B (2:45)

I have. And some areas of the country have more than others. But teeth, yes. Some areas of the country have more teeth than others. And they have varying degrees of, like, dental problems.

A (2:56)

And one of the biggest problems out there is TMJ disorders, or tmd. That is a suite of disorders affecting the tmj, or temporomandibular joint, which moves every time you chew, speak, or open your mouth. It's a joint that actually connects your jaw to your skull. And when that joint becomes strained or injured, it can cause stiffness, jaw dysfunction and pain. And this is not some niche problem. Tens of millions of people in the US have some form of tmd, and Justin specializes in treating it.

B (3:26)

Really what I do on a regular basis, like every day when we're seeing a new TMJ patient is diagnosis, assessment, figuring out what the problem is and then where it's coming from. And then, you know, that helps direct treatment from there.

A (3:41)

So today on the show, we sit our butts down in the dentist's chair to investigate one of the most pernicious problems of all. TMJ disorder. Why people get it, who's most susceptible to it, and how relief is possible. I'm Emily Kwong and you're listening to Shortwave, the science podcast from npr.

C (4:06)

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A (4:54)

Rooted in a history of diverse products spanning the healthcare industry, from wound care therapies that can accelerate healing to dental restoratives that preserve smiles. See how they're solving for you. Visit solventum.com okay Justin, so I read that an estimated 5 to 10% of the US population has some form of TMJ disorder. That is a lot of people. Do we know what causes this and who is most susceptible to developing it?

B (5:23)

Yes and no.

B (5:25)

So the overwhelming majority of TMJ issues are related to a cartilage pad that sits on top of the Bone in your jaw joint and the position of that cartilage pad. Overwhelming majority of people, popping, clicking, locking the jaw. Majority of those issues at some point are related to that cartilage pad not being in the proper position, which affects the movement of the joint and, you know, and then symptoms that are associated with that. Now, who's more susceptible? That's what we don't really know about. Oh, so sometimes, like, people who don't have teeth in the back of their jaw that might lead to an unsupported jaw joint, you get strain on the ligaments that support that cartilage pad, and then you have a problem that is associated with it.

A (6:15)

Got it. Okay. How do our teeth, which sit on the jaw, affect this joint, which is all the way. The jaw joint is like, all the way in the back, right? It's like right below our ear canal. So, like, when we look at the architecture of the jaw, why do our teeth matter?

B (6:32)

Right. So, you know, again, like, the teeth ultimately are the support system to the joint. So, like, let's just say, like, you don't have any teeth on half of your mouth, so you're going to chew on the left side of your mouth and you're going to probably develop a habit with the way that your jaw wants to rotate and shift to be able to function, to talk, to be able to chew, you know, to be able to say how great your podcast is. Your jaw joint is moving around every time that we're speaking or eating or functioning. And so if you're unsupported on one side, you start to develop habits with the way that you move your jaw to be able to function, and then that can weaken the structure. So again, using like, analogous to, like an orthopedic issue, like a hip issue. If you had one leg that's shorter than the other, it's a really common reason for having misaligned, you know, pelvis and start develop hip and back pain. And so really, it's the same type of thing. At the end of the day, I.

A (7:36)

Never realized our teeth support our jaw. Without it, we would just have a gap mouth. I thought the teeth supported my appetite. You know, like, emotionally speaking, the teeth. But the teeth are, like, serving an architectural purpose in our head, right?

B (7:54)

Oh, my God. That's a structure. Oh, no, it's an extension of the bone. And it's harder than bone in some cases. But, I mean, they really do matter. They're supposed to be there.

A (8:04)

What are some of the signs that a person has tmd and what are the Signs that they don't like. How do you even go about diagnosing this?

B (8:12)

Well, my TMJ exam is longer and more detailed than anything else that I do, including most surgeries that I do. And part of that reason is you really have to listen as a provider. And so, like, you know, do they have locking of the jaw? Do they have dislocating of the jaw? Like, you know, maybe just one side of their jaw is having a problem and the other one's moving fine. Maybe their jaw deflects a little bit. You know, it doesn't. Doesn't move so well on one side. But you start by listening, and then, you know, you. You compare, you know, what they're saying to what you're seeing on an exam. And then we take an X ray, we see if, you know, there's changes in the bone. You can get MRIs of the jaw joint, just way same way you get MRIs in a knee. And so, like, you know, those are. Those are forms of assessment.

A (8:56)

How do you say, like, aha. It is temporomandibular joint disorder. It's TMD for sure. What are you looking for?

