Management of TMJ Disorders (Podcast)

Expert advocates for a stepladder approach

Teeth should only come in contact when you swallow, says Karyn Kahn, DDS in Cleveland Clinic’s Section of Dentistry and Oral Surgery. Habits such as teeth grinding and clenching, gum chewing and nail biting can contribute to temporomandibular disorders, causing pain and dysfunction in the jaw joint and muscles.

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In a recent episode of Cleveland Clinic’s Head and Neck Innovations podcast, Dr. Kahn discusses the management of TMDs, including temporomandibular joint disorders (TMJs).

“It’s a stepladder approach to TMD management,” says Dr. Kahn, who serves as a consultant for craniofacial pain and jaw dysfunction with Cleveland Clinic. “We don’t have to jump right into a surgical procedure. We will find out what works conservatively.”

Dr. Kahn delves into:

  • Symptoms of a temporomandibular disorder
  • The diagnosis process for TMDs
  • Conservative therapies, including stabilization appliances and minimally invasive surgery
  • Promising treatments on the horizon
  • Advice for providers on when to refer patients with suspected TMDs

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Click the podcast player above to listen to the episode now, or read on for a short edited excerpt. Check out more Head and Neck Innovations episodes at clevelandclinic.org/podcasts/head-and-neck-innovations or wherever you get your podcasts.

Excerpt from the podcast

Dr. Kahn: What I enjoy most about the practice of temporomandibular disorders is the patient interaction and the co-discovery of what is going on with some of their symptoms. The symptoms of a temporomandibular disorder can vary from headaches to ear pain to ear stuffiness, tooth pain, TMJ clicking, popping, limited jaw opening and painful mastication.

It can oftentimes affect their quality of life. And then they've been to a provider with ear pain, and there is no pathology noted or reason for their pain. Where does this come from? Well, we can then look a little bit further – look at the oral habits that are going on. I look at the temporomandibular joints to see if the function and the source of pain is actually in the joints. However, in the majority of patients, I would say it's more muscle-related.

When we say muscle, we're referring to myofascial pain with referral. That's when it gets very, very interesting and very, very confusing to patients. For example, ear stuffiness can be the result of a clenching muscle, but we can't rule out any pathology either. So, that's how we work hand-in-hand with our head and neck providers to clear them for any pathology.

Then, let's go ahead and look for another cause for their pain, and with that, I look upon that as a co-diagnosis. We work with our patients to identify parafunctional habits, such as gum chewing, clenching, and grinding at night. We look at their occlusion to see if that's related to an overload to the joints and the muscles, and we come up with a plan then.

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