Tempero-Mandibular Joint TMJ Disorders

Dear Mr Friedland:
My daughter is a 4th year performance major in college and was diagnosed with TMJ about 2 months ago. An MRI showed nothing other than muscular problems.
Have you any literature or suggestions of how to find literature on this topic?  Are there clarinetists at different stages of their education/career that develop this problem and is there literature about different ways to correct it?
 
Thank you for your time and assistance.
I am writing to you (instead of my daughter) because of all of the school work and practice time she has right now).
 
Sincerely, PP

  

Date: October 5, 2008 5:54

Dear PP: First, I would like to say that TMJ is a tricky diagnosis. Having suffered it as a clarinetist and my wife as a pianist is why I mention “tricky”. It varies for almost everyone and there is   a lot of information out there, however it all depends upon whom you ask. Be very careful concerning your quest for an explanation for your daughter, as without disc damge, she may not have TMJ at all. And also exercise care prior to any drugs and/or surgery is undertaken. I would  ask who made the diagnosis and why was it TMJ? Here is a website for your information:

 

  

The temporomandibular joints connect the jawbone to the skull. Located at the sides of the head near each ear, these joints play an essential role in eating, speaking, and making facial expressions. In fact, the temporomandibular joint ( TMJ) is one of the most frequently used and complex joints in the entire body.

TMJ disorder can develop when one or both of the temporomandibular joints stop functioning properly. This may happen due to any number of causes and may result in chronic ear pain, jaw stiffness and soreness, difficulty opening the mouth, jaw popping or clicking, and headaches. Sufferers of TMJ disorder may experience either sharp pain or a dull, constant ache. Because the causes and symptoms of TMJ disorder are so varied, the condition is typically classified into three main sub-categories:

  • Myofacial pain
  • Internal derangement of the joint
  • Inflammatory joint disease

 

Here is an actual case of a flutist:

“I was diagnosed with TMJ over a year ago and I have tried to ameliorate it with the use of a night guard, a modified diet, physical therapy twice a week, and yoga. I am trying to finish a master’s degree in flute performance (this is my last semester). Playing the flute for fourteen years (for up to 10 hours a day) and clenching my teeth have been the cause of my TMJ. Recently, the pain has become excruciating not only when I am playing, but all the time. Through an MRI, I learned that I have slipped both of the discs that are between my lower and upper jaw (The discs might very well be perforated, too). My best options (as stated by my oral surgeon) are steroid injections and arthroscopic surgery. I had to withdraw from all of my classes on disability– except for the final requirement for my degree: an hour long flute recital. I truly do not think I can last an hour, let alone do all of the practicing required to prepare for the performance. I have been told by several doctors and physical therapists that I could be doing even more damage to my joints if I continue preparing for this recital (the date is set for April 20th,1999). One even suggested that I end my career as a flutist. I want this degree, but not at the cost of totally destroying my jaw and never being able to play the flute again. Should I withdraw completely from college and have the surgery right away? Would it be possible for me to perform a recital, however painful it might be, and then have surgery? Could steroid injections get me through my recital? Must I consider a new career? This is all very frightening for me. Since all of the doctors, physical therapists, and surgeons I have spoken to have different opinions, I honestly don’t know what to do. I do know that the pain is almost intolerable. Please help me”.

 

More than 10 million Americans suffer from TMJ disorder, a condition that affects the function of the temporomandibular joint, or jaw joint. Despite this fact, TMJ remains one of the most commonly misunderstood areas of dentistry. Please  take note of the multiple opinions out there, and proceed with caution.

I also have an article within my archives on the ailment. I suggest you proceed with caution especially prior to steroids and/or arthroscopic surgery. The bite plate is usually prescribed, but did not help my wife at all. She is a pianist and was experiencing clicking in her jaw and pain as well. Her dentist gave her the bite plate.

What I have suggested to all others is to complete rest the embouchure for as long as possible and following that to begin practice again almost as if you are a beginner. It has worked for me and others, however I may not have had TMJ, nor perhaps did those to whom I recommended complete embouchure rest, prior to resumption.

I hope I have helped you in some way. Good luck to you and to your daughter.

Sincerely,

Sherman Friedland

 

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One Response to Tempero-Mandibular Joint TMJ Disorders

  1. goodwillstacy says:

    Hi! My name is Stacy, and I am the Online Communications Coordinator for The TMJ Association. We have received many emails and calls from musicians or singers that have TMJ disorder. Like Sherman suggested, I would definitely visit our website. We have also just started an online forum for patients to discuss and support each other. We actually have a dedicated area for musicians and singers. Maybe you can share what has worked for you. Please visit and start some conversations! Because we just started there aren’t many patients yet, but we hope you will stop by. Please let us know if you have any questions!

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