B (9:03)

Mri.

A (9:03)

Mri.

B (9:04)

MRI proves it. You look at an image and you're like, well, cartilage is supposed to be here, but it's actually there. And you can't. MRI doesn't lie. So, you know, once you see it, you know it. I look at the health of the bone and the position of the bones, and so if there's not a lot of space in there, normal space for the cartilage to be sitting in, then the cartilage probably isn't sitting in the right spot. You can also see the health of the bone. And so inside the cartilage pad, there's synovial cells. And synovial cells produce a fluid that acts like a lubrication, but also nourishment to the bone. And so, like, again, while you're functioning, you're talking, you're chewing, you're breathing, moving your jaw around to do those things, you have to be able to heal from normal function. And so when that cartilage pad is not sitting in the right area, synovial fluid is not in the right area either. You have a diminished capacity to be able to heal, and you start to develop bone changes that you can see on an X ray in a lot of cases.

A (10:05)

Okay.

B (10:05)

And so it's all, you know, it's all related at the end of the day.

C (10:10)

Yeah.

A (10:11)

So once you make a diagnosis or you have a pretty good sense that, yes, Someone has tmd. What treatments are you pursuing? Like what. What do you think people should be doing to get help for this?

B (10:24)

Treatment ranges from things as simple as occlusal appliances. So like a thick invisalign retainer that sits on the teeth and just takes some of the pressure off the joints. Kind of like a knee brace, you know, would be on like a knee injury. But you also have, like, minimally invasive, like, procedures like this procedure called arthrocentesis, which really is just using some needle holes to inject water through the jaw joint, get rid of inflammation, get rid of some byproducts that are in there. And sometimes we inject things into the joint, like prp, which is essentially like a stem cell injection. We harvest some blood and concentrate growth factors from the blood and inject that in and around the joint to help reduce inflammation. People are injecting things like fillers like, that they use for, like, lip off label, obviously, but like they inject that in the jaw joint.

A (11:22)

So these are all of the more minimally invasive treatments. What about more invasive procedures like open joint surgery? What do you think of that?

B (11:29)

Right. I think majority of TMJ issues probably don't even need surgery at all. Yeah, but open joint surgery, you know, can fall into a couple different brackets. If it's a cartilage issue and the cartilage is in the wrong position.

A (11:43)

Yeah.

B (11:43)

You can reposition it and essentially hold it in place with a permanent stitch. But sometimes you have to remove the cartilage. Those are all day procedures.

A (11:53)

Like, if you're worried about tmd, who should you see?

B (11:57)

Always you start with your dentist.

A (11:58)

They're like your primary care doctor for your mouth.

B (12:01)

Exactly, exactly.

A (12:02)

Right. What can people do to manage jaw pain of any kind at home?

B (12:08)

Go see a dentist.

A (12:11)

You can't worm your way out of this.

B (12:14)

No, yeah, sorry. If you go on Amazon, you can find appliances that you can make at home. Those create more issues, way more issues than they ever solve.

A (12:25)

Oh, no. So don't be buying occlusal. That's what they're called, occlusal appliances. Don't go buying those on the Internet.

B (12:33)

It doesn't work.

B (12:36)

It keeps me in business.

A (12:40)

When you think about the next generation, how do you want TMJ to be incorporated into.

A (12:47)

Education and how people in your field are thinking about it.

B (12:50)

Yeah. So what we gotta do is we gotta standardize our TMJ education across dental education. And then everybody is just getting the same foundation when they're coming out of school and they're knowing they have the same tools at their disposal, same information, knowledge. That's I mean, that's the biggest thing. And we're starting to do that, which is amazing. That's the most exciting thing as a dental community, if we all can get on the same page on what the problem is and how to go about treating it.

C (13:24)

Wow.

A (13:24)

Wow.

B (13:25)

Sky's the limit.

A (13:26)

Justin, thank you so much for talking to me. It was fantastic. And as someone who loves my dentist, shout out to my dentist, it's great to have you on the show.

B (13:35)

Thank you so much, Emily. Really appreciate your time.

A (13:40)

And short wavers. Just so you know, this will not be the last episode we do about the dentist justice for our teeth. So if you have a question, email us@shortwavenpr.org this episode was produced by Burley McCoy. It was edited by Rebecca Ramirez. Tyler Jones checked the facts. Jimmy Keeley was the audio engineer. Beth Donovan is our vice president of podcasting. I'm Emily Kwong. Thank you for listening to Short Wave, the science podcast from npr.

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