TMJ: The Problem

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There seems to be a lot that is not known about TMJ. What has been your experience learning about TMJ? 

Temporo-Mandibular Joint Dysfunction, commonly called TMJ, affects over 10 million people in the United States.

Louis Abbey, DMD:

Louis Abbey taught Oral and Maxillofacial Pathology at Virginia Commonwealth University School of dentistry in Richmond, VA for 33 years. He has retired to the Boston area and is teaching at Harvard School of Dental Medicine and consulting with a pathology laboratory.

TMJ is a very interesting area for pain management, but I thank god that I don't have to deal with it. It is important to understand that we are dealing with a physical joint that gets as much activity as the knee. This joint is the only one in the body that both rotates and slides. It gets a lot of wear no matter what you do, but some people's mouths seem to have more difficulty adapting to changes.

Lots of practitioners are asked by patients to treat TMJ, but practitioner capability varies. We really don't know much about TMJ, and as human beings our expectation is that the joint should work perfectly every time. Unfortunately, there are simple, complex, and sometimes no solutions, once the symptoms have begun. There are many interventions that have been tried including medications, devices, and surgery. Surgery results can bring dramatic improvements or result in irreversible negative changes. The field is open for the use of untested solutions and sub-optimal care. With this complex disease and diverse symptoms, you can see how an inadvertent misstep can cause a patient to have a very unsuccessful outcome.

My experience at Virginia Commonwealth University was that surgeons did not operate a lot on the TMJ. I know there are people who believe TMJ is a psychological problem to be treated with medication. I tend to be careful to acknowledge that TMJ is a real problem for any patient. Unfortunately, successful treatment is often a matter of trial and error. Patients may have seen 20 health care providers, some of whom dismissed their complaints. Thus patients can be frustrated, guarded, vulnerable, easily excitable, depressed, anxious etc. and it may be very difficult to sort out the real problem from all the surrounding barriers that have been erected in the course of the patient's history.

Almost all dental (and some non-dental) practitioners have the opportunity to deal with TMJ: general dentists, orthodontists, oral surgeons, ENT specialists, pharmacists, neurologists, dental hygienists and psychiatrists and psychologists. The field is loosely defined and patients get referred around. This results in a lot of frustrated practitioners. The confusion and rejection patients may feel likely just adds to their problem.

Terrie Cowley:

Terrie Cowley is the founder and President of the Board of Directors of the TMJ Association, Ltd. The association motto is "Changing the Face of TMJ" and their website is www.tmj.org.

My story is probably similar to that of many others. I had pain and went to a good dentist who said "I won't touch you until your jaw is stable." Two years and seven dentists later It is incredibly lonely to be a patient with TMJ. Dentists feel frustrated and I don't believe they have the training to be able to manage pain medications long term. It is important for professionals to see this as a real disease, not just a problem affecting "hysterical women". The response to our organization has been tremendous. We are among the top three sites given by Google in response to the query "TMJ". Our website gets 40,000 to 60,000 visits a month and we have counted visitors from 117 different countries. We enroll between 50 and 70 new registrants each day.

It is hard to know the best advice to give to someone with TMJ. In my experience there is little success at pain clinics and patients do better if they have one health care provider, perhaps an internist, anesthesiologist, or psychiatrist, who sticks with them and treats their pain.

I had surgery at an academic medical institution to replace the disc. Unfortunately, I have not been the same since.

TMJ is a very complex condition affecting primarily women in the childbearing age. I think it will eventually shake down to 8 - 10 different diseases. TMJ patients have 3 times the normal use of health care resources, and it is not for management of TMJ but for a numbers of other conditions, like fibroids. There are connections between TMJ and a number of other health issues raising questions about the role of female hormones, the brain connection, and whether TMJ is a connective tissue disorder.

John Kusiak, Ph.D:

John Kusiak, Ph.D. is the Director, Molecular and Cellular Neurobiology Program, Division of Basic and Translational Sciences, at the National Institute of Dental and Craniofacial Research.

The National Institute of Dental and Craniofacial Research (NIDCR) has the lead role at the National Institutes of Health in sponsoring research on temporomandibular joint and muscle disorders, or TMJDs. These are a set of pathological conditions involving the TMJ, muscles of mastication and contiguous tissues. They pose a number of challenges for patients and their health care providers.

There are no generally accepted, science-based guidelines for diagnosing and managing TMJDs. The prevalence of the conditions is not precisely known, but studies indicate the dominant symptoms-facial pain and restricted jaw movement-occur in 5 to 15 percent of the general population. While some TMJDs have a specific cause such as trauma, in most cases the cause is unknown. Epidemiologic evidence suggests that TMJ problems are self-limiting in most patients. However, a subset of patients suffers persistent debilitating pain and/or dysfunction. In the absence of science-based treatment guidelines, health care providers have tried to help patients using a variety of approaches, often with less than satisfactory results. A technology assessment panel convened by NIH in 1996 urged caution in the use of invasive treatments, particularly surgery or other interventions that alter tooth structure or jaw position. Clearly, the current state of knowledge about TMJD is incomplete, and this poses a barrier to physicians and other caregivers in determining the best approaches for treating the disorders