Bill Klaproth (host):
This is OMS Voices, an AAOMS podcast. I'm Bill Klaproth. And with me is Dr.
Gary Bouloux, who is here to discuss TMJ disorder, causes, symptoms and
treatments. Dr. Bouloux, thank you for being here.

Gary F. Bouloux, DDS, MD, MDSc, FRCS (Eng), FACS: Happy to be here, Bill.

Bill Klaproth (host): Yeah, thank you so much. So, let's
talk about this. What is TMJ? We hear this a lot. So, tell us what is it?

Gary F. Bouloux, DDS, MD, MDSc, FRCS (Eng), FACS: Ironically, it's not a disease or a
disorder, it's just the temporomandibular joint or the jaw joint. And everybody
has two of them and, obviously, use to eat, chew, talk and live life.

Bill Klaproth (host): So, being that it is used more
than any other part of the body, it's susceptible to wear and tear and other
things. Is that right?

Gary F. Bouloux, DDS, MD, MDSc, FRCS (Eng), FACS: Just like a knee or hip.

Bill Klaproth (host): Right. So then, what causes TMJ
disorders?

Gary F. Bouloux, DDS, MD, MDSc, FRCS (Eng), FACS: That's a very good question. And majority
of the time, we really don't understand. We generally consider microtrauma and
macrotrauma to be major players. Microtrauma is typically overuse for different
reasons. Clenching, grinding, excessive functional activities, parafunction,
biting fingernails, chewing chewing gum. But many instances, we really don't
have an understanding.

Bill Klaproth (host): Okay. Is this something that as we
all age, since we're using, you know, these muscles so often, it just kind of
wear and tear. Is that true too?

Gary F. Bouloux, DDS, MD, MDSc, FRCS (Eng), FACS: In many patients, it is the younger
patients tend to be less wear and tear, but there tend to be a lot of
psychological factors, anxiety, stress, those sort of things, which overlay
increased activity of both the muscles and the jaw joints that seem to
predispose many individuals to disorders early in their lives.

Bill Klaproth (host): So, what are the symptoms then of
TMJ disorders?

Gary F. Bouloux, DDS, MD, MDSc, FRCS (Eng), FACS: The classic symptoms are pain with biting,
chewing, yawning; fatigue that develops with prolonged chewing, limited
opening, popping and clicking in the joint, which may or may not cause pain; or
limited opening.

Bill Klaproth (host): So, what about other things like a
headache or ringing in the ears? Can it cause those types of things too?

Gary F. Bouloux, DDS, MD, MDSc, FRCS (Eng), FACS: Absolutely. When you think of headache,
there are multiple causes of headache. And one of the designation is
temporomandibular joint disorder-generated headache, which can be hard to
distinguish from regular headache and takes a thorough history and physical
exam.

Bill Klaproth (host): Right. So, that's how you diagnose
it then. So then, how is TMJ disorder treated?

Gary F. Bouloux, DDS, MD, MDSc, FRCS (Eng), FACS: It varies. Most of us like to approach
things conservatively initially, which means a soft diet, vocal rest, heat,
anti-inflammatory medications and muscle relaxants. And sometimes an occlusal
orthotic splint, if you will, that patients wear between their teeth. After that,
if that's not successful on a different patient candidate and if needed, we
move on to surgical procedures. Some of which are minimally invasive and some a
little bit more invasive.

Bill Klaproth (host): Do you ever get to the point of
joint replacement?

Gary F. Bouloux, DDS, MD, MDSc, FRCS (Eng), FACS: We do. It has become more mainstream over
the last 20 or 30 years to approach some patients with joint replacement once
they have failed more minimally invasive procedures. And the outcomes are
excellent for the majority of patients.

Bill Klaproth (host): So you mentioned earlier rest,
soft food, things like this can help TMJ disorder. For the general population,
can they manage it like that and will it go away on its own for someone who
gives it rest, you know, soft foods, things like that?

Gary F. Bouloux, DDS, MD, MDSc, FRCS (Eng), FACS: That's a great question, Bill. And the
answer is yes, the majority of patients do quite well with conservative
treatment over a period of time. And it tends to be a self-limiting disorder in
the majority of individuals.

Bill Klaproth (host): At what point should someone see
an OMS?

Gary F. Bouloux, DDS, MD, MDSc, FRCS (Eng), FACS: I think when you get to the point where if
the pain is severe or the functional limitation is severe or if you find the
symptoms are more mild, but they haven't improved over a month or two, that would
be a great time to see your oral and maxillofacial surgeon.

Bill Klaproth (host): So then, speaking of that, how can
an OMS help with TMJ disorders?

Gary F. Bouloux, DDS, MD, MDSc, FRCS (Eng), FACS: Initially, just making the appropriate
diagnosis to ensure that it is TMD or a temporomandibular disorder, I think is
important. Then, initiating a conservative approach or at least verifying that
the patients had that previously. And then, of course, selecting appropriate
imaging such as MRI scans and CT to help confirm the diagnosis. And then,
initiating some treatment, whether that'd be arthrocentesis or whether it be
arthroscopy, both of those are minimally invasive procedures and certainly
should be the first line of attack, and then taking it to the more involved
procedures such as arthroplasty and total joint as needed.

Bill Klaproth (host): So TMJ, it sounds like it can be
anywhere from a minor annoyance to really severely affecting someone's quality
of life. It sounds like if you even think you might have a problem, it's a good
idea to see an OMS. Would that be right?

Gary F. Bouloux, DDS, MD, MDSc, FRCS (Eng), FACS: Correct. And I think that the variation in
the signs and symptoms and the quality of life issues varies from very
minimally concerning too severe. And again, it's patient-driven. And at that
point, yes, it would be great to get an opinion and guidance from an oral and
maxillofacial surgeon.

Bill Klaproth (host): Yeah, absolutely. Well, this is
very informative. Thank you for stopping by today. So as we wrap up talking
about TMJ disorders, Dr. Bouloux, anything you want to add?

Gary F. Bouloux, DDS, MD, MDSc, FRCS (Eng), FACS: We're here to help you. We remain the only
profession that can really manage temporomandibular joint disorders and have a
wide variety of treatment options that can be beneficial.

Bill Klaproth (host): Absolutely. Well, thank you for
your time.

Gary F. Bouloux, DDS, MD, MDSc, FRCS (Eng), FACS: I appreciate the conversation this
morning.

Bill Klaproth (host): Absolutely. That is Dr. Gary
Bouloux. And for more information and the full podcast library, please visit
myoms.org. And if you found this podcast to be interesting, please share it on
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