#8 TMD is a Progressive Disease, It only Gets Worse over Time

I write this series of articles for patients, not doctors.  I intend to view TMD from the patient’s point of view because it is the patients who are most confused regarding this problem they call “TMJ”.  There are many reasons why they are confused.  The first and greatest reason patients are confused is because the doctors (providers) are confronted with the disparate symptoms of TMD and themselves confused.  It staggers my imagination that a problem first identified almost 90 years ago has so few health providers totally in the dark.  But that is the case.  If you are a provider and want to learn the facts about TMD I refer you to my podcast on the “Dental Town” platform entitled “TMD Demystified”.  This podcast currently has 68 episodes which cover all aspects of TMD that are important and relates to the provider.  However, this article is directed at patients.  The more health providers are enlightened regarding TMD the less confusion will occur for patients.

But this article is directed to patients.  One of the most surprising things I discovered about TMD as I began treating patients non-surgically is how long many of the patients had obvious TMD symptoms that had gone undiagnosed or misdiagnosed or directed correctly.  Based on heath histories of over 4000 patients, the average patient has symptoms of TMD for 20 years before being correctly diagnosed.  This does not mean that every patient has 20 years of symptoms before being correctly diagnosed.  Some have symptoms for only a few months and some have had symptoms for 40 years.  But, in our practice, I estimate the average length of time a patient exhibits symptoms of TMD before being correctly diagnosed is 20 years.  That is a direct reflection on the knowledge of the health providers, not the knowledge of the patients.

There is a usual and customary history so common that is worth sharing in hopes that some of the cases of TMD will be recognized early rather than after 20 to 40 years.  As discussed earlier, TMD is primarily a female problem.  It is primarily a female problem because estrogen exacerbates inflammation.  In the female, the history starts as follows.  At age 12 through 15 the first symptom usually experienced is headaches.  These headaches can be preceded and associated with a clicking sound of the TMJ at any time.  But the most common first symptom is headaches shortly after the female reaches puberty and begins menstrual cycles. This is coincident with the large fluctuations of the estrogen hormone.  The other three most common symptoms of TMD, earache, neck pain, and jaw pain can also become apparent in the early stages but may also appear as time goes on.  The one thing about TMD that is absolutely consistent is the progressive and cyclical nature of the symptoms.  Progressive and cyclical symptoms are the hallmark of TMD 100% of the time.  The earliest symptom experienced does not have to be headache, however headache is usually the first symptom.  On occasion, earaches, neck pain, and jaw pain my be seen first.  As the months and years roll on the symptoms cycle and become worse and some of the other symptoms begin to appear.  Tinnitus (ringing or buzzing in the ears), subjective hearing loss (fullness in the ears) and vertigo (dizziness) appear much later after the initial symptoms.  These three symptoms are also the most common in males with TMD.  Males with TMD usually present for examination with a totally different history when compared to females.  The male variety of TMD deserves its own article and will not be covered at this time.

By the time the TMD patient begins to experience shoulder pain and arm/hand/finger tingling and numbness the initial symptoms of headache, earache, neck pain and jaw pain have been going on for years.

Finally, after many years of symptoms the patient begins to experience various types of jaw locking.  Although jaw locking is usually seen during the later stages of TMD it can appear at any stage of the disease and at any age.

Finally, a word needs to be said about jaw clicking.  Clicking of the jaw joints without pain is frequently experienced by patients as the very first indicator that the TMJ’s are not healthy and undergoing progressive damage.  A clicking noise of the joint is not a good sign, but not a symptom.  It is a sign of ill health in the joint.

You can see that TMD is a progressive disease that only gets worse over time.  The best time to seek treatment is when the first symptoms occur.  Clicking is a sign, and I usually tell patients to return for treatment when they experience their first symptoms.  It is true that that many patients can experience clicking and can go for years without experiencing symptoms. Treating clicking without other symptoms is not recommended.