Another factor with women experiencing more TMD is that the disease process known as EDS (Ehler Danlos Syndrome) is far more common in women than men. In fact, the most common subtype of EDS (hEDS- hypermobile EDS) shows that 90% of the patients are women. This number is staggering. And with the more common forms of EDS, it turns out that the prevalence is roughly 70% women and only 30% men have it. Again, this is a remarkable difference that exists in a disease process that greatly affects TMD. With EDS the ligaments and joints are all looser than they should be so the discs on top of the jaw bones (the condyles) are far more likely to slip off or become displaced…

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Another aspect of having a tooth pulled out is that upon removal of the tooth, the bite on that side will experience an almost immediate collapse in which the jawbone (condyle) will now go more deeply into the socket. This is where a TMJ problem begins. When that condyle jams further up into the jaw socket, it will impinge on the articular disc that covers the condyle. This can cause a gradual displacement of the disc and subsequent TMJ disorder. If multiple teeth are removed this can readily lead to the discs being pushed way out of proper placement and this can be quite painful for so many people.

With periodontal disease, the bone and gum support around the tooth becomes weaker over time. This can lead to the tooth getting loose in the socket and it can no longer be a good vertical support for the jaw joints. Just like the foundation of a house, if it starts to rot away, the whole house can tip sideways. The jaw is similar. If the teeth become looser due to periodontal disease, this can destabilize the jaw joints and the discs in those joints can become damaged more readily. By maintaining good periodontal support for your teeth, this will help the jaw joints stay healthier and stronger.

Unfortunately, oral cancer should be mentioned in this blog. Cancer in the mouth can lead to loss of teeth and bone which of course can lead to loss of TMJ support. This is why it is so important to keep up with your dentist and at least yearly have them do an oral cancer screening. This screening only takes a few minutes, yet it could save your life and your health. So many people are very afraid of cancer but if detected early enough it is fairly easy to treat.

As Dental Health awareness month is April, be smart and reach out to your dentist about your dental health. Ask questions. Ask if they are checking for periodontal disease. Ask about cavities. And most importantly, ask if they are checking for any signs of oral cancer or other diseases.

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The truth of the matter is that if you work with an experienced TMD (Temporomandibular Disorder) specialist, then such an advanced procedure is rarely necessary. The path toward surgery should always try to be avoided, but sometimes it is simply necessary.

When a patient first begins treatment, they must do an MRI to figure out how damaged the discs in the jaw joints really are. This gives the specialist a good baseline to begin with so that a comparison MRI 12-18 months later will help to determine if enough healing has occurred so that surgery is not needed. It’s all relative- if after the 12–18-month appliance therapy period, the patient just feels great, yet the discs are not quite perfect position, then no surgery is indicated. If there is still substantial discomfort, then there would be a discussion about the type of surgery and how to finish the case.

In almost all cases that require surgery, the process is either plication (put the discs back into proper anatomic position) or meniscectomy (remove the remnants of the damaged discs). In either case, the surgeon makes an incision that is only one inch long at the little crease just in front of the ear. He then goes into the joint and will fix the problem either way. Sutures are done internally to keep the discs where they should be, and external sutures are done to seal the area. These two surgeries are considered simple and logical and when done will last a lifetime in almost all cases. The key factor is having a surgeon who has done many cases over the years. It should also be mentioned that TRJ (Total Joint Replacement) is only done when the top of the jawbone (the condyle) is severely eroded beyond any reasonable chance of repair. This is a rather heavy-duty surgery because you are in full braces and the jaws are wired shut for a few months. Eating through a straw is no fun, but there are few other options.

Because TMD treatment is so misunderstood and mismanaged, there are many opinions coming from many practitioners about the proper course of treatment. Some surgeons will ONLY perform TJR while others would do arthrocentesis (flushing the joints) before considering plication or meniscectomy. For these reasons, insurance companies are hesitant to pay for a procedure and call it all ‘experimental’ which it most certainly is not. So please be well informed and understand the options!

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TMJ and sleep disorders are very common but not really understood.  This can explain why myths or misconceptions are out there.  The other side of this coin is this is also commonly misdiagnosed because symptoms vary from person to person and are similar to other problems.  One example of similarities is with Lyme Disease.  This is caused by a tick bite and the symptoms could be chronic headaches or migraines, jaw pain and tingling in the hand or fingers, notable symptoms of TMJ disorder. The big difference is Lyme disease does not have the clicking and popping or vertigo symptoms of TMJ disorder.  There are other examples as well; migraines, Trigeminal Neuralgia (short, sharp pain from touching of the jaw joint), or even a Ganglion Cyst (on the TM joint causing swelling and jaw pain).

Just remember all of us get sore muscles from time to time. The big difference is when the muscles in your jaw joints get sore and the soreness does not go away.  This is when you should ask your dentist for a referral. Otherwise, you could be prolonging the unnecessary pain or soreness and allowing the disc to possibly become further damaged.  TMJ disorder does affect other parts of your body. The myth of no popping or clicking means no TMJ disorder is not true.  These displaced discs can cause other symptoms of neck pain, backache, loss of balance, or hearing loss without the clicking or popping.

Another common myth is that TMJ disorder is harmless and that living with it will not cause problems.  It is true this condition is non-life-threatening but at the same time, it should be addressed.  Some possible development would be bruxism.  This process causes grinding of your teeth and clenching, wearing down your tooth’s enamel, and can cause sleep issues.  If the tooth enamel is worn down, then the potential of decay or tooth loss becomes greater.

For the sleep side of things, sleep can be interrupted by the clenching and grinding of your teeth.  Interrupted sleep or waking up unrefreshed is a symptom of both TMJ disorder and sleep apnea. It is not considered just a sleep issue.  The myth of sleep issues coming with age is not exactly true.  The aging process does decrease the tone in muscles and the airway muscles are not immune to this. The muscles in the airway no longer hold the jaw in the correct place and in turn, the airway becomes restricted. Your body is now fighting harder to breathe.  The use of a CPAP as the only treatment for sleep apnea is another myth.  The American Academy of Sleep Medicine has determined that an oral sleep appliance is very effective for mild to moderate apnea index.  This index tells us how many times your sleep is interrupted within a night.  The Epworth scale (tiredness level) in conjunction with the apnea index can determine if the oral appliance will be effective.

An interesting myth, sleeping on your side cures sleep apnea, actually helps with sleep apnea but does not cure it. By sleeping on your side, the tongue is not relaxed enough to obstruct the airway by falling back into the throat creating a blockage.  The tongue is off to the side allowing air to pass through the airway.  This is noted with mild cases of sleep apnea.  The side sleeping is most definitely not a cure but is recommended a lot for “positional apnea”.

There are so many more myths out there for both TMJ and sleep disorders.  Always consult with your dentist or physician when it comes to these issues.  You do want to address these symptoms because both these conditions will affect your brain and in turn affect cognitive functions, generating higher stress, and possible memory loss.

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