TMJ: The Problem

There seems to be a lot that is not known about TMJ. What has been your experience learning about TMJ?

Temporo-Mandibular Joint Dysfunction, commonly called TMJ, affects over 10 million people in the United States.

Louis Abbey, DMD:

Louis Abbey taught Oral and Maxillofacial Pathology at Virginia Commonwealth University School of dentistry in Richmond, VA for 33 years. He has retired to the Boston area and is teaching at Harvard School of Dental Medicine and consulting with a pathology laboratory.

TMJ is a very interesting area for pain management, but I thank god that I don't have to deal with it. It is important to understand that we are dealing with a physical joint that gets as much activity as the knee. This joint is the only one in the body that both rotates and slides. It gets a lot of wear no matter what you do, but some people's mouths seem to have more difficulty adapting to changes.

Lots of practitioners are asked by patients to treat TMJ, but practitioner capability varies. We really don't know much about TMJ, and as human beings our expectation is that the joint should work perfectly every time. Unfortunately, there are simple, complex, and sometimes no solutions, once the symptoms have begun. There are many interventions that have been tried including medications, devices, and surgery. Surgery results can bring dramatic improvements or result in irreversible negative changes. The field is open for the use of untested solutions and sub-optimal care. With this complex disease and diverse symptoms, you can see how an inadvertent misstep can cause a patient to have a very unsuccessful outcome.

My experience at Virginia Commonwealth University was that surgeons did not operate a lot on the TMJ. I know there are people who believe TMJ is a psychological problem to be treated with medication. I tend to be careful to acknowledge that TMJ is a real problem for any patient. Unfortunately, successful treatment is often a matter of trial and error. Patients may have seen 20 health care providers, some of whom dismissed their complaints. Thus patients can be frustrated, guarded, vulnerable, easily excitable, depressed, anxious etc. and it may be very difficult to sort out the real problem from all the surrounding barriers that have been erected in the course of the patient's history.

Almost all dental (and some non-dental) practitioners have the opportunity to deal with TMJ: general dentists, orthodontists, oral surgeons, ENT specialists, pharmacists, neurologists, dental hygienists and psychiatrists and psychologists. The field is loosely defined and patients get referred around. This results in a lot of frustrated practitioners. The confusion and rejection patients may feel likely just adds to their problem.