Pains + Anxiety +

Health Habits + Trauma = Chronic Pain

Repetitive injuries to TMD joint complex with poor healing ability sets up accumulative damage.

Poor healing ability is set up by poor health habits (PHH) over prolonged periods time

Did you know the jaw joint gets as damage in MVA as neck joints?

Why with multiple traumas as child, any open mouth procedure can set off painful TMD in 30's?

Why does pain from TMD's express itself during 30 to 50 year old women ? Grind & Anxiety peaks

Can you have severely damaged TMD without pain ? Yes, a few osteoarthritis cases show no pain.

Tearing Lateral Ligament TMD:

1. Blows 
2. MVA
3. Falls
4. Injury-sports

Did you know that majority of patients indicate no traumas ever ? Yet when ask specifics about childhood & teen years or our early driving record, we get multiple traumas, blows, falls, or injuries face or jaw.

All these blows, falls, traumas to jaw, cause tearing of Lateral Ligament of TMD:

lateral ligament TMD

MVA: Sudden acceleration deacceleration of condyle will tear lateral ligament of the temporomandibular joint.

In 22 of 25 post-whiplash cases, articular disc disorder was diagnosed.
Weinberg & Lapointe     1987. J Oral Max Surg          45:653

WHIPLASH illustration: Showing effect on TMD

Whiplash in ER:

1. Insurance will argue with ER doc on even neck images
2. Insurance refuses to allow any MRI imaging of TMD.
3. More damage to TMD occurs if there is blow to jaw
4. TMD occurs with even moderate whiplash
5. Tearing lateral ligament occurs with whiplash
6. Biggest concern for accident victim is completely displaced disc
7. Rapid referral to OFPS is only hope of recaputure
8. Did you know Medicare excludes jaw joint as not part body
9. So we go into ER financially necked w/ TMD damage

TALE TWIN SISTERS: following an MVA:

1. Cardiovascular condition sister has neck pain for week
2. Decondition sister has neck pain for lifetime

Cervical muscles

1. Pain in cervical system sets up guarding muscle activity in jaw
2. Cervical muscle contraction causes bracing in chewing muscles.
3. Poor posture neck causes reciprocal contraction hyoid then jaw muscles to brace

Progression of Disc displacement:

1. Clenching/grinding excessive muscle pull Superior Lateral Pterygoid (SLP)
2. Tension muscles set up variable contraction SLP
3. Pain in neck causes muscle bracing in chew & neck muscles
4. Sudden tearing lateral ligament in MVA, Fall, Blow

Tearing of lateral ligament of disc:

1. Pre-tear: micro tear from tension in muscles and clench/grind
2. Trauma: MVA: macro tear
3. Post-tear: increase micro tear from tension in muscles and clench/grind 

Reciprocal contraction:

1. Cervical bracing stimulates jaw clenching
2. Jaw clenching increases in cervical muscle activity

Sports-Related Injuries & TMD:

1. 11-18% all sports-related injuries were maxillofacial injuries
2. 44-99% of temporomandibular joint (TMD) problems are caused by trauma
3. Risk is dependent on sport played & amount  protection used
   1. female basketball injury rate = 7.5%
   2. female basketball 15 times higher than men’s football
4. males use more protective equipment (ACPF 37:3,2001)

MACRO TRAUMAS

Certain blows to jaw with right force and direction can tear the lateral ligament to jaw joint

Fall, produces tearing to lateral ligament of disc TMD

Neck muscle contraction causes hyoid muscle brace

Hyoid muscle brace causing jaw muscles contract

Jaw muscle brace increasing contraction rate of clenching braces muscles

The neck system aggravating chewing system is one reason why no one doctor or health care professional can manage TMD, it is too complex pathology as well as too complex joint.