Description of TMD
Temporomandibular disorder (TMD) is directly associated with anxiety and stress. In a time of stress, the neurons in somatosensory cortex (grey matter), which process sensory information from our entire body in general and orofacial area in particular, are working overtime.
As a result, multiple mistakes are made in the processing of the vital information these neurons receive. The smallest changes in the orofacial area, for instance a bite change due to a new filling, crown, or extraction or the long hygiene appointment or a slight injury to the jaw, may cause a catastrophic overreaction of the mechanism that protects the temporomandibular joint (TMJ).
This mechanism causes the muscle to tense or go into spasm, creating a natural splint. This splint is meant to prevent the joint from further function and damage.
However, if left unattended, the natural splint will further damage the joint and increase the patient’s stress, thereby creating a snowball effect. The rest of the body is affected by this vicious cycle, which may result in the total deregulation of the homeostasis.
How does TMD differ from TMJ injury?
The symptoms of TMD are caused by an error in the processing of sensory information. In the beginning, the joint is not damaged. Trauma to the joint may be present, but is not a necessary cause for TMD.
In the case of TMJ injury, on the other hand, the joint is damaged due to trauma, infection, or as a result of chronic TMD. Treatment of traumatic or infectious injury is different from the treatment of the injury caused by TMD.
Most of the symptoms are similar, and therefore it is sometimes difficult to differentiate one from another.
However, presence of swelling, redness, and tenderness to the touch in most cases indicate TMJ injury.
TMD symptoms are numerous and vary from case to case. Here is the list of the most common complaints of TMD patients:
- Pain and tightness of the muscles of mastication, especially in the morning.
- Limited mouth opening.
- Difficulty chewing solid foods.
- Clicking of the joint.
- Clenching, grinding (bruxism) at night or during the day.
- An uncomfortable bite.
- Frequent tension-type headaches in the frontal area or in the back of the head.
- Tenderness around the joint area.
- Neck pain.
- The sensation of clogged ears, with no visible obstruction. Loss of hearing may also be associated with this.
In order to treat TMD properly, the doctor must have a clear understanding of the problem that he or she is dealing with. They must always keep in mind that the head is connected to the rest of the body; therefore, the problems in the orofacial area will frequently create changes in the other parts of the body. The neck is most frequently affected, causing tension, limited motion, and pain. The upper and lower back are also frequently involved.Conversely, changes in the neck and the back frequently cause or exacerbate TMD symptoms.
The treatment of TMD must address not only the orofacial area, but include the whole body and mind. Dr. Deresh’s understanding that no one part of the body can be treated separately from the rest is what sets her apart from other providers and allows her patients to achieve the highest possible degree of success in the treatment of this complex problem.
Treatment begins with a one-hour examination and consultation. All the treatment options and the expected outcome are explained. Special care is taken to ensure the patient’s questions are answered.
After the initial assessment, treatment continues with the fabrication of the MORA (orthotic repositioning appliance), most commonly known as a splint. Similar splints are commonly used by other doctors who treat TMD. Most of the splints constructed in the offices of other practitioners function as simple night guards to protect teeth from the damage caused by parafunctional habits. They may have limited effect on TMD symptoms. In fact, for many patients, these night guards make symptoms worse.
The initial design and the precision and frequency of adjustment of Dr. Deresh’s splints plays a key role in the success of her treatment approach. Her splints correct the mistakes caused by anxiety, muscle tension, and occlusal changes through trigeminal input modification. MORA is an essential instrument in restoring precision to the communication with the somatosensory cortex.
This attention to detail makes it possible for Dr. Deresh to eliminate such symptoms as pain, limited mouth opening, clicking of the joint, and stuffed or clogged ear.
The participation of the patient in this complex treatment should not be underestimated.