Treating an "In" Malady

By Anastasia Toufexis

Today's "in" maladies have certain common characteristics: controversy over the extent to which the ailment exists; symptoms so variable that diagnosis is difficult; no simple sure cure, so that everyone from surgeons to quacks feels free to offer therapy. And oh, yes, it helps if someone famous suffers from the affliction. Hypoglycemia fit the bill in the 1970s. The '80s have brought two new worries, fatigue syndrome and something known as TMJ, a painful condition that affects the joints of the jaw.

Once dismissed by doctors as "all in the head," TMJ (short for temporomandibular-joint disorder) is now recognized as a genuine problem that plagues an estimated 10 million Americans, most of them women. Its symptoms are so confusing and wide-ranging that dentists, physical therapists, neurologists, psychiatrists, chiropractors, homeopaths, even astrologers are all in the treatment act. Fittingly, there is a notable victim: Actor Burt Reynolds.

The ailment, as its name suggests, is generally traceable to an impairment of one or both of the temporomandibular joints. These olive-size structures, composed of bone and a cushioning cartilage disk, are located at the points where the jaw meets the skull. TMJ may be triggered by infection, arthritis, a blow to the head, shouting at a football game, even chomping on a bagel. A major contributing factor is emotional stress that leads to teeth clenching or grinding. Excruciating pain radiating through the head and neck, earaches and muscle spasms are the most frequent complaints.

Sufferers routinely endure a medical odyssey before their problem is correctly traced to the troublesome joint. Pam Baird, 46, of Havertown, Pa., had unnecessary root-canal work and was treated for bronchitis and an eye infection. "When I finally learned what I had, it was such a relief that I just sat there and cried," she says. Despite such sagas, experts are concerned that TMJ is being overdiagnosed. "Any vague symptom above the chest has become TMJ," charges Dentist Charles Greene, co-director of Northwestern University's TMJ clinic, one of the dozens devoted to facial and jaw pain that have sprung up nationwide. Greene is especially skeptical of those who attribute such varied complaints as dizziness, loss of hearing and blurred vision to the jaw condition. Warns Greene: "There are a lot of scams going on."

To diagnose the condition, some dentists are now relying on sophisticated equipment, which includes ultrasound to measure the "noise" of the joint, as well as devices that record muscle electrical activity and track jaw motion. Other practitioners believe much of the high-tech, high-cost gadgetry is unnecessary. No matter how the diagnosis is made, experts usually favor a conservative treatment regimen that includes a switch to a softer diet (no steak or chewy candy, for example); application of warm, moist heat; facial massages; and exercises to stretch tight muscles. Aspirin, muscle relaxants, tranquilizers and antidepressants may be prescribed. Counseling on stress management and relaxation techniques like biofeedback is often part of the treatment.

Most patients are fitted with acrylic bite plates (about $600 apiece) to wear while sleeping or during the day. But some patients grind their teeth so furiously that they bite right through the plates. As a last resort, doctors recommend surgery to repair the joint. Until recently that meant a three-hour operation and a two-inch scar running in front of the ear. Now surgeons are increasingly using arthroscopy, a technique originally devised to correct knee damage. They insert the arthroscope, a thin telescopic tube, through an incision in the jaw and use tiny instruments to wash out debris, reposition the disk or cut away scar tissue. The operation takes about an hour and leaves a mark no larger than a freckle. Proponents believe the availability of the procedure may increase the percentage of TMJ patients who choose surgery from 10% to as much as 20%.

A few TMJ victims may need more radical interventions, such as completely removing the cartilage disk or implanting an artificial hinge. But many experts wince at some recommendations, such as capping every tooth in the patient's mouth in order to reconfigure a bad bite. So do TMJ sufferers. Ruth Shapiro, 40, of Los Angeles, demurred when told by an orthodontist that her only hope was to have reconstructive surgery that would involve breaking her jaw. "He said I wasn't even going to look the same," she recalls in horror. Dentists and patients alike hope such drastic prescriptions will soon disappear. Eventually, they say,temporomandibular-joint disorder should be a jawbreaker in name only.

With reporting by Scott Brown/Los Angeles and Janice M. Horowitz/New York