TMJ, TMJD and TMD from a Dentist's Point of View

What the heck is TMD? How did I get it? Is it permanent? Will it get worse? They have a million questions and nobody who can give them definitive answers except their personal doctors.

You know why? We, the community, need to hear from a DENTIST! Enter Stephanie Yap.

I met her on Twitter. Not only is she a dentist currently practicing in Queensland, Australia at Island Dental, but she also suffers from tmd in the form of bruxism. Just like me! (Also, when I say "form of bruxism" it makes me really want a chronic illness version of the Wonder Twins. Anybody else? Just me? I'll show myself out...)

In the interview below, Stephanie provides a TON of context for those of us feeling frustrated by the mystery of our condition.

1Stephanie, you are both a dentist and a bruxism sufferer. Can you talk a little bit about your symptoms and how they manifested?

I didn’t realize I had bruxism until I was in my second year of study. While in clinical practice, we have to learn on each other before we can see actual patients. It was my classmate that noticed my canine teeth had worn completely flat. 

Then my classmate proceeded to discuss my pain history with me. I realized why I was having such terrible jaw and neck pain, headaches consistently the moment I woke, why I didn’t feel truly rested after hours of sleep, or why I subconsciously chose to stay away from food I had to chew a lot because my jaw would tire easily. 

I pieced the information together and confirmed for myself that I suffer from sleep bruxism. I then took more notice and found that during the day I also clench my teeth terribly, which is another facet of bruxism termed Awake or Diurnal Bruxism.

2. Your practice is located in Australia. Can you talk a little bit about what the perception is of bruxism and tmjd in Australia right now? 

In my experience, the general population of low grade suffers do not realize they have bruxism or a tempromandibular disorder (TMD) because they are not in pain. Or any pain they experience does not consistently or severely prevent them from everyday function. 

Those who come seeking treatment are often disappointed because treatment of bruxism and TMDs are not instantaneous or a “one procedure” fix. Dentists may provide splints and jaw exercises, but treatment is largely self motivated and managed so compliance is often poor in long term management. 

TMDs and orofacial pain is a grey area because it involves and spans across multi-health fields. Dental and jaw symptoms are often the manifestation of what may be neurological, psychological, physiological or hormonal at its origin; or unless the TMD is specifically anatomical and physiological in origin to the tempromandibular joint (TMJ) itself.

3. Here in America, over fifteen percent of adult Americans have it. Do you know what the statistics are in Australia?

Looking for research on the topic, the latest review on bruxism literature I could find was from 1996-2010. In that it stated an overall prevalence rate of 20% for Awake Bruxism; and 8-16% for Sleeping Bruxism. 

It was reported more prevalent in children with 14-20%; and in adults years 60+ only 3% was reported. 

Statistics on bruxism prevalence is difficult once again due to people not being aware they may have awake or sleep bruxism because the act of grinding, clenching or other parafunctional activities are often involuntary, subconscious or we are asleep. Or people experience discomfort and pain but do not report it.

[Note: here’s the link to the research paper, reference if how you like https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3081266/ 

4. A lot of people don't think tmj/tmd/tmjd is a serious problem. In my experience, it's lead to a lot of very serious, life-changing problems. (I had to change my entire career to cope with losing my ability to speak comfortably.) 

How do you think we can get the message out to the public that this is something that really needs to be treated by a dentist?

That is a great question and a question which the dental community is constantly trying to advocate for about all aspects of dentistry, including TMDs. Prevention, early detection and early intervention is always the key! 

I’m not sure about America, but in Australia the government and the general perception on oral health is that it is secondary to medical health because it is not deemed life threatening, although in some instances it can be. 

So in Australia, if you have a problem with your mouth you need to fund it yourself (completely out-of-pocket or paying for private health insurance) whereas most medical procedures are paid for under our government Medicare scheme. 

What people often fail to fully grasp is that oral health is such a determinant factor to your overall health. If you are unhappy about the appearance of your teeth or are having pain it will affect your psychological health. If you have tooth or jaw pain, or have ground your teeth down it will affect your nutrition and general health because it will impact the sort of food and drinks you consume. 

And all of this impacts social interactions, self-confidence and quality of life. Problems with the mouth can progress quickly and silently and will only show once the situation is quite dire, and by then treatment required can take a lot of time, effort and cost. The message here is really about listening to your body, taking care of your body, going for your regular check-ups. And if not a dentist, also mention any symptoms to your doctor, physiotherapist or psychologist.

5. You mentioned that learning how to treat tmjd requires a lot of expertise. I know that's not a road you've chosen to go down in your practice. (And there don't seem to be too many experts here in the U.S. either. At least, not compared to how many general practice dentists there are.) Why do you think it's not a common expertise for dentists in Australia right now?

I think it’s a difficult area to understand. As mentioned previously, it is a very multi-faceted condition and requires detailed knowledge on many areas. So it's tough work to pursue and become a sole practitioner in the area of orofacial pain. 

I think personally it’s also very different work to general dentistry. The patient-dentist relationship is different, the gratification from your work is different – like any job, it takes a specific type of person willing to take on the difficulty and put in the hard yards because they have a passion for it. 

6. You and I already spoke briefly about why it's common for people with TMD to have a somewhat rocky road when seeking treatment, because there are so few specialists and not a lot of widely available public info. Why do you think it's not a hot topic in dentistry? Is it just old news to the medical world but misunderstood by the public?  

Again, in summary, because I may be repeating myself a lot, but I think it is largely misunderstood by professionals of the health world and public awareness suffers from our lack of understanding. 

Also it is any area where qualitative data is hard to gather, unlike the majority of the science we know in health. It’s hard to research and treat something where the cause is different and unique for each person. 

Unlike dental decay, an infection, a syndrome or disease where the cause is definable and science has allowed us knowledge to treat and/or manage it, the cause of brusixm or a TMD cannot always be defined and treatment can be trial and error because how can you fix something if you cannot define or control the cause [of the issue]?

7. And now for my Bridget Jones question. Last but not least, as an Australian dentist...were you offended by Finding Nemo?

By the movie? No! I love that story. Totally, grab shell dude! As a dentist, I do dislike how media continues to make dentists look like brutes, furthering the notion of ‘hating the dentist’. We know it’s not glamorous. We know it’s not comfortable. But all we want to do is help people.

8. Okay, I lied. One more question! Is there anything I didn't ask you that you'd really like to talk about?

Just a quick PSA! Dentists are humans too! We don’t know everything and we’re all just trying to do our part to help. It’s hard to keep your chin up when your week consists of people grumbling at you saying “I hate the dentist” or “I’ll be better once I’m gone”. 

We appreciate you coming to visit us, so please work with us. It’s ok to be scared. It’s ok to be anxious. Please don’t ever feel embarrassed. We are at your service, to help you. J

~

I hope you found some helpful answers in Stephanie's interview. I also hope you find yourself in a dentist's chair soon, asking them to check for signs of TMD before the pain starts. 

Dentist and TMD sufferer Stephanie Yap of Island Dental.

Dentist and TMD sufferer Stephanie Yap of Island Dental.