TMJ Disorder: “The Great Imposter”
By Dr. Leonard Feld, D.D.S.

The obvious thing that many people with symptoms such as migraines, fatigue, nauseous, dizziness, pain behind the eyes, depression, autoimmune symptoms, imbalance, fainting, difficultly swallowing, or ringing in the ears do is to visit their primary physician. Often medications are prescribed to ease the symptoms, but no cause for the symptoms is diagnosed.

The American Dental Association states that at any given time, 34% of the population reports having these symptoms (1) or any of the 86 recognized comorbid symptoms (2) often together or with a variety of intensity. So it should be no surprise that an estimated 50% of all visits to the family physician are due to these symptoms. The serious nature of the condition is clear (3).

Interestingly, these 86 symptoms, which also include anxiety, irritable bowel syndrome, neck pain and earaches, are also found in people with “jaw joint” or TMJ (Temporomandibular Joint) disorders. That is why TMJ disorders are often called “The Great Imposter.” Their symptoms can mimic other disorders (4) and a dental diagnosis is often not considered.

What is TMJ?

Simply put, the jaw joint is the location at which your lower jaw and upper jaw connect. Between the bones is a small, protective disc that plays a very important part in maintaining good health. This small disk made of fibrous tissue keeps your jawbone (or mandible) from coming into contact with the temporal bone of the skull. The disc also keeps your mandible from impinging on the large number of nerves and blood vessels that travel behind the joint and in front of the ear to your brain.

What happens to cause these symptoms? 

If this small disc becomes misaligned or displaced, the jawbone retracts, pinching the nerves and blood vessels once protected by the disc. This, in turn, can cause numerous reactions throughout the body. Since there are multiple nerves, the reactions can be complex, but let’s take a look at one of the most complex and powerful nerves in the body, the Trigeminal nerve.

An afferent branch of the trigeminal system, the auriculotemporal nerve, passes through the jaw joint at the posterior of the joint disc (5,6). It is unusual in that it has both motor and sensory capabilities. Due to its extreme high density of pain fibers, 28% of the sensory cortex is devoted to it alone. It is automatically and functionally a spinal nerve. Sitting atop the spinal cord, it has the ability to modulate the ascending spinal signal, thus modulating the spinal input into the brain. Any neurologist will tell you that physicians blame the trigeminal nerve for reasons behind vascular headaches (7).

When the trigeminal nerve is affected, it can cause symptoms such as dizziness and vertigo (8), ear pain (9,10), sensory and motor skills, and imbalance (11). When affected, the nerve also releases a neuropeptide called Substance P (“SP”). This SP does not get recycled; therefore it lingers in the body with endocrine-like properties (12).

There is a classification for medical disorders called “neurogenic inflammatory disorders” that are associated with elevated SP (13). These disorders mimic autoimmune disorders (14,15) whose symptoms can include depression (16) and anxiety (17), which are often symptoms for patients with TMJ disorders. Again, this is simply one example of a nerve affected when the mandible (jawbone) becomes misaligned.

How does the joint become misaligned?

Some of the most common causes are: 1) Natural misalignment where the lower jaw is too far back, causing an interiorly displaced disc. 2) A deep dental overbite. 3) Teeth clenching or grinding. 4) Missing teeth, causing an incorrect bite. 5) Trauma to the head or neck. 6) Extraction of wisdom teeth.

How is the problem identified?

A skilled and trained dental specialist in TMD (temporomandibular disorders) must be educated with post graduate education, since dysfunction of TMJ and CMD (craniomandibular disorder) is rarely taught in dental schools in the US. To evaluate the health of the jaw joint, a complete medical and dental history is taken, followed by use of the Joint Vibration Analysis, which is a computer test to determine the degree of jaw joint dysfunction. Further diagnostic testing includes complete head, neck and posture evaluation and radiographs to assist with the visualization of the jaw joints and related structures.

What is the treatment?

The good news is that there is a 95% successful non-surgical, non-medicinal and predictable answer to the traditional, temporary solution. The objective is to stabilize the lower jaw in its correct position to reduce symptoms and improve jaw movement. This can be done simply with a non-invasive, custom fit “mouth appliance” (anteriorly repositioning appliance or a mandibular orthopedic repositioning appliance 18,19,20).

We have found great success with this simple treatment for many patients who have spent years in pain, consulting with various physicians and specialists who simply cannot indentify the cause for their symptoms. The place to start is with an evaluation by a properly trained dental practitioner.

Dr. Leonard Feld is a dental specialist with offices in Los Angeles, San Jose, Phoenix and Palm Desert. He is the Co-Founder of the TMJ & Sleep Medicine Network and can be found at Southwest TMJ Specialty Group in Palm Desert (760) 341-2873. Dr. Feld’s philosophy is always a conservative, non-invasive and non-surgical treatment.

REFERENCES: (1) American Dental Assoc. Future of Dentistry: Dental & Craniofacial Research (2) Simmons HC, Gibbs SJ: J Craniomand Pract 2005 (3) Albert H. Owen III: Its All in Your Head 1988.(4)Brock Rondeau: Intro to TM Dysfunction Manual 2007.(5) Johansson A-S, Isacsson G,Isberg A,Granholm A-C: Scand J Dent Res 1986 (6) Johansson A-S, Isacsson G,Isberg A: J Oral Maxillofac Surg 1990 (7) Okeson, Jeffery P: Jehery P. Okeson 6th ed. (8) Buisseret-Delmas C,Compoint C,Delfini C,Buisseret P:J Comp Neurol. 1999 (9)Costen JB: ann Otol Rhin Laryngol 1934 (10) Costen JB: J Kansas M Soc 1935 (11) Warner TF, Tomic S, Chang CK: J Reprod Med. 1996 (12) Matsuishi T,Nagamitsu S,Shoji H,Itoh M,Takashima S,Iwaki T,Shida N,Yamashita Y,Sakai T,Kato H: J neural Transm. 1999 (13) Jennings,Dwight: Journal American Academy of Craniofacial Paik. Vol 21 #1 April 2008 (14) Felix H, Oestreicher E, Felix D, Ehrenberger K: Adv Otorhinolaryngol. 2002 (15) Ylikoski J,Paivarinta H,Eranko L,Lehtosalo J: Acta Otolaryngol.1984 May-Jun (16) Yap AU,Tan KB,Chua EK,Tan HH: J Prosthet Dent.2002 Nov (17) Biederman J,Newcorn J,Sprich S: Am J Psych 1991 (18) Simmons HC,Gibbs SJ: J Craniomand Pract 1995 (19) Simmons HC,Gibbs SJ: J Craniomand Pract 1997 (20) Hall HD: J Oral Maxillofac Surg 1995