As dental crew members returned to scientific observe throughout the pandemic, with all the brand new protocols and PPE together with N95 respirators, many started to expertise temporomandibular joint (TMJ) dysfunction (TMD) signs for the primary time or noticed a rise in earlier signs. In September 2020, I wrote an article addressing this improvement, “The complexities of temporomandibular disorder.”
The survey outcomes
Because of seeing and listening to from hygienists about TMD following the article, I made a decision to carry out a casual survey to find out what signs and coverings dental professionals have been experiencing. The survey was performed from mid-October to mid-November 2020.
The survey consisted of ten questions together with the questions under, together with the respondent’s e-mail deal with and curiosity in being contacted in regards to the survey:
- Have you ever returned to scientific dental hygiene following the COVID shutdown? Had been you working full- or part-time previous to the shutdown? What’s your present standing, full- or part-time?
- What TMD signs are you at the moment experiencing?
- Did you’ve gotten any TMD signs previous to your return?
- If sure, what have been they? What was the prior analysis?
- What has helped your present TMD signs?
- What has made your present TMD signs worse?
- Have you ever sought remedy to your present signs?
- If sure, what was the analysis and really helpful remedies?
Most respondents didn’t depart their e-mail deal with or need to be contacted for additional questions in regards to the survey. I reached out to those that had requested being contacted.
Of the respondents, 66% had been working full-time previous to the pandemic, and have returned to work full-time after the shutdown, whereas 34% have been employed part-time each earlier than and after the shutdown. Solely two respondents acknowledged they’re not practising as a result of COVID-19 considerations, or non-COVID health-related points. The odds of people that had TMD signs previous to shutdown have been break up, with 35% having prior TMD signs and 65% not having any earlier signs.
For these at the moment experiencing signs, the most typical was headache. This corresponds to a bigger analysis survey performed by Anne Guignon, MPH, RDH, in June 2020 (private communication), on the affect of PPE utilization on health-care professionals, with 53.62% of her survey members stating they have been affected by extra complications than ever whereas carrying PPE. Different signs famous in my casual examine have been:
- TMJ ache and popping on motion
- Tightness/ache within the lateral and medial pterygoid or masseter muscular tissues
- Elevated clenching and bruxing
- Occlusion feeling “off”
- Restricted vary of movement with an lack of ability to open or shut fully or to eat a sandwich
- Chipped posterior tooth and heavy put on aspects
- Transient tooth sensitivity
The Guignon examine likewise famous TMJ ache, clogged or ringing ears, and chunk/occlusal modifications.
How clinicians are coping
For these experiencing signs, carrying a splint throughout the day or nightguard at night time, use of nonsteroidal anti-inflammatories (ibuprofen was essentially the most generally cited), muscle therapeutic massage or fascial launch, consuming a delicate food plan, or utilizing moist warmth or ice have all lowered signs.
Different useful cures included chiropractic remedy, mediation, muscle relaxants, or Botox injections. Many respondents acknowledged they felt using the N95 respirator had considerably elevated their signs and lowering put on time decreased their points. Having to take care of their airway by positioning the mandible ahead whereas carrying the N95, together with the stress related to it, gave the impression to be the main causes of concern. The excessive stress ranges of returning to scientific observe with all the extra protocols added to their misery. Being conscious of mandibular place whereas carrying the N95 usually helped together with taking frequent breaks.
As dentistry begins to know the connection between N95 utilization and quite a few associated signs from complications, dry mouth, tiredness, and shortness of breath, to pimples, amongst others, different protecting units shall be developed to cut back signs whereas defending the dental skilled and affected person.
A number of members talked about that with the added protocols and sufferers being away from look after prolonged durations, the hygiene appointment was tougher, particularly with out using energy scaling. As well as, sufferers seeing their hygienist, who often is the one among their few social interactions, need to spend extra time speaking than common, once more rising the hygienist’s stress ranges when there’s insufficient time for remedy.
The significance of a analysis
But with all the signs and stress, solely 20% have sought remedy for TMD, with the remedy of selection as having a nightguard made or remade. No respondents talked about a definitive TMD analysis!
TMD consists of a myriad of indicators and signs, and one sort of remedy might or might not alleviate the dysfunction. Understanding that TMD can both be associated to a muscular drawback, a structural joint drawback, or a mixture, the astute clinician will decide the suitable remedy. Using solely a nightguard for remedy when a correct analysis has not been rendered is like placing a Band-Support on a bleeding wound—it helps, however might not remedy the issue.
Understanding the anatomy of the joint and musculature is a vital consideration. Acceptable diagnostic instruments akin to MRI, CBCT/standard CT, panoramic, cepholmetric imaging, chunk evaluation, doppler auscultation, or injections are invaluable in figuring out the suitable course of remedy and the proper analysis.
But, all of it begins with a via intra- and extraoral analysis, analyzing opening, closing, lateral excursive vary of movement whereas palpating the joint and muscular tissues. Analyzing the affected person’s posture can be vital. For a lot of who’re experiencing TMD signs, each dental professionals and the lay public, using respirators/masks usually ends in attempting to take care of the airway. When it turns into tough to take care of regular airflow, the tendency is to reposition the mandible or all the head ahead. By transferring the pinnacle ahead, it turns into heavier off the spinal column and might result in muscle ache. Muscle ache can lead to complications or neck/again ache.
Extended ahead head posturing, together with different microtraumas, might trigger the meniscus or disc inside the joint to maneuver out of place, making a structural joint drawback. Having a real TMD analysis is paramount to assuaging signs.
Usually sufferers say “I’ve TMJ,” or I’ve TMD,” however that’s not a analysis. It’s only an outline, and as dental professionals experiencing TMD signs, we have to perceive our personal analysis—muscular, structural or mixture—with the intention to assist our sufferers who’re additionally experiencing related ache and discomfort.
Thanks to all who participated within the survey—I admire and worth your insights. Though this was a small casual examine, it highlights the significance of understanding the TMJ, the construction, perform, and TMD for each ourselves and the sufferers we deal with. If you wish to be taught extra about TMD, please attain out to me at email@example.com.
Ann-Marie DePalma, MEd, RDH, CDA, FAADH, FADIA, is a know-how advisor for Patterson Dental, a author for RDH journal, and an creator in dental hygiene textbooks. She is the 2017 Massachusetts Faculty of Pharmacy & Well being Sciences Esther Wilkins Distinguished Alumni recipient. She is a steady member of the American Dental Hygienists’ Affiliation and an energetic member of the Massachusetts Dental Hygiene Affiliation.