Until recently, TMJ disorders were believed to be strictly related to teeth (malocclusion) and/or jaw dysfunction, i.e., “mechanics” of teeth and jaw function. Diagnosis mainly involved pushing on and applying pressure to various places on the face to test for sensitivity/pain and measuring how wide a person can open their mouth (i.e., the jaw opening). In addition, jaw imaging and diagnostic tools were used to look at jaw/disc position and jaw movement.
The findings from a recent major study funded by the National Institutes of Health – OPPERA (Orofacial Pain: Prospective Evaluation and Risk Assessment) – demonstrated the need for a paradigm shift in both the research and treatment of TMJ disorders – a shift that moves away from focusing solely on the localized area of pain and dysfunction (e.g., jaws, teeth) to a comprehensive assessment of the “whole person,” which incorporates medical and other allied health specialists in both the research and treatment of TMJ disorders.
OPPERA found that TMJ disorders are complex systemic diseases with genetic and immunologic components. Further, the physical pain associated with TMJ disorders involves changes in the central nervous system (i.e., the brain and spinal cord), resulting in a mismatch between the severity of pain symptoms felt by individuals and the amount of actual pathology (e.g., inflammation, joint degeneration) seen with imaging in the jaw joint itself. In other words, some people can have very little inflammation or degeneration of the jaw joint and have severe pain, while others have enormous trauma or damage to the jaw joint, but experience very little pain. (This is a finding common in other conditions as well, such as knee/hip osteoarthritis, endometriosis, etc.) The study did not yield specific diagnostic tests for TMJ disorders, however it has shed a light on the type of research that is needed – both now and in the future – to develop diagnostics and treatments based on 21st century science.
Comorbid Conditions as Predictors
The OPPERA study found that people with TMJ disorders commonly experience widespread pain in other areas of the body, as well as other medical conditions.
The investigators also found that the most influential predictor of developing a TMJ disorder was a simple checklist of 20 pain- and non-pain conditions and symptoms. Preexisting pain conditions such as poor sleep quality and cigarette smoking were all independently associated with the incidence of TMJ disorders. OPPERA investigators also commented that finding a higher exposure of the fetus to estrogen in utero increased the incidence of developing TMJ disorders, which “poses the intriguing possibility of organizational hormonal contributions to [TMJ disorders].”
The OPPERA study found the presence of the following conditions to be significant predictors of developing a TMJ disorder:
- Irritable bowel syndrome (IBS)
- Genital pain
- Tension-type/migraine headaches
- Patient’s self-report of jaw parafunction (e.g. clenching, grinding/bruxing teeth)
- Frequency of somatic symptoms (e.g. nausea, fatigue, dizziness)
- Deteriorating sleep quality
Important to Rule Out Other Conditions
You should always share all of your conditions (including TMJ) and symptoms with your primary care physician or internist, even if you don’t think they are relevant or related, it will help him/her with understanding your entire medical picture. Doing so, will help to rule out any other condition(s) that mimic TMJ symptoms, such as:
- Sinus or ear infections
- Decayed or abscessed teeth (consult a dentist)
- Various types of headache
- Facial neuralgia (nerve-related facial pain)
- Giant cell arteritis
- Coronary artery disease
- Connective tissue disorders such as Ehlers Danlos Syndrome and Scleroderma
- Eagles syndrome
- Oral, head, breast and neck cancers
- Lyme disease
- Acromegaly (a rare condition with excessive production of growth hormone in adults)
- True serum sickness
Before undergoing any costly diagnostic test, it is always wise to get an independent opinion from another health care provider of your choice (one who is not associated with your current provider).