Dentists are not trained to treat TMD, but are rather just trained for the management of the pain that TMD causes.
TMD patients suffer from a variety of symptoms that are frequently misdiagnosed as something else. The symptoms include: head pain, headache, scalp pain, eyes pain, ear pain, stuffy ears, jaw pain, facial muscle pain, neck muscle pain, teeth sensitivity to hot and cold, etc…
Of all the symptoms TMD patients suffer, headache is the one that is most confusing to pinpoint. Headaches can be caused by a variety of conditions such as sinus infections, ear infections, eye infections, brain tumors, stress, or hormonal imbalances. Occasionally, patients get referred over to the dentists. But even the dentists cannot recognize what it is that causes the headaches as currently TMD education is non-existent for dentists. Dentists at this point in time are simply not trained to treat TMD directly, but are rather just trained for the management of the pain that TMD causes.
Ear problems are also very common for TMD patients. The TMJ is located extremely close to the ear canal and the middle ear. The muscles that surround the TMJ and the fascia and ligaments that holds the bones in place are intricately connected with the ear and the nerves that support the ear. The symptoms range from ringing in the ear to stuffy ear to ear pain to vertigo. As the mandible and the TMJ is pushed backward a state of compression to the ear happens. A compressed ear can also result in blockage of the Eustachian tube.
The Eustachian tube (pharyngotympanic tube) connects the middle ear cavity with the nasopharynx. It aerates the middle ear system and clears mucus from the middle ear into the nasopharynx. Opening and closing functions of the Eustachian tube are physiologically and pathologically important. Normal opening of the Eustachian tube equalizes atmospheric pressure in the middle ear; closing of the Eustachian tube protects the middle ear from unwanted pressure fluctuations and loud sounds. Mucociliary clearance drains mucus away from the middle ear into the nasopharynx, thus preventing infection from ascending to the middle ear.
Abnormal or impaired Eustachian tube functions (i.e., impaired opening or closing, defective mucociliary clearance) may cause pathological changes in the middle ear. This can then lead to hearing loss and other complications of otitis media (middle ear infection).
However, if a physician determines that the problems are not ear-related then it is then most likely from the TMJ. As the condyle is shifted posteriorly it puts pressure on the ear causing the problems. The middle ear controls balance, hence vertigo can be an issue as well. The shifting of the condyle can be as little as 1 or 2 mm. There are cases where the symptoms disappear after the mandible is moved forward only by 1-2 mm.
Many TMD patients have teeth grinding problems. (But not all teeth grinding problems are from TMD). As the mandible is forced to occlude with the maxilla during functioning and if the maxilla is retruded the mandible ends up being too far posteriorly. The mandible will attempt to reposition itself anteriorly. Grinding happens when the mandible moves forward during sleep. The teeth from the mandible make contact against the teeth from the maxilla, causing excessive wear and tear. This process happens throughout the night. The muscles of mastication (i.e. masseter, temporalis, medial pterygoid) are automatically activated when the teeth are touching. It is similar to having dinner for 8 hours straight. Bruxism (teeth grinding) is very detrimental to the teeth. They can develop fatigue and start showing crack lines. Teeth with crack lines are sensitive to hot and cold and susceptible to fractures. Patients who grind their teeth at night will feel sore in their facial muscles in the morning after waking up.