Thread by @BadgleyLaurence

TMD: Quite an analysis; which neatly confuses reasonable understanding of Temporal Mandibular Disorder (TMD). My next retweet of this analysis will bring etiology & treatment of TMD to a more understandable & clinically manageable level of understanding. Use of Botox intriguing.

https://twitter.com/BadgleyLaurence/status/1329192634280144896

TMD is a biomechanical disorder. & commonly found associated with Hypermobility Syndrome. Lay people commonly refer to this disorder as TMJ (disorder of the Temporal Mandibular Joint). The secret to understanding this order is to observe numerous people with this disorder.

My clinical findings in dozens of patients with TMJ & Hypermobility Syndrome (called Hypermobility Spectrum Disorder; HSD) is a thoracolumbar functional scoliosis (remits reclined when gravity is absented) with one shoulder lower & head tilted toward the lower shoulder side.

There is an explanation why this posture, which is commonly seen on the sufferers’ driver’s license pictures, is causal of TMJ.

TMJ typically occurs on up-side of face of a tilted head. My theory goes as follows: the brain prefers equal dental occlusion (same touch pressure of upper and lower teeth from side to side) as a functional preservation of dental proprioception; knowing head posture in space.

In order to maintain symmetric dental sulcus occlusion, the Masseter muscle on face-up side contracts to lift up the same side mandible bone, & does so against gravity. Over time, this unconscious splinting of one jaw muscle leads to chronic & painful spasm within this muscle.

In patients with TMJ, it is often possible to see asymmetrical 3/4 view facial contours, with more fullness & prominence on the side with the chronically spastic Masseter muscle, and the cheek is more full on this side.

There are other signs that attend the spastic, hypertrophic, and more hyperdynamic Masseter muscle. One sign is that when the jaw is open, & as the examiner grasps and pinches the spastic Masseter, pain is aroused; unlike on the other side.

Another clue is that as the spastic Masseter closes jaw, this hyperdynamic Masseter exerts excess & asymmetric force; causing TMJ on this side to more forcefully close than on the other side. This can arouse a clicking sound. This forceful closure can also damage the TMJ.

People with TMJ experience asymmetric opening of the jaw, & the proximal mandible condyles can be felt (palpated) to both shift laterally; often toward side of the symptomatic TMJ. Then, when the jaw closes, the side with the hyperdynamic Masseter forcefully slams the TMJ shut.

On side of TMJ, the mandible condyle closes into the joint fossa obliquely, & in doing so rides up & over the joint rim. The bony TMJ fossa is shallow anatomically. Nature gives the joint a cartilaginous natural rim to deepen fossa pocket of this joint; to stabilize this joint.

Over time, as the symptomatic TMJ closes, the hyperdynamic mandible condyle scrapes the shallow rim of the TMJ; wearing it down; causing permanent & painful damage to the joint rim. This Masseter pain and facial pain explains why so many people have TMD.

Over time, the TMJ rim becomes degraded & the joint becomes sloppy & even more greatly prone to subluxation, stretch of TMJ ligaments, and pain generation .

IMO, pain of TMJ disorder is generated by stretched joint ligaments & chronic muscle spasm of the associated Masseter muscle.

THERAPY: an SIJ belt helps to stabilize the pelvis, reduce a functional scoliosis, reduce shoulder asymmetry, & reduce head tilt. Yoga for back muscles; perhaps a shoe lift to elevate the lower shoulder side; shrug exercises to tone the shoulder Superior trapezium muscles.

ADDITIONAL THERAPIES: massage & biofeedback to the spastic Masseter muscle; chewing gum on face-down side to correct crossed muscle syndrome of the Masseters; perhaps a night dental splint; Cannabis lotion & heat to the spastic Masseter muscle to relax it.

TMJ disorder is an example of asymmetry of an upright body tower often seen in those with Hypermobility Syndrome, which is associated with Fibromyalgia. The head weighs ~10 pounds & is at top of the body tower. Asymmetric shoulder girdles potentiate chronic head tilt.

TMJ disorder is terribly painful & debilitating. There are probably as many theories of etiology of TMJ as there are doctors & dentists interested in this problem. Disconcertingly, the majority of doctors and dentists have precious little interested in this disabling disorder.

The observations, theories, and the therapy set discussed in this essay are my own unique inventions. I routinely use my methods with patients who have TMJ & with some success. The data I have collected are case studies.

Not all medical clinical problems need to be subjected to placebo controlled random trials to discover medical truths. To my mind, if a rational therapy provides evidence of benefit, then that benefit demonstrates that the theory of etiology was correct.

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