What is TMD?

It occurs to me that I’ve written about the experience of having temporomandibular disorder, but not what this poorly-understood affliction actually is.  And as some sources suggest a commanding fraction of adult humans have some sort of jaw dysfunction, looking into this strange affliction is a worthwhile exercise.

Temporomandibular disorder is a catchall term for broad symptom patterns that include pain in the mastication or chewing muscles and the temporomandibular joint, where the mandible meets the temporal bone of the skull.  A variety of known conditions can cause TMD symptoms, including gout, several kinds of arthritis, and head or neck trauma.  Other TMD cases, like mine, have no such tidy instigator, but still fall under the TMD umbrella.  This makes the term TMD rather like the term “cancer”: both describe potentially dozens or hundreds of distinct diseases with their own etiologies, severities, and treatment recommendations based on similar outward symptoms.  Muddying things further, the term “temporomandibular disorder” itself is not standardized, referring either to the entire complex or to the most common sub-pattern and being rarely used outside the United States.  So, my diagnosis can mean all sorts of things.

TMD was still a poorly recognized affliction when mine started, despite being a known recurring pattern of symptoms since the 1960s.  I described my symptoms as “headaches,” so that’s how they were tested.  I went through CT scans, MRIs, EEGs, back X-rays, and one memorable consultation with a psychiatrist who seemed to find my being introverted more diagnostic than a headache journal that had nothing in the “when it stopped” column and put me on tricyclic antidepressants for a few weeks.  Those left me in a dazed, zombie-like state in which I could tell that I still had the same aches but I could not be arsed to care, and I kept telling my friends the same jokes over and over.  I did not tolerate the Elavil somnambulance for long.  The X-rays, at least, revealed some partially fused vertebrae in my upper back that partly explain why I’m as picky about my chairs as I am.

(In Dr. Nelson Sanchez’s defense, tricyclic antidepressants are used off-label for migraines as well as for depression, so it was not a totally ridiculous prescription.)

The specialists revealed a very different picture than any of those examinations could have shown.   A combination of stress clenching and nocturnal bruxism put chronic strain on my jaw muscles, in particular the masseter and temporalis.  The resulting muscle strain made many common jaw movements painful or uncomfortable, something my conversation partners have noticed, and the loss of range of motion eventually caused both of my jaw joints to chronically misalign.  This cruel feedback loop compounds the strain, to the point that high school was one long ache in my temporalis muscles, never abating for four years.  In between, I had occasional episodes of acute, debilitating head pain focused on the backs of my eyes combined with nausea and extreme sensitivity to light and sound, which later acquired a hallucination pattern I came to recognize as the classic migraine aura.  Thinking back, I had at least one similar episode in elementary school, but I had no idea what was happening that day and convinced myself that I was cranky and that I really really disliked the Edgar Allan Poe poem “Anabel Lee” that was the subject of the day’s exercise.  Turns out I rather like that poem.

A series of diagrams showing a healthy jaw joint and one where the tissue behind the jaw has intruded into the joint, pushing the jaw forward.

In effect, I somehow acquired a repetitive stress injury to both jaw joints, similar in concept to carpal tunnel syndrome and exacerbated with stress.  The treatment was various sorts of occlusal splints or “bite plates,” mouthpieces I would wear during the day or at night thereafter to short-circuit my nightly teeth-grinding and keep my jaw out of unhelpful configurations.  I also received injections into the joints themselves and transcutaneous electrical nerve stimulation, or TENS.  A physiotherapist I visited suggested some exercises I do to reduce the underlying tension.  All of this turned my constant muscle aches to much more manageable constant muscle aches, to recurring but non-omnipresent muscle aches, to an unpleasant dull hum that forms the background noise of my life.  At the same time, this dramatically reduced my incidence of migraines, even though migraines are officially a separate, equally confusing condition that has a distressing amount in common with epilepsy.

With or without the treatment that makes this condition bearable rather than crippling, it has surprising effects on my quality of life.  It changes the way my voice sounds because of how it freezes my jaw.  It rules out small indulgences like gum that would otherwise dangerously exhaust my jaw muscles.  It means I have to be picky about how I sit, how I stand, and especially how I sleep, so that odd positions and postures don’t pull my neck muscles unduly and tug on everything else.  It dramatically limits the endurance and enthusiasm I can put into cunnilingus, to my stark frustration.  Eating, perversely, is an enhanced treat because those jaw movements are just enough to work out the knots of tension for an hour or so, adding a layer of pleasure to the consumptive act that others do not share.

The treatment that keeps my TMD symptoms down doesn’t do as much for these limitations as I might like, but it has had the nigh-magical effect of mostly removing that distracting haze of pain and discomfort that kept me weaker and less effective at virtually all of my activities for years, so I’m pleased with the results.  I have to be, because I’m going to be subject to all of this for the rest of my life.  My TMD is not the side effect of some other condition, but a problem in itself.  Because of that, it cannot be cured by current medicine.  This burden is mine, but now, it has a name.
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