Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
TMJ syndrome can be caused by trauma, disease, wear
and tear due to aging, or habits.
Trauma: Trauma is divided into microtrauma and macrotrauma. Microtrauma is internal, such as grinding
the teeth (bruxism) and clenching (jaw tightening). This continual hammering on the temporomandibular joint can change the alignment of the teeth. Muscle involvement causes inflammation of the membranes surrounding the joint. Teeth grinding and clenching are habits that may be diagnosed in people who complain of pain in the temporomandibular joint or have facial pain that includes the muscles involved in chewing (myofascial pain). Macrotrauma, such as a punch to the jaw or impact in an accident, can break the jawbone, cause dislocation of the TMJ, or damage the cartilage disc of the joint. Pain in the TMJ can be brought on by dental work whereby the joint is stretched open for extended periods of time. Massage and heat application after the dentist finishes can be helpful.
Bruxism: Teeth grinding as a habit can result in
muscle spasm and inflammatory reactions, thus causing the initial pain. Changes in the normal stimuli or height of the teeth, misalignment of the teeth, and changes in the chewing muscles may cause temporomandibular joint changes. Generally, someone who has a habit of grinding his or her teeth will do so mostly during sleep. In some
cases, the grinding may be so loud that it disturbs others.
Clenching: Someone who clenches continually bites on things while awake. This might be chewing gum, a pen or pencil, or fingernails. The constant pounding on the joint causes the pain. Stress is often blamed for tension in the jaw,
leading to a clenched jaw.
Osteoarthritis: Like other
joints in the body, the jaw joint is prone to undergo arthritic changes. These changes are sometimes caused by breakdown of the joint (degeneration) or normal aging. Degenerative joint disease causes a slow progressive loss of cartilage and formation of new
bone at the surface of the joint. Cartilage destruction is a result of several
mechanical and biological factors rather than a single entity. Its prevalence
increases with repetitive microtrauma or macrotrauma, as well as with normal
aging. Immunologic and inflammatory diseases contribute to the progress of the
Rheumatoid arthritis: Rheumatoid arthritis causes inflammation in joints and can affect the TMJ, especially in children. As it progresses, the disease can cause destruction of cartilage and erode bone, deforming joints. Rheumatoid arthritis is an autoimmune disease. It causes disease in a variety of organs and features persistent joint inflammation. It occasionally affects the TMJ, especially when it affects children.