Mysteries of TMD
Many causes, many symptoms continued...
Rheumatoid arthritis and Lyme disease also can cause TMD
because these diseases affect joints. So can psoriasis, a chronic skin disorder
that can have several components, such as scaly patches, but also may cause
arthritis. Trauma, such as the car accident that injured Zee, is another
culprit, although Zee says she believes undiagnosed arthritis already had
weakened her jaw and the blow she received "finished off" the disc.
Oftentimes, stress is to blame, as along with stress come such
habits as teeth grinding and jaw clenching. And in a recent study, poor posture
seemed to be at the root of the problem. An Air Force study published in the
February 2000 issue of the Journal of the American Dental Association
showed that posture training reduced symptoms by 42% in a group of patients who
had suffered for at least six months from TMD.
Treat with caution
While causes of TMD remain elusive, most TMD sufferers can find
some relief in any number of treatments. Cottrell estimates that more than 80%
of his patients recover on their own once they understand the problem and are
careful about what they eat and how they open their mouths. Ten percent find
relief by wearing a plastic mouth guard during the night that prevents jaw
clenching or teeth grinding during sleep.
Still, some patients are more difficult to treat, and in the
end they may need jaw surgery. However, Kenneth Gruber, MD, chief of the
chronic diseases branch of the Dental and Cranial Facial Research at the NIH,
says surgery should be the very last resort. "Our recommendation is,
generally don't do anything radical or irreversible," Gruber tells
Conservative approaches include eating soft foods, applying
heat or ice packs, and avoiding extreme jaw movements like wide yawning,
singing, gum chewing, or talking while cradling a telephone between your
shoulder and jaw. Physical therapy and medications, such as muscle relaxants,
anti-depressants, corticosteroids, and pain pills often are prescribed, and
newer medications such as the Cox-2 inhibitors are very effective.
If, like Zee, conservative, reversible treatments don't do
anything to quell the symptoms, it may be necessary to consult an oral and
maxillofacial surgeon for further tests. But experts warn that if your jaw is
opening and closing, you probably don't need surgery.
As for Zee, steaks, chewing gum, and salads will probably never
be part of her diet again. Still, she says, "I've been fortunate. The
quality of my life has improved immensely."