They also can occur after a obvious trauma, such as a traffic accident, a blow to the face, a fall or less obvious events involved in necessary medical or dental procedures, which can precipitate TMD. Even subtle repeated traumas, like clenching and bruxing, day or night, excessive gum chewing, nail biting or cradling a phone between the shoulder and the side of the head can cause or perpetuate TMD. Other long standing conditions including postural problems with forward or tilted head, mouth breathing, systemic diseases, developmental abnormalities as well as dental occlusion (malocclusion) not synchronized with healthy muscle and joint function can predispose to TMD.
Stress may play a part. Stress and tension may awaken a quiet, asymptomatic TMD or aggravate an existing temporomandibular condition. However, stress alone does not cause TMD if a patient has healthy dental occlusion, masticatory muscle, temporomandibular joint and jaw function.
An initial evaluation of a patient with TMD begins with a carefully obtained comprehensive history including chief current complaints, the history of the onset of the problem, how it has progressed and what increases and decreases the occurrence and intensity of the symptoms. Inquiry about what medical and dental evaluations and treatments have already been performed and their results is valuable.
TMD's manifest as a variety of symptoms, including headaches, pain the ear, neck, temporomandibular joints (TMJ) and disruption of normal mandibular function. Symptoms commonly relate to the dental and oral structures, the jaw, TMJ and masticatory muscles or to nearby head and neck structures.
Because of the complex anatomic, physiological and neurological interrelationships in the head and neck, the symptoms of TMD can coexist or mimic symptoms of other diseases. It is important for patients to be evaluated by the appropriate doctor(s) to rule out the presence of other primary diseases. Timely referral to providers in various medical fields may be indicated to rule in/rule out co-morbid conditions. Other providers may give contemporaneous or subsequent care. TMD patients frequently experience a different constellation of symptoms, with variable occurrence and some changes over time. Some of the commonly reported symptoms are:
Headaches, facial, dental pain; pain in the jaw joints or on jaw movement; ear pain, tinnitus, ear pressure; neck, back, shoulder and chest pain.
Jaw movement: limited, deviated, slow or irregular; Head movement: limited range of motion; Ears: muffling, dizziness, clicking; Throat: difficulty swallowing, prolonged speech; Jaw Joint: clicking, locked or dislocated jaw, facial asymmetry.
Traumatic occlusion, clenching, bruxism, tooth abrasion, chipping on natural, restored or denture teeth, looseness of teeth: bone loss without gum inflammation, movement of teeth causing spreading or crowding, loss of teeth and occlusal changes. Notably, patients with TMD frequently describe some of the symptoms listed above even though a temporomandibular disorder may not be the actual cause.
