Is asymptomatic the same as “normal” and is “No pain, No problem” the standard of TMJ care today?
Many chronic conditions such as hypertension, diabetes, heart disease, arthritis and neck problems go on for years without pain or notable symptoms by patients. TMJ dysfunction is also a progressive, measurable problem that ultimately leads to muscle or joint pain, bite issues, tooth fracture and loss, headaches, ear pain, dizziness, among other head and neck symptoms.
In medicine, it has become standard to consider chronic, measurable joint damage as “normal” only because it isn’t painful. There are many reasons this has come to be the norm and is accepted. Early intervention is better than almost all attempts to manage advanced bone and joint disease, especially the TMJ.
We know that infants that have short lingual frenum’s (tongue tied) don’t nurse well, have more problems eating as teeth erupt, and have altered jaw growth. Likewise, early allergies to foods and environmental triggers can enlarge the tonsil tissue in the nose and throat. This leads to a cascade of growth distortions throughout the maxilla, mandible, and TMJ that strongly influence the onset of TMJ misalignment, damage and dysfunction over time.
Crooked teeth are the initial sign (not symptom) that growth has been negatively affected. Straightening the teeth with braces may or may not correct an underlying TMJ problem. Sometimes the TMJ becomes symptomatic as orthodontics begins to move teeth that have an unstable jaw joint. Over our life, the adaptive systems change in response to direct injury, growth disturbances, and small or large injuries throughout the body. This is adaptation. As our adaptive capacities change over time, the compensation may be exceeded and pain or altered movement becomes noticed. One respected TMJ author (McNeill) estimates that 75% of the population may experience signs of TMJ/masticatory problems.
A study this year (2018) assessed the Temporomandibular Joints (TMJ’s ) of 186 randomly selected people between ages of 18-21 that had no symptoms of a TMJ problem or an obvious bite problem found upon closer evaluation that 33.4% of the TMJ’s examined had early stretching/damage to the TMJ ligaments. 8% showed incomplete disc displacement and 5% had discs that fully displaced. None had symptoms based on current dental misconceptions of TMJ dysfunction.[1]
The earlier children are screened by a TMJ expert the better the opportunity to guide growth through non-surgical orthotic treatment as they progress through orthodontics or as a general risk assessment as they approach the teenage years. This can help avoid more complex damage to the TMJ, and less effective therapy if intercepted earlier and growth is redirected back towards heath of the jaws and TMJ together.
[1] Assessment of the Temporomandibular Joint Function in young adults without complaints from the masticatory system: International Journal of Medical Sciences, 2018;15(2). Kondrat, Sierpinska, Radke.
