FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

MOST CASES OF TMD RESPOND TO SIMPLE MEASURES AND A LITTLE TIME

Question: About a week ago, my jaw randomly popped, and since then I have been having jaw pain. When I wake up in the morning, one side of my jaw is very sore and I find it difficult to eat breakfast. As the day continues, my jaw begins to hurt less, however, when I open my mouth wide, it continues to hurt. Any idea what is going on? Should I go to the doctor?

Answer: It sounds to me like an inflammation of the temporomandibular joint, or TMJ. This joint is located where the temporal bone in the skull and the lower jaw bone (or mandible) meet. To add to the alphabet soup that we doctors love, inflammation in this joint is referred to by another acronym. It’s called TMD, which stands for temporomandibular disorder.

TMD can be caused by many things. If there has not been any direct trauma or injury to the jaw, but there’s pain when you wake up, you may have been grinding your teeth during the night. Grinding or clenching the teeth for extended periods of time can put too much pressure on the joint and lead to inflammation. TMD is also associated with bad alignment of the back teeth, dislocation of the TMJ, arthritis in the TMJ, and injury to the jaw or the side of the head.

TMD often causes jaw pain in the morning. The pain is usually just in front of the ear on the affected side. Sometimes the pain can radiate to the ear, cheek, temple and even the neck or shoulder. People also complain that their jaw just doesn’t seem to be working correctly. They can have difficulty opening their mouth wide, feeling like the jaw catches or they have noise when they open and close their mouth. Frequently the pain is made worse by chewing.

You should see a physician about this problem. Usually it can be diagnosed by physical exam. Sometimes an X-ray or MRI is ordered to further assess the problem, but this is only necessary in long-standing cases. The good news is that about 80 percent of cases are temporary and respond to very simple measures. Some of these are eating a soft diet, avoiding chewing ice, gum and hard candy, using hot packs or ice packs on the painful area, and taking over-the-counter, anti-inflammatory drugs such as naproxen or ibuprofen.

Many people -- even some with long-standing TMD -- find osteopathic manipulative treatment, or OMT, is helpful. Though all D.O.s learn how to administer this treatment as part of their training, you might want to look for one who devotes a large portion of his or her practice to OMT if you’re seeking relief from TMD.

If poor teeth alignment is the cause of your problem, you may need to see a dentist. Or, if the cause is grinding your teeth, then a simple dental protector worn at night may keep you from grinding your teeth. This can often be very beneficial.

Low-dose antidepressants are effective in some cases. However, a new study published in January found that patients seeking treatment for TMD were five times more likely to already be taking an antidepressant than those who go to the dentist for routine dental care. This raises interesting questions about the proper treatment for TMD in these patients.

Fortunately, you probably won’t need surgery. The need for it is rare. Statistically, it is indicated in less than 5 percent of all cases.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.