Temporomandibular+Joint+Dis-ease+(TMJ)

[[image:TMD1.png width="246" height="218" align="right"]]
A general term covering most chronic or acute inflammation, pain & soreness of the temporomandibular joint.

Etiology:
-Injury to the jaw, temporomandibular joint, or muscles of the head and neck - such as from a heavy blow or -whiplash -Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth -Presence of osteoarthritis or rheumatoid arthritis in the TMJ

Types
-**Myofascial pain** (most common form of TMD, which is discomfort or pain in the muscles that control jaw function and the neck and shoulder muscles) -**Internal derangement of the joint** (meaning a dislocated jaw or displaced disc, or injury to the condyle) -**Degenerative joint disease** (such as osteoarthritis or rheumatoid arthritis in the jaw joint) -A person may have one or more of these conditions at the same time. Scientists are exploring how behavioral, psychological and physical factors may combine to cause TMD.

Signs and Symptoms
-Pain, particularly in the chewing muscles and/or jaw joint, is the most common symptom. Other likely symptoms include: -limited movement or locking of the jaw. -radiating pain in the face, neck or shoulders. -painful clicking, popping or grating sounds in the jaw joint when opening or closing the mouth. -a sudden, major change in the way the upper and lower teeth fit together. possible swelling

Related Symptoms
Headaches Earaches Dizziness Hearing problems

Important note about angina: According to Richard N. Fogoros M.D., "Jaw pain is a fairly common manifestation of angina." "Unexplained episodic jaw pain should be evaluated by a physician"

Diagnosis
-Palpation of the TMJs and chewing muscles for pain or tenderness -Listening for clicking, popping or grating sounds during jaw movement -Examining for limited motion or locking of the jaw while opening or closing the mouth -Regular dental X-rays and TMJ x-rays are not generally useful in diagnosing TMD. Other x-ray techniques are usually needed only when the practitioner strongly suspects a condition such as arthritis or when significant pain persists over time and symptoms do not improve with treatment. These include: -arthrography (joint x-rays using dye) -MRI -CT

Biomedical Treatment
-NSAIDs -Tricyclic antidepressants: Antidepressants, such as amitriptyline or nortriptyline, taken at bedtime have proved effective in relieving TMJ pain. -Muscle relaxants: Drugs, such as carisoprodol (Soma, others), may be used for a few days or weeks to help relieve pain caused by TMJ disorders. These drugs can be habit-forming and should be withdrawn gradually. -Corticosteroid drugs. For significant pain and joint inflammation, corticosteroid drugs injected into the joint space may provide relief. -Botulism toxin. Injecting botulism toxin (Botox, others) into the jaw muscles used for chewing has relieved pain associated with TMJ disorders. -Bite guard. NTI is best. Bite guards sometimes aggravate sleep apnea symptoms. -Cognitive behavioral therapy. If symptoms of TMD are made worse by poorly managed stress or anxiety, cognitive behavioral therapy may be recommended. This approach includes interventions increase awareness of and change stress-inducing behaviors, learn relaxation techniques, and manage stress. -Corrective dental treatment: includes balancing the biting surfaces of your teeth, replacing missing teeth, or replacing needed fillings or crowns. -Arthrocentesis: involves insertion of a needle into the joint so that fluid can be irrigated through the joint to remove debris and inflammatory byproducts. -Surgery: Surgery to repair or remove the disk between the mandible and temporal bone may be beneficial. When advanced osteoarthritis is present, a partial or total joint replacement may help remove bone-on-bone contact and improve joint mechanics and motion.
 * Medications:**
 * Therapies:**
 * Surgical or other procedures:**

TCM Disease Categorizations
//Mian Tong:// “facial/jaw pain” //Nie Chi:// “gnashing of teeth” //Nie He:// “clenching of teeth” //Er Tong:// “earache” //Mian Fu:// “facial swelling”

TCM Etiology & Pathogenesis
-Physical strain or traumatic injury: results in Qi stagnation and Blood stasis in the channels and collaterals of the Shaoyang and Yangming; this, in turn, can lead to lack of nourishment (Blood and Qi) to the sinews over time. -Exogenous pathogenic factors: local vacuity of Defensive Qi and Blood allows invasion of Wind-Cold-Damp, causing obstruction of Qi and Blood in the channels and collaterals. -Emotional stress: excessive rumination (Spleen) or prolonged anger/frustration can cause bruxism or jaw clenching, leading to Qi stagnation and Blood stasis.
 * Repletion:**

