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CHAPTER 1
THE CONTROVERSIAL TMJ
A few years ago the rumor was going around that Burt Reynolds had AIDS: he looked ill, he wasn't able to work, he had lost a lot of weight. It turned out that he had a TMJ disorder as a result of getting hit in the jaw while filming City Heat. In a newspaper interview (San Francisco Chronicle, May 24, 1987), he described his symptoms: "When your jaw, your bite, goes off, your equilibrium goes off too. You're in a kind of brain pain that comes up and whips your eyeballs out. Then the nausea starts. It's like being seasick all the time. You throw up, can't lie down, can't take any light. If the phone rang, I'd fall on the floor with a pillow over my head because of the pain. I had tubes in my ears and I didn't eat - just drank soup. I kept getting thinner and thinner. It was scary." He saw thirteen dentists before he found one that could alleviate the pain.
What Is the TMJ?
TMJ is the abbreviation for temporomandibular joint (also called the cranio-mandibular joint). A joint is where two bones join together. You have two TMJs - one in front of each ear connected to the horseshoe-shaped jawbone that has your lower teeth in it. The TMJ is a ball-and-socket joint. The jaw has rounded ends that fit into a socket and slide on a disc, or pad, as your mouth opens for chewing, biting, eating, talking, yawning, kissing, or making various facial expressions. Your lower teeth need to mesh in a very precise way with your upper teeth when your jawbone opens and closes. Your TMJ can give you problems for many different reasons, and we'll discuss each of them in Chapter 5.
The TMJ Controversies
Burt Reynolds' story illustrates the two kinds of controversy surrounding TMJ: its symptoms can be confused with a lot of other illnesses, and its cure is far from agreed upon. The reason for the difficulty diagnosing TMJ disorders is that pain in one part of your body can be referred to other parts through the connecting nerves and muscles. The reason why the treatment of TMJ disorders is controversial is that the causes are still not fully understood.
The controversy over treating TMJ disorders was evident at a workshop of the American Dental Association in late 1989. A lawsuit had been filed to stop eleven experts from discussing the treatment and diagnosis of TMJ disorders, but it was not successful, and 700 dentists signed up for this workshop that had originally been scheduled for a 225-person auditorium. The main source of conflict over TMJ disorders in the dental profession is the role of a bad bite, or malocclusion. A large segment of the dental profession believes that bad bites cause TMJ disorders, and therefore the treatment is bite correction at prices that can range from a few thousand dollars up to $15,000 or $20,000 if every tooth has to be capped. The accumulated scientific evidence doesn't substantiate this expensive treatment, however. It favors a more conservative and cost-efficient therapy that includes a soft diet, use of heat and ice, medications, stress management, and splint therapy. For a small percentage of the cases, surgery may be recommended.
The experts at the ADA workshop reported that a survey of the scientific literature showed that TMJ problems may lead to bad bites, but not the reverse, and that TMJ problems may be self-limiting and go away by themselves: This second conclusion was derived from research that showed that most TMJ disorders occur in people between the ages of 24 and 44 and that they rarely occur in people over 65. Because many dentists still believe that malocclusion is the major cause of TMJ disorders and that untreated TMJ problems can lead to permanent degenerative disease, these conclusions were hotly debated at the ADA meeting.
The final word is not yet in, but in the chapters that follow we'll look at various causes of TMJ disorders and the latest scientific evidence about their treatments. This information should help you become an informed consumer of dental treatment and help you to manage your TMJ problem over the long term.
- Cranial Mandibular Disorders, Guidelines for Evaluation, Diagnosis & Management by American Academy of Cranial Disorders, Charles McNeill DDS. (Quintessence Publishing, 1991).
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