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Mysteries of TMD

Biting Pain
By
WebMD Feature

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 itself.

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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.

Debilitating 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 ears.

For more than a decade, doctors tried and failed to discover what caused Zee's pain. She was variously diagnosed with multiple sclerosis, migraine headaches, rheumatoid arthritis, lupus, PMS, and depression.

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 swell shut.

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.

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