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A fully functioning TMJ involves the temporal bone, the mandible, their articular cartilage, a fl exible disc or meniscus that separates the bones, and a stretchy joint capsule that allows a generous range of motion. The muscles that cross the joint are short and powerful, and they have higher resting tension than most muscles. This means that the mouth is mostly closed when we're relaxed. (It also means that those muscles get especially stressed when have our mouths open for long periods—for instance, when we undergo a dental procedure.) Because the masseter, temporalis, and pterygoid muscles are located close to—even overlaying—the TMJ, their actions are extremely effi cient. This gives us excellent bite force. (See the sidebar "How Strong is the Human Bite?" on page 42 for more information on this topic.) When any combination of TMJ components has a problem, the repercussions ripple far beyond the jaw. The pain that ensues can affect virtually every aspect of our well-being. The pain initiated by TMJ irritation can quickly develop aspects of chronic pain and central sensitization. This means that the symptoms a person experiences are generated in the central nervous system, and not necessarily tied to the severity of specifi c biomechanical damage. It also means that repairing any damage may not lead to resolution of the pain. And the whole-body compensations that develop in response to jaw pain can exacerbate that pain, creating yet another self-sustaining pattern. "I've had jaw problems for a while. I had some bad dental work in my 30s. I was in a couple of car wrecks, a dog bit my face, I had a fall. But I never had chronic pain until the last couple of years." SOME TMD STATISTICS It's hard to say how many people have TMD, because consistent diagnostic criteria for this condition have not been established. Instead, statistics on TMD symptoms like orofacial pain and chewing diffi culty are gathered as an indicator for how common TMD might be within a given population. Estimates suggest that some 10 million people in the United States have symptoms of TMJ disorders—this works out to about 1 in every 8 adults. Women are diagnosed 2–9 times more frequently than men. This is such an extreme discrepancy that some researchers consider estrogen receptors in the jaw to be a possible contributing factor for TMD. People who live with mood disorders (especially anxiety, posttraumatic stress disorder, and depression) or addiction have TMD more often than the general population. People who have rheumatoid arthritis (RA) are very likely to also have TMD problems (53–93 percent of people with RA report pain at the jaw). SOME TMD CONTRIBUTORS It is clear that while problems at the jaw may trigger pain responses, the way that pain is manifested throughout the body goes far beyond biomechanical contributors. However, it is important to understand possible anatomical disruptions in the whole TMD picture. The table below lists the Yo u r M & B i s w o r t h 2 C E s ! G o t o w w w. a b m p . c o m / c e t o l e a r n m o r e . 37 TMJ Structures and Damage structures usually involved in jaw problems, and what can go wrong with them. Here is a short list of possible contributors to jaw pain: • Trauma, for instance, a car accident or blow to the jaw. Trauma can cause muscle strain or irritation, disc displacement, and chemical damage to structures related to infl ammation. • Jaw use, in the form of bruxism, teeth- clenching, and repetitive activities like gum chewing or playing the violin. • Occlusion problems. A dysfunctional bite can distort the force that moves through the joint. Research suggests this can be one factor but is usually not alone. • Hormones. As stated previously, a link exists between estrogen levels and TMD risk. Further, the higher a woman's estrogen levels, the more pain with TMD she is likely to report. • Psychological factors, especially about stress management, can be contributors and sustainers of TMJ dysfunction. And having a chronic pain syndrome that interferes with both eating and self- expression is especially challenging. It is easy to see how the stress of dealing with TMD can exacerbate symptoms to the point that jaw pain quickly becomes a whole-body problem. "I know I've been kittywampus for years, but now I look in the mirror and I feel like I don't recognize myself anymore. It's incredibly upsetting." STRUCTURE DAMAGE IT CAN SUSTAIN Muscles (temporalis, masseter, lateral and medial pterygoids) Muscle injury, trigger points that refer to distant locations Joint capsule Can be stretched and infl amed Meniscus Can be displaced, torn, or worn down Articular cartilage Can be worn down, damaged by joint infl ammation Bones (mandible, maxilla) Can degenerate under the articular cartilage "TMJ Disorders" Watch Ruth's video by scanning the QR code or go to this page in the digital edition to view it.

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