Dec. 4, 2000 -- At work, Deborah Zee, 45, picks and chooses
whom to speak to and for how long. She never attends loud concerts, and when
she looks at a menu in a restaurant, she decides what to order based not on
what she wants to eat, but "how much I want to suffer."
Zee, like more than 10 million Americans, most of whom are
women, suffers from temporomandibular disorder (TMD), a collection of medical
and dental conditions that affect primarily the temporomandibular -- or jaw --
joint and surrounding muscles, nerves, and tendons. TMJ, an older name for the
disorder, now usually refers only to a disease or disorder of the joint
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Unlike other joints in the body, the jaw moves up and down,
forward and backward, and from side to side. It enables us to chew, talk, yawn
-- even kiss. Until one day, it doesn't -- or at least not without pain.
For Zee, the pain that began in her 20s and worsened until it
became what she describes as "your worst headache, earache, and toothache
combined," means she no longer indulges in long conversations or submarine
sandwiches. Even noise is a problem: it sparks tinnitis, or ringing in the
Then one day, a drunken driver rear-ended the car she was
driving, and her head slammed into the steering wheel. After the accident, the
pain she'd suffered for years became unbearable. An MRI showed that the soft
disc, a shock absorber of sorts, that lies between the temporal bone at the
side of the head and the condyles, the rounded ends of the lower jaw, had been
knocked out of place and torn. Surgery to repair the damage failed, and two
years ago Zee received an artificial joint implant in her jaw.
On the whole, she says, her quality of life has improved,
thanks in large part to a new arthritis drug, Vioxx. But on bad days, the
inflammation can be terrible, causing her face to bulge out and her eyes to
Many causes, many symptoms
The most common symptom of TMD is pain in the jaw joint or the
muscles when chewing, according to the NIH's National Institute of Dental
Research. Other symptoms include clicking, popping, or grating sounds in the
jaw when opening or closing the mouth, or a change in the way the upper and
lower teeth fit together. TMD patients also may suffer limited movement or
locking of the jaw, headaches, earaches, dizziness, or ringing in the ears.
But because TMD includes so many different conditions, its
causes vary widely and in most cases are simply unknown. "TMD is really a
garbage term," says David Cottrell, MD, associate professor and director of
the Oral Maxofacial Residency Program at Boston University Medical School.
"It could be one of 15 different things. In most cases, we don't know the
exact cause." Nor do researchers know why the disorder strikes women far
more frequently than men. Hormones may play a role because patients often
report improvement during pregnancy, explains Cottrell.