TMJ

TMJ is the abbreviation for temporomandibular joint.  There are two. They connect your jaw to the skull. Each is the size of the tip of your pinky finger and is located less than an inch in front of the opening to the ear.  A very clear and precise anatomic landmark.

TMJ is also used to describe a wide variety of conditions or signs and symptoms in the head, face, jaw or neck.  This is not so clear. There is no single condition, diagnosis, or thing called TMJ. See section below, “Why being specific about TMJ is important.”

Alfred Tennant, DDS, DABOP

Orofacial Pain Specialist

Florida Craniofacial Institute is very fortunate to have Dr. Tennant on our team. He is the only fellowship trained, Board Certified Orofacial Pain Specialist in the Tampa Bay area. He is a Diplomate of the American Board of Orofacial Pain and a Fellow of American Academy of Orofacial Pain. Dr. Tennant is one of a small handful with this advanced training in the entire state of Florida. Dr. Tennant’s calm and meticulous nature, blended with his in-depth knowledge base, has allowed him to excel in the management of this very challenging subset of patients.

Resources

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VIDEOS FROM THE AMERICAN ACADEMY OF OROFACIAL PAIN

What is an Orofacial Pain Specialist?

An Orofacial Pain Specialist is a dental professional with an advanced level of training and expertise in the diagnosis and treatment of pain disorders in the mouth, jaw, face, head and neck. Unlike general dentists, Orofacial Pain Specialists do not treat typical dental conditions such as cavities or infections. Instead, they focus on non-dental pains that affect the jaw, mouth, face, head, and neck, with a particular emphasis on TMJ.

The Role of an Orofacial Pain Specialist

Orofacial Pain (OFP for short), recognized by the American Dental Association as one of the twelve dental specialties, requires practitioners to undergo extensive training beyond dental school. This specialization prepares them to tackle both common and challenging temporomandibular problems and complex chronic pain conditions that many healthcare providers may not commonly see and diagnose.

Conditions Treated by Orofacial Pain Specialists

Beyond TMJ disorders, Orofacial Pain Specialists are trained to diagnose and manage various chronic pain conditions. These include nerve pain conditions such as trigeminal neuralgia, headache disorders like migraines and cluster headaches, and persistent toothaches that do not stem from typical dental issues.

Additionally, Orofacial Pain specialists hold advanced training in Dental Sleep Medicine, which involves addressing snoring and obstructive sleep apnea through customized oral appliances.

Signs and Symptoms of TMJ

  • Pain in the face, jaw, neck, and shoulders
  • Difficulty chewing, swallowing, eating, speaking
  • Pain in the jaw joint
  • Painful clicking or popping in the jaw joint
  • Limited mouth opening (we avoid using scary words like “locking”)
  • Disc position changes or joint remodeling (avoiding scary words like disc “dislocation” or “displacement”)
  • Altered, uncomfortable or uneven bite
  • Altered, annoying, jaw function and mechanics. Stiffness in the jaw
  • Pain around or in the ear. Ear fullness or ringing

Why being specific about TMJ is important

If given the diagnosis of TMJ, ask about the type. “Can you be more specific?”. This is the only way to choose the best treatment.  Otherwise, you’re guessing about treatment and prognosis.

The paragraph below is a hypothetical patient exam.  Notice how TMJ the disease and TMJ the anatomic site is used.

An oral maxillofacial surgeon or orofacial pain specialist evaluating a TMJ patient will ask themselves many questions early on. Does this patient have a neuropathic or somatic problem? Or both? Should this be treated surgically? For simplicity, let’s assume we have decided there is a somatic pain problem that is musculoskeletal in nature. Further, it’s a TMJ pain (not various other musculoskeletal pains). You are still not done! It could be arthritic, autoimmune, infectious, ligamentous, or various other things. The treatments for each are different. A neuropathic problem around the TMJ is treated very differently from a ligamentous problem of the TMJ or rheumatoid arthritis of the TMJ. None are good surgical candidates.

TMJ, when used as a final diagnosis of a disease process, can lead to confusion, poor communication, bad treatment decisions and bad outcomes. Being specific is the antidote. Being specific is good.

CAUSES OF TMJ

The cause of most types of TMJ is multifactorial. Meaning several factors working together for amplified effect. Because of this, the best treatment is often a multidisciplinary approach, as shown in the next section.

Instead of cause, it’s best to ask about Risk Factors. Common Risk Factors include:

The Perfect TMJ Recipe

  1. Being Female. Studies show 2:1 to 3:1 female to male ratio.
  2. Multiple overlapping pain conditions. Central Sensitization Syndrome.
  3. Sedentary lifestyle. Obesity.
  4. Presence of, and severity of, psychiatric conditions. Especially anxiety and depression. Fight or Flight vs Rest and Digest. Gravitating to the former.
  5. Allostatic overload. Modern times: pollution of air, light, sound. Systems become overwhelmed.
  6. Diet that is calorie dense and nutrient poor. 
  7. Sleep is suboptimal.
  8. Macrotrauma, microtrauma. Clenching. Bruxing.
  9. Age group 25-55.
  10. Some malocclusions.

If someone can check off all 10, they have a pretty good chance of coming up with TMJ.

INSIDER TIP: TMJ rarely occurs in isolation. There are almost always other underlying painful medical conditions that must also be addressed. Failure to do so will slow you down.

Migraine, tension type headache, autoimmune diseases, arthritis, myofascial pain, back and neck pain, fibromyalgia, irritable bowel syndrome, sleep disorders are commonly seen with TMJ.

WAYS TO TREAT TMJ

Giving a specific recommendation without knowing the specific diagnosis and other unique variables is not possible.  For many patients, it is common to recommend a treatment plan that includes some or all of these:

  • Optimum management of existing medical conditions.
  • Physical Therapy. Home self-directed and/or provider directed.
  • Corrective oral appliances.
  • Many drug classes are helpful. Can be injected: Botox, steroid, or long-acting anesthetic. Oral agents. Compounded topicals.
  • Surgeries and bite adjustments. Are uncommon and helpful under the right set of circumstances.
  • Lifestyle enhancements in the areas of nutrition, exercise, sleep, psychology.
  • Self-care and avoidance.

It all depends. Sometimes the best treatment is as simple and straightforward as taking out one wisdom tooth or fixing a cracked tooth.

TMJ Insurance Coverage

Dr. Tennant is in-network with most major medical insurance providers. However, please note that he is not a Medicare or Medicaid provider.

Insurance tends to be more consistent in covering office visits and diagnostic testing. Coverage for TMJ treatments, however, can vary significantly. No insurance plan covers every possible treatment option. For example, one plan might include coverage for Botox or a specific oral medication, while another plan from the same company may not.

Ultimately, some treatment decisions may need to be made independently of insurance coverage. To support you, our dedicated insurance team will review your plan in detail and help you make the most of your available benefits.

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