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Reducing Temporomandibular Disorder (TMD) symptoms and comorbidities

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  Posted by: The Probe      5th August 2022

TMD alone causes a patient much distress and discomfort, but it has also been linked with several comorbidities that have a much greater impact. The combination of more than one ailment can significantly reduce a patient’s quality of life, often making them feel despondent and antisocial. 

Tinnitus often presents comorbidly with TMD.[1] Given the proximity of the ear canal to the temporomandibular joint (TMJ) it is unsurprising that the latter can affect the former. Tinnitus is often described as a ringing sound, similar to the tones we sometimes hear as we lose another sound frequency to the aging process. However, tinnitus sufferers may experience other sounds that might be described as buzzing, hissing, whistling – just about any sound could be endured. The sound experienced may vary in volume or pitch, and can occur intermittently or be a constant.[2]

A potential symptom of TMD is ringing in the ears, in some instances treating TMD will also alleviate the patient’s tinnitus symptoms. However, in other instances while the two conditions are correlated, the TMD is not always the causative factor.

Tinnitus is by no means the only TMD comorbidity. TMD is more common in people experiencing chronic stress, bruxism, sleep complaints and insomnia, anxiety, and depression.[3], [4], [5] These conditions often overlap, for instance psychological disturbance can reduce sleep quality and increase the likelihood of bruxism.[6] The exact cause and effect relationship between these conditions is not yet fully understood or agreed upon, but they do appear to be associated.[7]

TMD is also associated with various pain conditions such as migraine, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis. Moreover, the severity and duration of TMD pain appears to be positively associated with the incidence of comorbidities. In other words, the more the patient is affected by their TMD, the more likely they are to have another condition present as well.[8] Pain conditions can have a marked impact on quality of life, they are another factor that can adversely influence sleep and mental wellbeing. Likewise, not getting sufficient quality sleep can reduce resilience to pain.[9] This bidirectional relationship between pain and sleep can thus create a vicious circle, with pain thwarting good sleep, and that lack of sleep increasing the patient’s perception of pain.

With all these overlapping conditions how can the dental team help patients? Well, the good news is that because these problems are linked, progress with one can have a positive impact on another. As dental practitioners, helping a patient with TMD probably will not eliminate another condition, but it can certainly improve the patient’s quality of life. Moreover, by giving the patient a concrete treatment plan, particularly where they feel like they are actively contributing to their own recovery, this can be very beneficial for how they feel about their illness. Chronic conditions can make a person feel helpless, which is very bad for their mental wellbeing. A plan of attack, and steps a patient can take, will help them regain some sense of control.

With TMD, some patients may benefit from physical tools to assist their jaw rehabilitation exercises, such as the OraStretch Press, [10] available through Total TMJ. This simple yet effective device helps the user to gradually open their mouth wider, and with more comfort over time. With continued use of the OraStretch Press, a typical patient can gain 1-2 mm per week in range of motion. These exercises enable patients to maximise their range of motion, reduce joint pain, and develop jaw muscle strength.

The experience of TMD comorbidities can be very disheartening for patients, as they may feel problems are stacking up, one after another. If there is a silver lining to be found, it is that by understanding where conditions are linked, and how, treating one can lead to progress with the other. For some patients, treating their TMJ issues will also resolve their tinnitus symptoms. For others, getting a better handle on daily stressors will help alleviate their symptoms. The body is an incredibly complex system, rarely does something effect only one part in isolation. By looking at dental patients more holistically, the dental team might better aid their general wellbeing.

 

 

For more details about Total TMJ and the products available, please email phil@totaltmj.co.uk or karen@totaltmj.co.uk

 

Author: Karen Harnott Operations Director Total TMJ

 

[1] Mottaghi A., Menéndez-Díaz I., Cobo J., González-Serrano J., Cobo T. Is there a higher prevalence of tinnitus in patients with temporomandibular disorders? A systematic review and meta-analysis. Journal of Oral Rehabilitation. 2019; 46(1): 76-86. https://doi.org/10.1111/joor.12706 April 11, 2022.

[2] British Tinnitus Association. All about tinnitus. British Tinnitus Association. https://www.tinnitus.org.uk/all-about-tinnitus April 11, 2022.

[3] Babiloni H., Martel A., Lavigne G. Sleep disturbances in temporomandibular disorders: a narrative review. Oral Surgery. 2020; 13(4): 335-348. https://doi.org/10.1111/ors.12451 April 11, 2022.

[4] Auerbach S., Laskin D., Frantsve L., Orr T. Depression, pain, exposure to stressful life events, and long-term outcomes in temporomandibular disorder patients. Journal of Oral and Maxillofacial Surgery. 2001; 59(6): 628-633. https://doi.org/10.1053/joms.2001.23371 April 11, 2022.

[5] Bertoli E., de Leeuw R. Prevalence of suicidal ideation, depression, and anxiety in chronic temporomandibular disorder patients. Journal of Oral Facial Pain and Headache. 2016; 30(4): 296-301. https://doi.org/10.11607/ofph.1675 April 11, 2022.

[6] Serra-Negra J., Scarpelli A., Tirsa-Costa D., Guimarães F., Pordeus I., Paiva S. Sleep bruxism, awake bruxism and sleep quality among Brazilian dental students: a cross-sectional study. Brazilian Dental Journal. 2014; 25(3): 241-247. https://doi.org/10.1590/0103-6440201302429 April 12, 2022.

[7] Fernandes G., Franco A., Siqueira J., Goncalves D., Camparis C. Sleep bruxism increases the risk for painful temporomandibular disorder, depression and non-specific physical symptoms. Journal of Oral Rehabilitation. 2012; 39(7): 538-544. https://doi.org/10.1111/j.1365-2842.2012.02308.x April 12, 2022.

[8] Dahan H., Shir Y., Velly A., Allison P. Specific and number of comorbidities are associated with increased levels of temporomandibular pain intensity and duration. The Journal of Headache and Pain. 2015; 16: 47. https://doi.org/10.1186/s10194-015-0528-2 April 11, 2022.

[9] Irwin M. Sleep and inflammation in resilient aging. Interface Focus. 2014; 4(5): 20140009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142016/ April 11, 2022.

[10] OraStretch Press System. https://www.craniorehab.com/orastretch [Accessed March 2022]


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