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Sustained and Repeated Mouth Opening Leads to Development of Painful Temporomandibular Disorders Involving Macrophage/Microglia Activation in Mice

Temporomandibular disorder (TMD) is a set of heterogeneous musculoskeletal conditions involving the temporomandibular joint (TMJ) and/or the masticatory muscles. Up to 33% of the population has had at least one symptom of TMD with 5-10% of them requiring treatment. Common symptoms include limited jaw movement, joint sound, and pain in the orofacial area. Once TMD becomes chronic, it can be debilitating with comorbidities that greatly reduce one's overall quality of life. However, the underlying mechanism of TMD is unclear due to the multicausative nature of the disease.

Prevalence of TMD in Sjӧgren Syndrome Patients

Sjӧgren's Syndrome seems to play a role in temporomandibular joint disorders.

Early Molecular Response and Microanatomical Changes in the Masseter Muscle and Mandibular Head After Botulinum Toxin Intervention in Adult Mice

The Botox-injected masseters had greatly increased expression of genes involved in muscle atrophy at the 1 week time point compared to the control side muscles. At the end of the study, 2 weeks after injection, the Botox-injected masseters were about 20% smaller than the control side masseters, and the Botox-side condyles had lost about 40% of relative bone area compared to the control side condyles.

Centralized Pain in TMD: Is It All in the Head?

We are pleased to introduce Sophia Stone, a new contributor to The TMJ Association, whose passion is to separate TMD fact from TMD fiction. Sophia has a background in medicine and research and can draw on her personal experience as a TMD patient.

Beth's Story

  • May 13, 2015

After injuries to my jaw, from years of falling off green and problem horses, a couple of bad spills left me with excruciating ear and neck pain.  After seeing numerous specialists, I was diagnosed with a TMJ dysfunction and began splint treatment with an orthodontist.  After a couple splints, braces, and a lot of physical therapy, I was better. Then I fell off another horse. My equilibrium was still off. Another round of splint therapy didn’t work as well so I was referred to a surgeon. My opening was in the single digits.

In 1985, while in grad school, I had my first surgery where silastic sheeting was used to help protect the joint for the first several months afterwards.  The silastic was supposed to be temporary but when they tried to pull it out, one broke into pieces – so back into the operating room to get the pieces removed.   I had several arthroscopic surgeries to clear scar tissue from the joints.   With the degeneration, I had various grafts to improve function.  Muscle flap and ear cartilage were tried, but they quickly fell apart.   My jaw joints fused and the surgeon I had wouldn’t do anything. 

After a bleak discussion with my jaw doctor, and having finished an MBA, I decided to get involved with horses again, but this time small equines, because I was tired of putting all my money into medical bills.  I bought Town & Country’s Colorful Cat, “Cat,” in March of 1997, just before he turned two years old.  He was the second small American Shetland Pony I put with a trainer in Indiana for the 1997 show season.  That year, 1997, Cat won numerous halter grand champions at various shows around the country, including the National Congress Grand Champion for Classic Shetland Stallions.  Then he was awarded the 1997 Classic Halter Pony of the Year and National All-Star Champion.  I was so proud, and it was nice having someone else do the work involved.  I bonded with Cat every time I visited, spending as much time as possible with him.   Even though it was months between visits, he still whinnied and came to me when I arrived at the farm.

In 1998, I found a surgeon to reconstruct my joints using skull bone (which only lasted a year.)  The following year he put in bilateral metal joints that have been in place for 12 years.  During this time, I was told that my jaw was probably not a problem to begin with.  More than likely, I had an untreated cervical injury.  A tough thought to swallow, but at this point it’s only a theory. 

When Cat was 4, I lost my job and had to sell my ponies.  After joining General Electric, I started inquiring about Cat and found he had been through an auction and was in bad shape.  Research, phone calls, etc., I was able to buy Cat back and have him shipped to a trainer in Pennsylvania.  He had been gelded, his tail had been docked (by an amateur), and he was skinny.  My trainer and his family brought back the sparkle in Cat’s eyes and into show shape, building up his trust and calming his fears.  Cat went on to win three Classic Roadster National Congress Grand Champions. 

At one point, I sent Cat to the New Bolton Center (University of PA) because I thought he had a pain problem that no one else saw. Dr. McDonald saw it right away and documented it. Then she got a surgeon to fix his tail.

Cat is home now, boarded at a local stable. My family considers him as part of the family and not an investment.  We dabble in the show scene now and then, but mostly to catchup with old friends. Cat, my dog Gracie, and now my new pony, “Joe,” bring a lot of joy, pride, and at times relaxation to my life.  They take my mind off troubles and make me look at what’s really important in life.  Adversity comes with life.  Its how we learn to deal with it that really makes the difference. Medical stuff can make one crazy, but, for me, pets bring peace and perspective. For me, it’s the right balance. Cat is a pony with a lot of heart, and he definitely got mine.   He demonstrates courage daily, and passes it on. I feel blessed to have him.

My jaw story is not over.  It’s been 30 plus years, 13 surgeries, more than $300,000 in medical bills, a limited opening (12 – 15 mm), chronic pain, several bleeding ulcers from medication, and now chronic sinus infections and sleep apnea. All the surgeries have left scar tissue in my nose from the nasal intubation. I need surgery to fix my nose and throat but because of my limited jaw opening, the standard oral intubation is out of the question. The current challenge is to find a comfortable CPAP mask.

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