TMJ Disorders

TMJ dysfunction or disorder, also known as temporomandibular joint disorder (TMD), is a condition that causes mild or severe pain in the muscles and ligaments that control jaw movements. TMD disorders may occur when the mandibles and jaw structures (ligaments, jaw bone, disks, temporal bone, and muscles) are not correctly aligned or synchronized in movement. TMD can be acute or chronic. It can also lead to inflammation or irritation in your jaw joints.

According to researchers, TMD disorders can be classified into the following three main categories:

Myofascial pain involves discomfort or pain in the muscles that control jaw, neck, and shoulder function. It is the most common type of TMD.

Internal derangement of the joint involves a displaced disc (cartilage cushion between the jaw bone head and skull), dislocated jaw, or injury to the condyle (the rounded end of the jaw bone that articulates with the temporal skull bone).

Degenerative or inflammatory joint disease includes osteoarthritis or rheumatoid arthritis affecting the TMJ.

You may have one or more of these conditions simultaneously. Sometimes, other health conditions may co-exist with TMD, such as sleep disturbances, chronic fatigue syndrome, or fibromyalgia (a painful disorder affecting muscles and soft tissues throughout the entire body.) These conditions might share some common symptoms and similar disease mechanisms, but it is unclear whether they share a common cause.

Risk factors and Causes of TMD

The exact cause of TMD is not easy to determine. It could be due to a combination of factors like:

• Wearing away (erosion)of the joint cartilage
• The disk erodes or moves out of its proper alignment
• Jaw joint or surrounding tissues injury like a heavy blow or whiplash
• Connective tissue disease affecting the TMJ
• Acute trauma
• Arthritis such as osteoarthritis and rheumatoid in the joint
• Stress
• Genetics
• Long-term (chronic) teeth clenching or grinding (bruxism)
• Chewing gum excessively
• Poor posture

Symptoms of TMD

TMJ disorder is more common in women than men in the 20 to 40-year age range. It may be temporary or last for several years. Symptoms may include:

• Headaches occur in one or more regions of the head (tension headaches).
• Pain around your ear
• A jaw or facial pain/ tiredness
• Clicking, grating, or popping sounds in the jaw when you open or close your mouth.
• Joint lock, making it hard to open or close your mouth
• Tinnitus, or ringing in your ears
• Difficulty/ pain when chewing
• Pain or tenderness in your jaw joint
• Jaw soreness or discomfort commonly prevalent in the morning or late afternoon
• Pain in your neck or shoulders
• Swelling on the side of your face
• Dizziness (vertigo)
• Toothache
• A shift in the jaw, changing the alignment of the upper and lower teeth (known as malocclusion)
• Sensitivity of the teeth without the presence of a dental disease
• Numbness or tingling sensation in the fingers

Diagnosis and Tests

TMD’s exact cause and symptoms are unclear; therefore, there are no standard diagnostic tests since identifying the disorders can be difficult. Your health care provider will discuss other signs that you may have and take a detailed medical history.

You will be asked questions about the location of your pain, when it occurs, what makes it worse or better, whether it is just in one area or spreads to other body parts, and whether you have back pain or headaches.

The doctor will examine your jaw to:

• Feel your jaw for tenderness and listen to it when you open and close your mouth for clicking or popping sounds.
• Press around your jaw to identify areas of pain and discomfort
• Observe the range of motion in your jaw when you open and close your mouth

For an accurate diagnosis, your dentist or doctor must rule out other conditions that may be causing your jaw or facial pain.

If TMJ is suspected, further tests will include:

• Dental X-rays (radiographs) may be taken to examine and determine the damage extent in your jaw joints.
• Panoramic X-rays will also show an overview of your jawbone, teeth, and TMJs.
• Cone beam computed tomography (CBCT) scans will be done to capture images of facial bones, jaws, teeth, and sinuses. These pictures, when stitched together, will provide a detailed 3-D image.
• A dental computed tomography (CT) scan will be carried out to provide detailed images of the joint anatomy.
• Magnetic resonance imaging (MRI) scans may be used to view and reveal inflammation, soft tissues, disk position, and possible jaw locking.
• TMJ arthroscopy procedure might be done; it involves inserting a small thin tube (cannula) and a tiny camera(arthroscope) between the joint space to view and determine a diagnosis.

TMJ Treatment Options

In most cases, signs and symptoms of TMJ disorder go away without treatment, but if the condition persists, your health care provider may recommend several treatment options, which include:

Non-Surgical or Home Treatment Options

These are basic self-care practices at home, such as:

• Reduce jaw movements
• Diet changes like eating soft foods (to rest the jaw muscles) and avoiding chewy, crunchy, or hard foods
• Avoid gum chewing, nail-biting, and tough foods like beef jerky, caramel, and taffy
• Reduce stress and coping habits like jaw clenching
• Hot or ice packs your jaw to reduce swelling
• Practice jaw stretching exercises to help improve jaw movement
• Posture training
• Night guard/ splint or orthopedic device; worn in the mouth at night to prevent tooth grinding
• Get enough sleep and avoid sleeping on your belly or placing your hand on the jaw when sleeping on the side.

Medications

The medication is prescribed depending on your condition and overall health. Your doctor may recommend certain drugs to treat your symptoms, such as:

Over-the-counter medications such as nonsteroids, anti-inflammatory drugs (NSAIDs), and pain relievers like ibuprofen.

Prescription medications like:

• Muscle relaxers (but to be used for short periods) to relieve pain caused by muscle spasms
• Local anesthetics
• Tricyclic antidepressants such as amitriptyline for pain relief and bruxism control, and sleeplessness
• Corticosteroids (also known as steroids)

Physical Therapy

Physical therapy depends on areas that require attention, such as stretching, exercising, and strengthening the jaw muscles. Others include:

• Resistance exercises
• Acupuncture
• Moist heat and ice
• Oral splints or mouth guards (occlusal appliances) fitted over your teeth to relieve pain
• Tissue mobilization

Surgical Treatment

Surgical options are considered when there is still severe pain and all other treatment options are not working. Surgical options may include the following:

• Open joint surgery to repair or replace the joint.
• Corrective dental treatment to align your teeth and improve your bite.
• Arthrocentesis to dislodge a stuck disk and remove debris and fluid from the joint.

We Can Help

Do not ignore your jaw pain even if it comes and goes because early treatment can prevent the condition from worsening. Untreated TMDs can seriously affect your overall health and function, limiting chewing, biting, speaking, and yawning.

If you think you have TMJ symptoms, contact Axon Health Associates today or schedule a consultation. We are glad to help improve your overall health and quality of life.