Temporomandibular joint disorders.(Women's Health Adviser)

More than 10 million Americans experience temporomandibular joint disorders each year. These common but poorly understood conditions are characterized by pain in the jaw and associated muscles. The pain can be quite severe, limiting normal jaw movement and inhibiting the ability to speak, eat, and swallow.

The etiology is unclear, but new research suggests that temporomandibular joint disorders (TMD) may be the result of a heightened response to stress that manifests as jaw clenching or tightening. This results in pain and, if prolonged, can cause physical changes in the jaw joint.

TMD patients are significantly more likely than controls to report other disorders, including fibromyalgia, irritable bowel syndrome, and non-cardiac chest pain. An unpublished study compared rates of 13 comorbid disorders in patients referred for TMD to an orofacial pain clinic versus patients receiving a routine dental exam. TMD patients had an average of 4.5 comorbid conditions, compared with 1 condition in dental patients.

Symptoms

Pain in the face, jaw joint, and ear or surrounding tissues, as well as headache, are the primary complaints. Pain in the posterior molars may be present; sometimes it migrates from one side of the mouth to the other. Patients may also say their jaw locks when open or closed. There may be a limited ability to open the mouth comfortably. Patients may say that their bite feels uncomfortable or "off," or is changing.

It's important to rule out other possible causes of jaw pain, including otitis media or tooth abscess.

Ask if the patient has experienced any unusual stress recently in any area of her life. A sleep assessment is important, too, because poor sleep quality induced by stress is associated with bruxism, a contributing factor to jaw pain. Patients who are taking selective serotonin reuptake inhibitors may experience sleep problems accompanied by bruxism or jaw clenching, especially if the dosage has recently been increased.