What is TMD?.
If your molars are cracked and worn, you might think you need to get your teeth fixed.
If you have frequent headaches, you might think you need to take a headache relief medication.
In both cases, you might be wrong.
Symptoms such as worn molars, headaches, popping jaws, and neck or shoulder pain, may signal that you have temporomandibular disorders, or TMD. This collection of disorders centers on the functioning of the temporomandibular (jaw) joint and may also involve the airway.
To understand more about TMD, we spoke with Mary Burns, D.M.D. Dr. Burns serves on the faculty of Harvard University and Boston University and lectures internationally on the topic of TMD. Dr. Burns has been working with White Family Dental for five years, training their practitioners on a wellness approach to the dentognathic (teeth and jaw) system.
TMD can be a serious health issue, and not just because of pain in the jaw, neck and teeth, Dr. Burns says. TMD can cause other complications, such as sleeping problems, difficulty chewing, earaches, swelling on one side of the face, dizziness and hearing loss. “People can end up debilitated by TMD if you don’t address it,” she says.
How is TMD treated?
“Traditionally, the way dentists have treated patients has been pathology based, meaning someone comes in with a problem, they report symptoms and the dental provider addresses those problems,” Dr. Burns says.
For example, if a patient has cracked teeth, the dentist will fix the teeth. However, this approach might neglect finding the root cause of the cracked teeth.
“The way we look at treating the patient now is that we assess them from a global standpoint, head to neck,” Dr. Burns says. The key to this approach, she says, is that it is wellness focused, not pathology focused.
To assess TMD in a wellness-focused manner, Dr. Burns says, “We measure the patient’s head and neck three-dimensionally and evaluate where their alignment is off and then we realign and fix their bite. This can involve orthodontics, dentistry; sometimes it even involves surgery. We want to bring the patient back to their most biologically optimal condition. But it’s not a quick fix. It’s a therapy process that takes time.”
Achieving this biologically optimal condition may also require attention to the airway’s role in TMD. “One of the things that has come out in the past decade is that when the airway is challenged, people clench and grind their teeth in an unconscious effort to create a larger airway,” Dr. Burns says.
This clenching and grinding can damage the teeth. “Over the years, dentists tried to find solutions to fixing the teeth, without finding solutions to the real problem, which was the breathing problem,” she says.
The first step in treatment is creating a custom-made removable appliance that aligns the jaws and neck, but also helps support the airway, Dr. Burns says. “Once we finish that therapy, we reassess the airway.”
For some people, the appliance is enough, Dr. Burns says. However, others may have a skeletal problem that requires orthodontics or even jaw surgery. Dr. Burns speaks from personal experience. She herself has had jaw surgery, which resolved her TMD and allowed her to avoid sleeping with a continuous positive airway pressure (CPAP) machine at night.