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Temporomandibular joint (TMJ) syndrome



What is TMJ?

Temporomandibular joint (TMJ) syndrome or TMJ joint disorders are medical problems related to the jaw joint. The TMJ connects the lower jaw to the skull (temporal bone) under your ear. Certain facial muscles control chewing. Problems in this area can cause head and neck pain, a jaw that is locked in position or difficult to open, problems biting, and popping sounds when you bite.

The TMJ is comprised of muscles, blood supplies, nerves, and bones. You have 2 TMJs, one on each side of your jaw.
Muscles involved in chewing (mastication) also open and close the mouth. The jawbone itself, controlled by the TMJ, has 2 movements: rotation or hinge action, which is opening and closing of the mouth, and gliding action, a movement that allows the mouth to open wider. The coordination of this action also allows you to talk, chew, and yawn.

• If you place your fingers just in front of your ears and open your mouth, you can feel the joint and its movement. When you open your mouth, the rounded ends of the lower jaw (condyles) glide along the joint socket of the temporal bone. The condyles slide back to their original position when you close your mouth. To keep this motion smooth, a soft disc lies between the condyle and the temporal bone. This disc absorbs shock to the temporomandibular joint from chewing and other movements. Chewing creates a strong force. This disc distributes the forces of chewing throughout the joint space.

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TMJ CAUSES

TMJ can be caused by trauma, disease, wear due to aging, or habits.
Trauma: Trauma is divided to microtrauma and macrotrauma. Microtrauma is internal, such as bruxism (grinding the teeth) 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 (bruxism) 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 or damage the disc.

o 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.

o 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 have 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 disease.

• Rheumatoid arthritis: Rheumatoid arthritis causes inflammation. As it progresses, the disease can cause destruction of cartilage and erode bone, deforming joints. It is an autoimmune disease involving the antibody factor against immunoglobulin G (IgG). Chronic rheumatoid arthritis is a multisystem inflammatory disorder with a persistent symmetric joint involvement. Certain

TMJ Symptoms

• Pain in the facial muscles and jaw joints may radiate to the neck or shoulders. Joints may be overstretched. You may experience muscle spasms from TMJ. You may feel pain every time you talk, chew, or yawn. Pain usually appears in the joint itself, in front of the ear, but it may move elsewhere in the skull, face, or jaw.

• TMJ may cause ear pain, ringing in the ears (tinnitus), and hearing loss. Sometimes people mistake TMJ pain for an ear problem, such as an ear infection, when the ear is not the problem at all.

• When the joints move, you may hear sounds, such as clicking, grating, and/or popping. Others may also be able to hear the sounds. Clicking and popping are common. This means the disc may be in an abnormal position. Sometimes no treatment is needed if the sounds give you no pain.

• Your face and mouth may swell on the affected side.

• The jaw may lock wide open (then it is dislocated), or it may not open fully at all. Also, upon opening, the lower jaw may deviate to one side. You may find yourself favoring one painful side or the other by opening your jaw awkwardly. These changes could be sudden. Your teeth may not fit properly together, and your bite may feel odd.

• You may have trouble swallowing because of the muscle spasms.

• Headache and dizziness may be caused by TMJ. You may feel nauseous or vomit.

TMJ disorder treatment

Proper diagnosis is critical to make sure you receive treatment for your particular condition. At The Smiles Dr we will only recommend treatment after conducting a thorough health history, clinical exam, taking appropriate X-rays, and perhaps confirming the condition through other diagnostic tests.
At All Day All Night Dental we may prescribe a multiple-phase treatment plan. Simple and painless techniques are available to decrease discomfort. Here are a few of the treatments we offer:

