10 Facts to get straight with your TMD patient

The theoretical concept of illness perception model suggests that patients tend to develop beliefs about the cause, severity, prevention behaviours and treatment of their condition, when confronted by symptoms and signs of an illness. It is a way for patients to give meaning to their own disease and its symptoms. These beliefs are modulated by several factors including culture, gender, psychosocial aspects, level of knowledge and previous experiences. Illness beliefs further influence the patients’ emotional response, which can lead to feelings of helplessness, guilt and/or depression.

In the context of temporomandibular disorders (TMD), where patients present with increased levels of distress and impairments in quality of life, misconceptions about their jaw condition can delay appropriate diagnosis, hinder their compliance to treatment, and consequently this increases the risk of developing chronic TMD. The healthcare professional plays a pivotal role to amend these misbeliefs through understanding the patients’ initial beliefs about their condition and disseminating evidence-based knowledge in order to reduce pre-existing barriers that they bring to their consultation. 

A recently published article by Cintra et al. reported 10 common patient misbeliefs about TMD, and how the healthcare professional can rectify them by getting the facts straight. 

1.Everyone has TMJ, but not TMD

TMJ stands for temporomandibular joint. It allows the opening and closing of the mouth and is located in front of the ear. TMD, temporomandibular disorder, is the disease that can affect the TMJ, the muscles of mastication and associated structures.

2.There are different types of TMD, with different signs and symptoms and different treatments

Pain in the face, head or ear, joint clicking or crepitation, deviation and jaw locking are all signs and symptoms that can be present in TMD. TMD however is not a single disease, and each condition requires its own specific treatment. 

3.TMD commonly causes persistent or recurrent pain in the face, jaw, head and ear. Although this may cause apprehension, TMD is a benign disease.

Many patients believe that TMD is a serious condition. While TMD can disrupt daily quality of life, it is not a serious life-threatening disease. Information about the condition and assurance of its benign and generally non-progressive nature can be helpful to alleviate this fear.

4.The persistence or recurrence of pain caused by TMD is rarely sustained by tissue damage

There is not a single causal factor for TMD. While excessive mouth opening, masticatory effort and jaw trauma are known risk factors and can cause injury to the TMJs and masticatory muscles, leading to pain and dysfunction, the resultant condition typically heals within three months. If pain persists beyond this period, there are most likely other contributing factors such as genetics, poor sleep, stress, anxiety, negative thoughts and emotions, and pain in other regions of the body. 

5.Imaging exams rarely show the cause of TMD pain

While CT and MRI of the TMJ may show bone degeneration, deformed or displaced disc, marrow oedema and synovitis, these findings do not predict how much pain a patient experiences or how much it impacts their quality of life. TMJ imaging however is still useful in cases when the clinical diagnosis remains ambiguous or unclear.

6.Joint noises do not mean that your jaw will wear out or dislocate

Jaw popping and noises tend to stabilise over time and rarely progress to a more serious problems. Treatment is necessary when these noises area associated with pain, dysfunction or social embarrassment. 

6.Missing teeth are not the cause of TMD pain

The number of teeth, whether they are aligned or not, and even facial asymmetry do not cause TMD-related pain or dysfunction. On the other hand, the presence of TMD pain can alter the way you chew and position your jaw. Tooth replacement, bite alignment and surgeries to correct facial asymmetry should be performed for the purpose of improving chewing and aesthetics, but not to treat TMD.

8.Bad posture is not the cause of TMD pain

While back and neck pain can contribute to the persistence and recurrence of TMD pain, the way you sit, stand or position your head and neck is not the cause of TMD pain. 

9.Bad jaw habits contribute to the cause of TMD pain

Jaw habits performed while awake such as clenching your teeth, tensing your jaw, chewing gum, biting fingernails, biting objects, holding the phone with your shoulder may contribute to TMD pain in vulnerable individuals. 

10.Braces, dentures and surgery are not the first choice of treatment for TMD

Dietary counselling, hot and cold compresses, relaxation techniques, physical therapies, splint therapy and reversing parafunctional jaw habits are effective, safe, cheaper and less invasive. Orthodontic and prosthetic treatments are unnecessary for the treatment of TMD. Minimally invasive TMJ surgery may have a role in select cases of TMJ disorders; however surgery may not solve the problem and may be associated with adverse effects. “Total joint replacement” is rarely required and is typically reserved for cases where all non-surgical and minimally invasive treatments have been exhausted. It is important to avoid the early use of aggressive and irreversible treatments, with conservative treatment being the most recommended for the initial care of TMD. 

For further reading:

Cintra, DN, de Oliveira, SAS, Lorenzo, IA, Costa, DMF, Bonjardim, LR, Costa, YM. Detrimental impact of temporomandibular disorders (mis)beliefs and possible strategies to overcome. J Oral Rehabil. 2022; 49: 746– 753. doi:10.1111/joor.13330