Coping with Temporomandibular Disorders (TMD) in Teenagers

Temporomandibular disorder (TMD) is a generic term for several clinical signs and symptoms involving the masticatory muscles, the temporomandibular joint (TMJ) and associated structures. Signs and symptoms of TMD in children and adolescents have been investigated since the beginning of the 1970s. The most frequent clinical signs of TMD are:

• TMJ noises (on palpation by dentist); • Limitation of mandibular movements; • TMJ and muscle tenderness; • Headache; • TMJ clickings (when open or close the mouth); • Bruxism; • Limited opening of the mouth; • Jaw pain; and • Facial pain.

Clinical signs and symptoms of TMD above were present in teenagers. Muscle tenderness and joint sounds were the most prevalent, respectively. There are both local and systemic factors associated with TMD development. The forecast from various TMD signs that may become a severe disorder later in life is unclear.

The etiology of TMD has been considered to be one of the most controversial issues in clinical dentistry. Currently, TMD is regarded not an individual entity, but a group of different diseases of varying etiology and pathology. The debate still exists in this day and age because of the limited knowledge regarding its etiology and natural progression.

The role of gender in TMD is also extensively discussed in academic literature. TMD is rated to be 1.5-2 times more prevalent in women than in men. Furthermore, the predominance of women seeking treatment for TMD pain is even higher, with a ratio of 4:1. In my practice about 80% of the patients treated for this disorder are women. Moreover, the most striking gender differences have been encountered in women aged 20-40 years. It is not common for children, adolescents and the elderly to have TMD.

TMJ disorder is a complex chronic debilitating illness. Dentists have strategically developed many treatments for this condition over the years. Depend on the basic cause or causes, either one or the combination of the following treatment methods are used. They include:

• Pain medications to ease acute pain. These, also known as the NonSteroidal Anti-inflamatory Drugs or NSAID's, are the "first" drugs of choice. Examples of these drugs are Aspirin, Motrin and Advil. • Skeletal relaxer medication (for example flexeril) to downgrade muscular tension. • Steroid injection (hydorcortisone) to reduce inflammation. • Soft diet to lower the workload for the joint. • Apply external heat to the joint to relax the muscles around the joint. • Occlusal splint or Orthotic appliance to reposition the joint to its ideal arrangement. • Orthodontic treatment to fix teeth malalignment. • Physical therapy (posture training) to straighten the neck. • Arthroscopic surgery to remove scars inside the joint. • TMJ surgery to repair damages of the joints. • Total joint replacement surgery to replace the real joint with an artificial one.

The key words to keep in mind about TMD treatment for children are "conservative" and "reversible." Conservative treatments are as simple as possible and are used most often because most young patients do not have severe, degenerative TMD. Conservative treatments do not invade the tissues of the face, jaw or joint. Reversible treatments do not cause permanent, or irreversible, changes in the structure or position of the jaw or teeth.

Signs and symptoms of TMD clearly make an early appearance in children between the ages 12 and 18. Routine dental examination should include evaluation of these signs and symptoms to identify them. These youngsters should be watched more closely. Because most TMD problems in teenagers are temporary and do not get worse, simple treatment is all that is usually needed to relieve discomfort.