Temporal mandibular disorders or tmds are a variety of conditions which affect the
jaw joints and or the muscles around the jaw it's fairly common and while loads of people
have signs of tmd only a small number of people actually get painful symptoms
it usually lasts a few months before getting better but can also come back from time to time
a person suffering from tmd may hear some clicking popping and grinding or grating
noises when they open and close and these may or may not be painful they might also get some
soreness and aching in their jaws it might be consistently worse at a different time in the
day or when they do specific actions like biting chewing or yawning someone with tmd
might also find it hard to open their mouth wide and some people might actually get a locked jaw
other symptoms include headaches earaches and neck aches and some might find it even hard to sleep
the exact cause of tmd isn't really known but there are a few things which may collectively play
a role in causing or worsening it and while it's easy to blame the teeth it's usually not the cause
a person's lifestyle is a huge factor which affects the tmd and strongly relates to the
habitual changes a person might make and is usually stress induced if a person is
constantly stressed they are more likely to be clenching and grinding their teeth
and this usually results in overworking these muscles of mastication overworking these biting
muscles can cause them to grow like any other muscle in the body and this can be especially
worse if they're overgrown asymmetrically this can also happen if someone is repeatedly biting
on pencils or their nails or even if their dietary mainly consists of hard and chewy foods
other examples of habits which can worsen tmd are playing with your tongue piercings
or consistently placing your head in awkward positions like when you hold the phone between
your ear and your shoulders the last cause we'll talk about is poor posture by having a forward
head posture you'll be slowly changing the way that the temporomandibular joint
functions leading to tmd now just before we move on to speak about managing tmd we'd really
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so tmd usually gets better with time and tends to respond well to reversible and non-invasive
treatments that said it should be conveyed strongly to the patient that the most important
part of the treatment is carried out by themselves there have been many studies which show that most
patients get better with self-care this means that they need to reduce any stresses that are
currently happening in their lives and while this can for some people mean huge life changes it's
paramount to explain to the patient that there is a bio psychosocial aspect to tmd what they think
feel and do can affect their physical symptoms and so we need to make sure that they are lessening
the amount of stress in their lives if the patient constantly negatively reinforces thoughts like i
can't cope with this or there must be something really wrong with me they'll start to feel anxious
this anxiety will usually result in inhibition and lessen how much they enjoy doing things which will
increase the attention to their symptoms and ultimately cause them to notice the pain more
the more they notice the pain and the lack of sleep the more they believe that initial thought
that there is something seriously wrong with me and this vicious cycle continues leading to more
pain and more symptoms other methods of self-care involve giving the muscles an opportunity to rest
this can be done by avoiding habits which might be worsening their tmd like nail biting and
ensuring their posture is correct so they don't strain their neck a soft diet is also recommended
until the symptoms are gone and then the patient should return to their normal diet if the symptoms
haven't gone within two to four weeks of changing their diet then it should be recommended that they
return to their normal diet because chewing tough foods is unlikely to be the cause of their tmd
also being placed on a soft diet for a long period of time can cause them to lose fitness in their
muscles of mastication and lead to poor nutrition another method of self-care that should be
recommended is to allow the jaws to relax making sure that their teeth are in a resting position
not touching each other with their lips pressed gently together they can use a reminder system by
for example placing a little sticker on something that they use really often like their phone
and every time they see this sticker it will encourage them to relax their jaw the patient
should also be encouraged to engage in breathing and jaw exercises one breathing exercise that
they could do is to sit somewhere where they are relaxed place one hand beneath their rib cage and
slowly and deeply inhale trying to fill their lungs with air while feeling their hand rise
pause for a few seconds before slowly exhaling while imagining all their tension is being drained
out of their body repeat this 10 times and try to do it once or twice a day one exercise which
has been recommended by physiotherapists to encourage smooth and protective jaw opening
is to go to a mirror place your fingers just in front of your ears over your jaw joints and curl
your tongue to the roof of your mouth then while keeping your tongue there open your jaw slowly and
smoothly in a straight line avoiding any sideways deviations repeat this five times a day the second
exercise a patient should learn is to strengthen the muscles and control the jaw movements by
placing your hand under your chin while in a resting position with your teeth slightly apart
then open your mouth while your hand resists the opening and hold it there for five seconds and
repeat this five times a day too other forms of management for tmd include the recommendation of
appropriate analgesics for when the pain intensifies and last but not least the
fabrication of a splint for your patient a splint can protect the teeth from parafunctional habits
like clenching and grinding and reduces tension in the facial muscles so just to briefly summarize
studies show that the most patients will get better with a combination of self-care and
de-stressing breathing and jaw exercises a splint and the use of analgesics as required
this combination has been shown to have between 68 and 95 success in treating tmd once you've
given this initial treatment to your patient you want to review them in about three months if you
find that it lasts for more than three months then its chronic tmdr needs to be referred to
either the nearest oral and maxillofacial surgery oral medicine or oral surgery department they may
consider additional treatment options like the use of cognitive behavioral therapy physiotherapy
and other pharmacotherapies rarely they may opt for a surgical approach for very specific cases
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