If you're looking for answers about TMJ (temporomandibular joint)
pain, your dentist is a good place to start.
For sufferers of this all-too-common disorder,
a proper diagnosis is the first step toward relief - that's where
your oral health care team can help.
Above: Normal chewing forces
Below: Abnormal chewing forces (malocclusion)
Over 10 million Americans suffer from TMJ
Disorder. This large group includes people of all ages - pre-teens,
teens, young adults, the middle aged and seniors. The words "TMJ
Disorder" are often a catch-all term used to describe dysfunction
of the jaw muscles and joints. It can be as minor as slight clicking
or popping sensations when the mouth is opened and closed, or
as serious as persistent pain extending into the face, neck and
shoulders affecting posture and even mobility.
The temporomandibular joints connect the jaw
bone to the skull and are located just in front of each ear.
They are sliding "ball and socket" joints and dependent
upon proper alignment to work smoothly. These are also the most
complex and frequently-used joints in your body, cycling over
2,000 times per day. You can feel the joints work by placing
your fingers on them while opening and closing your mouth.
When the joints are not working properly,
you may experience any of these symptoms:
- pronounced noises associated with movement
in the TM joints (clicking, popping or crunching)
- pain when the jaw is opened fully
- limited range of opening
- clenching or grinding teeth
- facial pain and a sense of facial muscle
fatigue
- ear pain not related to ear infections
- occasional "locking" when the jaw
seems to "stick open" temporarily
- ringing in the ears (tinnitus)
- frequent headaches
A good understanding of what causes TMJ Disorder
begins with a basic knowledge of how the TM joints work. Both
joints consist of a "ball", known as the condyle,
located on the lower jaw (mandible) and the "socket"
or fossa on each side of the skull. In between the two
bone surfaces a "disc" acts as a shock absorber to
allow a smooth, gliding action for the joint. The disc is held
in place against the back of the joint by ligaments and connective
tissue containing blood vessels and nerves. Muscle groups attach
directly to the jawbones to align, stabilize and control jaw
movement.
A TMJ Disorder may develop for any number
of reasons:
- lost or crooked teeth
- overbite
- teeth that fit together poorly (malocclusion)
- degenerative arthritis
- various head or neck injuries including whiplash
- stress causing clenched teeth (bruxism) and
muscle spasms
Any of these conditions can result in a misalignment
or displacement of the jaw which places stress on the nerves,
blood vessels, muscles and connecting tissues of the TM joints.
When the condition is prolonged, your body may begin to compensate
by adapting an unnatural position involving the muscles of the
neck, back or even the arms and pelvis.
Your dentist can serve as the key member of
a health care team which could, depending on the cause of your
TMJ Disorder, include an orthodontist, oral surgeon, your primary
care physician, a physical therapist, and even a psychologist.
Because other types of pain have been shown to mimic TMJ Disorder,
a careful and thorough dental and medical evaluation is essential
to arrive at an accurate diagnosis. If your condition indicates
causes other than dentition, your dentist may refer you to another
member of the health care team or a specialist for further diagnosis
or treatment.
If your symptoms point to a dental problem,
your dentist will most likely take x-rays of your teeth and jaw.
Dental casts may be required to check the fit (occlusion) of
your upper and lower teeth and determine whether they come together
correctly.
If a malocclusion is detected, your teeth
may require some restoration to improve the alignment of your
"bite" and TM joints. This may include the addition
of crowns or a "re-contouring" of tooth surfaces to
improve the "bite" or occlusion.
When bruxism, or "grinding" of the
teeth, is a persistent, unconscious reflex, an orthotic, sometimes
called a "splint", may be custom-fitted to separate
the upper and lower teeth slightly and align the bite. If an
orthotic is prescribed, you may be instructed to wear it during
the course of your day or only when sleeping.
In the short term, your dentist or physician
may prescribe some treatments for immediate relief of pain and
muscle spasm. These often include prescription muscle relaxers,
pain killers, heat compresses or ice packs. The doctors may also
suggest self-care techniques such as posture correction, specialized
exercises to improve jaw muscle flexibility and strength, and
a diet which excludes hard foods like carrots or firm breads.
To relieve stress and anxiety, biofeedback,
relaxation techniques or psychological counseling are often employed.
Physical therapy can include ultrasound, postural training, mobilization
and jaw exercises.
Only in rare cases is surgery required to
correct a TMJ Disorder. Arthroscopy or arthrocentesis utilizing
tiny instruments and needles to flush the joint and introduce
anti-inflammatory medication can provide relief. Soft tissue
repair is usually required when the disc must be repositioned
or to release a "locked jaw".
When arthritis causes severe degeneration
of the joints, various procedures are performed to repair or
replace severed or perforated discs and smooth bone surfaces.
Surgery, however, for TMJ Disorders is generally considered appropriate
only after all other therapies have been fully explored.
If you suffer pain or discomfort you believe
may be related to your TM joints, please ask us for help. The
successful treatment of many TMJ Disorder sufferers begins with
gentle, experienced care„right here in the dental office.
Normal TMJ
Thinning and compressed disc
Severe compression and damage to the disc and articular surfaces
of the TMJ
