TMJ Survey Yields Valuable Insights Into Condition, Sufferers
The TMJ Association, Ltd. has released the results of an extensive survey they conduceted with 1,511 people living with temporomandibular joint disorders (TMJD). The goal for this survey was, "…to provide patients, providers, and scientists with a fuller understanding of these conditions - who experiences them, and the treatments being recommended to TMJ patients and whether these treatments help them."
TMJD, as defined by a 1996 National Institutes of Health Technology Assessment Conference on Managing Temporomandibular Disorders, is "a collection of medical and dental conditions affecting the joint and muscles of mastication, as well as contiguous tissue components." It is thought that as many as 10 to 36 million adult Americans are affected by TMJD.
Demographics: Survey participants were 90 percent women; 96 percent were non-Hispanic white; average age was 40.8; 70 percent were employed; 79 percent had some college or a college degree; 57 percent were married, 29 percent had never been married and 12 percent were divorced.
Onset and Diagnosis: Slightly more than half of the survey respondents said their TMJD-related pain began between the ages of 18 to 39. On average, they reported that it took approximately four years following the onset of pain to receive a diagnosis. When they were finally diagnosed, 73.6 percent of the diagnoses were made by a dentist and 21.8 percent by a medical doctor.
Perceived Cause: Given a list of possible causes of TMJD, survey participants were asked to indicate which they personally believed caused or contributed to their condition. The results were:
- Trauma - 65 percent
- Stress - 49 percent
- Teeth clenching - 47 percent
- Arthritis - 17 percent
- Orthodontics - 11 percent
- Dental problems - 9 percent
- Heredity - 9 percent
Pain: Using the 0 - 10 pain scale with 0 equates to no pain and 10 is the worst pain ever, 80 percent of respondents reported an initial pain score of four or more. Within the last four weeks, 53 percent said they had a pain score of 4 or more and 56 percent reported severe pain "off and on all day." Fifty-three percent indicated that the pain had mildly to moderately interfered with their work, while 23 percent said it had extensively interfered with their work-related activities.
Therapies: Participants were asked to rate the effectiveness of a variety of nonsurgical and nonpharmacological treatments that were recommended by their health care providers. It turned out that the most frequently recommended treatment was also the most effective. Thermal therapy (the application of hot or cold compresses) was used by 65 percent of the respondents and 74 percent of those who tried it said it helped reduce their symptoms. The second most recommended therapy was jaw exercises (60 percent), however, only 49 percent of those using it felt it was effective. Fairing a little better in effectiveness was the flat-plane/stabilizing splint (orthotic) with 52 percent trying it and 56 percent feeling it had helped reduce symptoms.
Medications: Respondents reported that a number of different medications had been prescribed to treat their TMJD. Following are the medication categories and the percentage of participants for whom they had been prescribed:
- Anti-inflammatories - 73.3 percent
- Nonprescription pain relievers - 56 percent
- Antidepressants - 50.5 percent
- Opioids - 48.3 percent
- Anti-anxiety medications - 40.8 percent
- Muscle relaxants - 40.3 percent
Surgical Procedures: A substantial number of participants (394) reported having undergone one or more major surgeries to address their TMJD symptoms. Of those who had undergone surgical procedures:
- 54 percent had one to three surgeries
- 30 percent had four to nine surgeries
- 15 percent had 10 or more surgeries
The surgical procedures were also rated as to effectiveness.
Less invasive surgeries (arthrocentesis and arthroscopy):
- 54 percent - Somewhat or significantly better
- 17 percent - No change
- 26 percent - Somewhat or significantly worse
More invasive surgeries (condylectomy, condylotomy, coronoidectomy, disc plication, eminectomy, and maxillary or mandibular osteotomy):
- 6 percent - Significant improvement
- 32 percent - Some improvement
- 28 percent - No change
- 46 percent - Somewhat or significantly worse
Comorbid Conditions: People with TMJD tend to have other comorbid (overlapping) conditions as well. According to this survey, the nine most prevalent comorbid conditions were:
- Tension headaches
- Degeneragive arthritis
- Chronic fatigue
- Gastrointestinal issues
In addition to identifying other conditions they had experienced, respondents were asked to indicate whether these conditions occurred before or after the onset of TMJD. All of the comorbid conditions were found to be much more prevalent after the onset of TMJD.
If you would like to see additional survey results, you can download a copy of the full journal article with accompanying tables here: Temporomandibular Disorders and Associated Clinical Comorbidities
Hoffmann RG, et al. Temporomandibular Disorders and Associated Clinical Comorbidities. Clinical Journal of Pain. 27(3): 268-274, March/April 2011.