-Poor diet: poor food choices and irregular eating habits can damage the Spleen and Stomach, leading to Qi and Blood vacuity. This leads to malnourishment of the muscle channels of the Shaoyang and Yangming in the face. -Chronic disease, aging: long-term stasis from chronic injury, decline of Qi and Blood/Liver and Kidney Qi due to aging, and certain chronic diseases (arthritis, ankylosis, neoplasms, SLE) results in lack of nourishment to the sinews and muscle channels of the Shaoyang and Yangming in the face.
 * Vacuity:**

Qi Stagnation and Blood Stasis
Symptoms: severe pain that is fixed in location and sharp or stabbing in quality; pain may be exacerbated by stress and is usually worse at night; patient may have history of traumatic injury to jaw
 * Tongue:** normal color and coat (if chronic, may be dark/purplish)
 * Pulse:** wiry or choppy
 * Treatment Principle:** Move Qi and quicken the Blood, eliminate stasis and relieve pain
 * Herbal Treatment:** Tong Qiao Huo Xue Tang (Unblock the Orifices and Quicken the Blood Decoction)

Wind-Cold-Damp Invasion
Symptoms: -Expel Wind, scatter Cold, eliminate Dampness, open the channels and collaterals, relieve pain -Scatter Cold, expel Wind, eliminate Dampness, warm and open the channels and collaterals, relieve pain -Eliminate Dampness, expel Wind, scatter Cold, open the channels and collaterals, relieve pain Wind Predominant: Fang Feng Tang (Siler Decoction) Cold Predominant: Wu Tou Tang (Aconite Decoction) Damp Predominant: Qiang Huo Sheng Shi Tang (Notopterygium Decoction to Overcome Dampness)
 * Wind predominant:** sore, aching pain that is intermittent or moves around
 * Cold predominant:** severe, fixed pain that is aggravated by cold and relieved by warmth
 * Damp predominant (a.k.a. Fixed Bi):** heavy, sore, fixed aching pain that is aggravated by dampness; swelling and numbness in the affected area may be present
 * Tongue:** possibly moist, white coating with Wind predominant or greasy, white coating with Damp predominant
 * Pulse:** floating, tight, slippery, slow are theoretically possible; wiry or tight are most common
 * Treatment Principle:**
 * Herbal Treatment:**

Qi & Blood Deficiency
fatigue, poor appetite, loose stool, abdominal distention, facial pallor, dizziness, palpitations
 * Tongue:** pale with scallops
 * Pulse:** thin and weak
 * Treatment Principles:** Boost Qi and nourish Blood, nourish the sinews, stop pain
 * Herbal Treatment:** Ba Zhen Tang (Eight Treasure Decoction)

Liver & Kidney Deficiency
soreness and weakness of the low back and knee joints, insomnia, dream-disturbed sleep, blurred vision, dizziness, tinnitus, loose teeth Herbal Treatment: Da Bu Yin Wan (Great Tonify the Yin Pill)
 * Tongue:** read with little coating
 * Pulse:** thin and rapid
 * Treatment Principles:** Supplement the Liver and Kidneys, nourish Blood and supplement Essence, nourish the sinews, stop pain

Acupuncture Treatment
Thread Tai Yang -> ST-7
 * Basic points:** SI-19, ST-5, ST-6, ST-7, Ashi, TW-17; LI-4, GB-20

Wind-Cold-Damp: TW-5, GB-20, Moxa Qi stagnation and Blood stasis: SP-10, LI-4, LV-3, GB-41 Qi and Blood vacuity: BL-17, BL-18, BL-20, ST-36, SP-6, GB-39 LV & KI vacuity: BL-18, BL-23, KI-3, KI-6, SP-6, LV-3, LV-8
 * Modification based on the pattern:**

Herbs for TMD:
Bai Zhi (Angelica root)-acrid, warm; LU, ST, SP Chuan Xiong (Ligusticum root)-acrid, warm; LV, GB, PC Xi Xin (Asarum herb)-acrid, warm; LU, KI Gao Ben (Ligusticum rhizome)-acrid, warm; BL, GV Man Jing Zi (Vitex fruit)-acrid, bitter, cool; BL, LV, ST