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Michigan Head & Neck Institute

TMJ Blog

11. 29. 2017

TMJ

Could My Teenager Have TMD?

All children and teenagers have accidents, sports injuries, and countless falls throughout their youth. Most of the time, there is nothing to worry about. However, if your adolescent child says that they are experiencing pain, or they hear noises in their jaw, then they should be evaluated by a TMJ specialist (dentist who is skilled in TMJ orthopedics) right away.  It is possible that they may have sustained an injury to their TMJs (temporomandibular joints). TMD in teenagers is more prevalent than previously thought.

tmd in teenagers

 

could my teenager have tmd?

 

Acute macrotrauma is either an impact injury or hyperextension injury, like falling and hitting your chin on the ground.  TMJ disc displacement is usually the result of a ligament injury, and ligament injuries in the human body are a result of acute macrotrauma.  If a TMJ disc is displaced during adolescence, facial asymmetry could be a result. This is best documented through magnetic resonance imaging (MRI).  Facial asymmetry usually means that the TMJ dysfunction has reached an advanced level, as it has stopped the condylar growth within the joint, affecting the facial skeleton.

Teenagers who have injured their TMJs may have a midline discrepancy of their upper (maxillary) and lower (mandibular) teeth. This dental discrepancy happens naturally, because the teeth continue to occlude even after there have been changes – good or bad – to the TMJs.  Subsequently, this change in dental occlusion causes a midline discrepancy; TMD in teenagers eventually leads to facial asymmetry.

The best time to treat TMJ disc displacement is early in the process, which is why great emphasis is placed on taking your child to a specialist, should they become injured.  With the right treatment methods, further progression of TMD  in teenagers and associated symptoms/dysfunctions can be eliminated.

One condition that you may have heard before is something called “Cheerleader’s Syndrome”, which affects teenage girls who participate in sports activities.  This syndrome is known in the medical world as Idiopathic Condylar Resorption (ICR).  Very rarely is this condition seen in teenage boys.  According to studies, the frequency of females to males is 9:1.  Microtrauma and Macrotrauma to the jaws can either initiate a symptomatic response, or it can exacerbate an already present underlying condition.  ICR is a progressive disease affecting the TMJs, and can result in malocclusion and facial disfigurement as well.

Unfortunately, ICR is not well understood, but can be treated by the right clinician.  Patients who suffer from ICR are usually in their pubertal growth phase and have specific occlusal relationships.  They may even be candidates for orthognathic surgery or extensive orthodontics prior to the onset of the disease.

While no specific one cause has been identified, the female predisposition may stem from the levels of estrogen in the body.  Estrogen has been known to interfere with bone metabolism and cartilage within the joints.  Tissues surrounding the TMJs can be affected, then causing symptoms such as headaches, clicking/popping noises, jaw pain, facial pain and crepitus.

Treatment of TMD in teenagers is approached the same way as treatment of adults.  First, the initial screening is done, followed by the Head & Neck Exam, and Range of Motion (ROM) measurements.  A formal workup including necessary x-rays, impressions and MRI is performed, followed by a consultation to review the treatment options.  Achieving a stable joint position is done with a mandibular repositioning appliance that is worn in the mouth, much like a retainer.  Dr. Klein prefers conservative methods before surgery would even be considered.

This is one example of a mandibular repositioning device that could be worn:

As seen in the illustration below, the orthotic device will move the lower jaw forward, taking pressure off the jaw joint:

By wearing the appliance, it creates changes in your jaw joint/s to decrease and/or eliminate the existing pathology.  It does this by moving your lower jaw downward and forward to decompress the tissues within the jaw joint/s.

Aside from an intraoral appliance, physical therapy can be used, including the TENS unit, physical massage and/or heat applications.  Pain-relieving injections are also an option for more severe cases.  And of course, patient education is very important to Dr. Klein and his staff.  They are available to answer any questions you may have and can be reached at (586) 573-0438.

References:

Schellhas KP, Piper MA, Omlie MR. Facial Skeleton Remodeling due to Temporomandibular Joint Degeneration: An Imaging Study of 100 Patients. Cranio. 1992;10(3):248–259.

Ahn SJ, Lee SP, Nahm DS. Relationship Between Temporomandibular Joint Internal Derangement and Facial Asymmetry in Women. Am J Orthod Dentofacial Orthop. 2005;128(5):583–591.

Schellhas KP, Pollei SR, Wilkes CH. Pediatric Internal Derangements of the Temporomandibular Joint: Effect on Facial Development. Am J Orthod Dentofacial Orthop. 1993;104(1):51–59.

Simmons HC 3rd, Gibbs SJ. Initial TMJ Disk Recapture with Anterior Repositioning Appliances and Relation to Dental History. Cranio. 1997;15(4):281–295.

Simmons HC 3rd, Gibbs SJ. Recapture of Temporomandibular Joint Disks Using Anterior Repositioning Appliances: an MRI study. Cranio. 1995;13(4):227–237.

Wolford LM. Idiopathic Condylar Resorption of the Temporomandibular Joint in Teenage Girls (cheerleaders syndrome). Proceedings (Baylor University Medical Center). 2001;14(3):246-252.

Wolford LM, Cardenas L. Idiopathic Condylar Resorption: Diagnosis, Treatment Protocol, and Outcomes. Am J Orthod Dentofacial Orthop. 1999 Dec;116(6):667-77.

Simmons HC 3rd. Your 13-year-old daughter fell at school – She reports a clicking jaw – What Should Happen Next?.  Cranio. 2017, 35:3, 133-134.

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The contents of this website, such as text, graphics, images, and other materials are for informational purposes only. While there are many commonalities among multiple TMD and sleep apnea cases, each patient is unique. Information on this website should be used to educate the reader about what they should discuss with their doctor if they are suffering from the listed symptoms. The information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Seek the advice of your physician or you may call our office with any questions you may have regarding TMD or sleep apnea. If you think you may have a medical emergency, call your doctor or 911 immediately.


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