of his/her symptoms and the nature of the problems present.
Elliott J. Alpher, D.D.S., P.C., is Chair of the Division of Dentistry at George Washington University Medical Center. He is Director of the Metropolitan Area Temporomandibular Joint and Myofascial Pain Center in Washington, D.C. He is also a member of the FMAGW Medical Advisory Board.
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