TMJ Causes

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TMJ SYMPTOMS

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Headaches (tension or migraine)
Pain behind the eyes or blurring of vision
Unexplained tooth pain
Earaches, congestion or ringing in ears
Clicking, popping or grating sound in the jaw joints
Limited opening or locking of the jaw
Dizziness
Pain when chewing
Facial pain and/or numbness of face and head
Neck and/or throat pain
Difficulty in closing the teeth together
Tired jaw
Hearing loss

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Poor posture
Neck and upper back restriction, tight facial/mouth muscles/myofascial trigger points
Trauma or whiplash
Your teeth and your bite
Clenching or grinding
Mouth breathing
Parafunctional habits: nail biting, frowning, chewing on pencils, etc.

Now let’s get in to what causes TMJ / TMD with a bit more detail.

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Causes of Temporomandibular Disorders (TMD)

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Factors that cause the onset of TMDs are called INITITATING FACTORS.

Factors that increase the risk of TMDs are called PREDISPOSING FACTORS.

Factors that interfere with healing or enhance the progression of TMDs are called PERPETUATING FACTORS.

There is not a single cause, factor or theoretical model that can explain the onset of TMDs.
From Orofacial Pain: Guidelines for Assesssment, Diagnosis, and Management, 5th Edition

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TRAUMA

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Trauma is described as any force applied to the masticatory structures that exceeds that of normal functional loading. Most Trauma can be divided into 3 categories:

1. Direct Trauma

Jaw fracture from some impact
In children, condylar and subcondylar fractures from impact
Impact injury to the jaw that causes disc displacement
Wide or prolonged opening, such as with yawning or dental procedure
Third molar extraction
Intubation – medical term for insertion of a tube into the mouth

2. Indirect Trauma

Acceleration-Deceleration (whiplash) after a motor vehicle accident
Any neck injury, can refer pain to the TMJs, face, and head

3. Microtrauma

Any sustained or repetitious adverse loading of the masticatory system
Poor posture
Mouth breathing
Parafunctional habits:
- Clenching is more of a single contraction episode, and this can occur during day or night
- Bruxing is an oral parafunctional activity that can occur day or night. Bruxing is classified as a series of rhythmic contractions, tooth grinding. ~ 20 to 38% of children brux, and 25% to 50% of adults brux
- Lip biting
- Nail biting
- Sucking on the inside of one’s cheeks

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ANATOMICAL FACTORS

1. Skeletal Relationships

Genetic or developmental
Retrognathia – the jaw or mandible is receded posterior or set back from normal
Micrognathia – abnormal smallness of the jaw or mandible
Steep articular eminence

2. Occlusal Relationships

Basically how the upper and lower teeth come together

Large overjet
Anterior open bite
Unilateral posterior crossbite
Lack of firm posterior tooth contact (missing back teeth)
Malocclusion following dental filling or crown

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PATHOPHYSIOLOGICAL FACTORS

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1. Systemic Factors

Degenerative
Endocrine
Infectious
Metabolic
Neoplastic
Neurologic
Rheumatologic
Vascular disorders
Altered collagen metabolism
Hypermobility – I personally feel I see a lot of this and corresponding TMDs

2. Local or Peripheral Factors

Chewing efficiency or lack of
Masticatory ( Jaw) muscle tenderness
Pathologic and/or adaptive responses to disease
Disc derangement/Osteoarthritis, what came first?
A “sticky” disc or “adhered” disc
Prolonged immobilization of the jaw, leading to capsular tightness
Female hormones

3. Genetic Factors

Little research is available with regard to genetic susceptibility for TMDs

A recent study examined the relationship between catechol-o-methyl transferase (COMT) polymorphism, pain sensitivity , and the risk of TMD development
Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) Study

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PSYCHOSOCIAL FACTORS

Psychosocial factors include individual, interpersonal, and situational variables that impact the patient’s capacity to function adaptively.

1. General Distress

Anxiety
Excessive sympathetic nervous system activity as an overresponse to life stressors
Limited coping skills
Physical response to stress
Depression

2. Primary gain

Produces positive internal motivations. For example, a patient might feel guilty about being unable to perform some task. If he has a medical condition justifying his inability, he might not feel so bad.

3. Secondary gain

Can also be a component of any disease, but is an external motivator. If a patient’s disease allows him/her to miss work, avoid military duty, obtain financial compensation, obtain drugs, or avoid a jail sentence, these would be examples of secondary gain.

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