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.
TMJ is comprised of muscles, blood
supplies, nerves, and bones. You
have 2 TMJs, one on each side of
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
can be caused by trauma, disease,
wear due to aging, or habits.
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
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
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
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
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,
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
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
- 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
- Orthodontics, to put the teeth
in proper position
- TENS- Transcutaneous Electrical
- Trigger Point Injections
- Physical Exercises for the Jaw
- Appliance Therapy (An acrylic,
retainer type of device)
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,
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
o Do you have any oral habits that
you have not mentioned?
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,
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
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.
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.
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
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.
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.
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
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