- Taking a non-aspirin pain reliever or prescription medications such as muscle relaxants, analgesics, or anti-inflammatory drugs
- Eating soft foods
- Avoiding chewing gum
- Applying moist heat or ice
- Physical therapy
- Teaching relaxation techniques to control muscle tension
- Stress management training techniques
- Posture training
- Wearing bite plates to eliminate the harmful effects of clenching or grinding the teeth, and a better positioning of the jaws
- Adjusting the bite, known as "occlusal equilibration" involving removing interferences when the teeth touch
- Replacement of defective restorations that prevent the jaws from meeting properly
- Orthodontics, to put the teeth in proper position
- Surgery
- TENS- Transcutaneous Electrical neural Stimulation
- Trigger Point Injections
- Physical Exercises for the Jaw
- Appliance Therapy (An acrylic, retainer type of device)

In most cases we treat the symptoms related to TMJ disorders can be successfully treated to reduce or eliminate your discomfort. Postponement of treatment usually results in more damage to the joint, muscles, or teeth.
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EXAMS & TESTS

• Medical history: In diagnosing your jaw problem, the dentist will ask the following questions:
o What kind of pain do you have?
o Is it an ache or a throbbing pain or a sharp stabbing pain?
o Is the pain continuous or intermittent?
o Can you outline the area of pain on your face with your finger?
o What helps to alleviate the pain? What aggravates the pain?
o Do you grind or clench your teeth? Do you bite your nails or chew on any objects, such as pens or pencils?
o Do you hold the telephone with your shoulder against your ear for a long time?
o Do you chew gum often? For how long?
o Do you have any oral habits that you have not mentioned?

• Physical examination: During the physical examination, your doctor will examine your head, neck, face, and temporomandibular joints, noting any of the following:
o Tenderness (pain) and its location
o Sounds, such as clicking, popping, grating
o The mandible (lower jaw) range of motion and whether it is easy to open and close and can move from side to side and forward-backward without any pain
o Your assessment of pain on a scale from 0 (no pain) to 10
o Wear on buccal cusps of the mandibular teeth, especially the canine
o The rigidity and or tenderness of the chewing muscles
o How your teeth fit together: normal, open bite, crossbite, overbite, dental restorations, or skeletal deformity

• Imaging: X-rays may be taken of the mouth and jaw. CT or MRI may also be used. The MRI was designed for soft tissue and, therefore, will show the location of the TMJ disc in relationship to the jaw and skull bones. That will give the doctor a better idea as to the proper treatment approach.

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TMJ disorder and headaches

One out of every 15 Australians suffers from chronic headaches, and they spend over millions of dollars every year for over-the-counter medications to relieve their pain. They never imagine that their headaches may be caused by TMJ, and that their pain is the result of a bad bite.
At All Day All Night Dental we know a bad bite can put your jaw-to-skull relationship out of alignment.
When this happens, TMJ symptoms occur. This cluster of symptoms can include: headaches, earaches, ear ringing, loud jaw clicking, even stiffness and pain in the jaw, neck, shoulders and back. This cluster has puzzled doctors in the past. Now we can put a name to it: TMJ.

The two most common forms of headaches are Tension type (TTHA) and Migraine. The tension type is commonly a symptom of TMJ, but both tension and migraine types of headaches overlap when patients have had pain for long periods of time.

Many TMJ sufferers have been involved in a motor vehicle accident resulting in neck and back pain. Tension of the muscles of the face and head also contributes to the occurrence of facial and head pain, as does clenching and grinding of the teeth. Another common symptom involves the ears since the temporomandibular joint is very close to the ear. An evaluation of the TMJ, facial, and cervical muscles can help these patients.

Dentists are often the first to diagnose TMJ. They are familiar with conservative treatments. Specially trained facial pain experts can be helpful in diagnosing and treating TMJ.

|Prevention|

If you tend to have occasional bouts with jaw pain, avoid chewing gum or biting on objects, such as pens or fingernails. Avoid eating hard or chewy food. When you yawn, support your lower jaw with your hand.
See your dentist if you grind your teeth at night or find yourself clenching your jaw. The dentist can make a splint for you.

|Outlook|

Most people do well with conservative therapy, such as resting the jaw or using a mouth splint. The success of treatment depends on how severe the symptoms are and how well you comply with treatment.
Only about 1% of patients require joint replacement.


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