TMJ / TMD
Temporomandibular Joint Disorders (TMD)
Temporomandibular Joint Disorder (TMD) occurs as a result of problems with the jaw, jaw joint and surrounding facial muscles that control chewing and moving the jaw. These disorders are often referred to as TMJ, which simply stands for temporomandibular joint, of which everyone has two naturally. The Dysfunction of this joint and the conditions it causes are medically referred to as TMD.
What Is the Temporomandibular Joint (TMJ)?
The temporomandibular joint (TMJ) is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull, which is immediately in front of the ear on each side of your head. The joints are flexible, allowing the jaw to move smoothly up and down, side to side and enable you to talk, chew, and yawn. Muscles attached to and surrounding the jaw joint control the position and movement of the jaw.
What Causes TMD?
The cause of TMD isn’t always clear and simple to pinpoint, but it is widely believed that symptoms are brought on by problems with the muscles of the jaw or with the parts of the joint itself.
Injury to the jaw, temporomandibular joint, or muscles of the head and neck – such as from a heavy blow or whiplash – have been linked to TMD, as well as natural normal joint wear and degeneration. Other possible causes include:
Grinding or clenching the teeth, which puts a lot of pressure on the TMJ
Dislocation of the soft cushion or disc between the ball and socket
Presence of osteoarthritis or rheumatoid arthritis in the TMJ
Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth
Sleep related breathing disorders are commonly linked to joint stress and dysfunction
What Are the Symptoms of TMD?
People with TMD can experience severe pain and discomfort that can be temporary or last for many years. Women, men and even children can suffer the effects of TMD, and there is no real age limit or set parameters as to whom it effects or how the symptoms display themselves.
Common symptoms of TMD include but are not limited to the following:
Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide
Limited ability to open the mouth very wide
Movement disorders, shaky or unsteady gait
Balance issues
Tinnitus
Headaches (over the eye, in the temples, behind the eyes, and at the base of the skull)
Neck, back, shoulder or chest pain
Limited head movement (sometimes related to Torticollis)
Jaws that get "stuck" or "lock" in the open- or closed-mouth position
Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain) or chewing
A tired feeling in the face
Tumors of the jaw joint
Neurological ticks or disorders (sometimes associated with Tourette’s)
Difficulty chewing or a sudden uncomfortable bite – as if the upper and lower teeth are not fitting together properly
Swelling on the side of the face
May occur on one or both sides of the face
Ear ache or pain in the ear canal
In some cases nervousness, forgetfulness, suicidal tendencies, insomnia, sinusitis, fatigue, indigestion, constipation, ulcers, dermatitis, allergies, frequent urination, kidney and bladder complications, cold hands and feet, body pains and numbness and a host of sexual failures and gynecological problems have been linked.
Because of the complex anatomic, physiological and neurological interrelationship in the head and neck, the symptoms of TMJ/TMJ can coexist or mimic symptoms of other diseases. It is important for patients to be evaluated by the appropriate medical professionals to rule out the presence of other primary diseases prior to treatment.
In a study done by the U.S. Government National Institute of health, it was reported that close to 40% of the population suffer from at least one symptom of TMD and over 25% suffer regularly from pain related directly to it.
How Is TMD Diagnosed?
The dentist will examine your temporomandibular joints for pain or tenderness; listen for clicking, popping, or grating sounds during jaw movement; look for limited motion or locking of the jaw while opening or closing the mouth; and examine bite and facial muscle function. Sometimes panoramic X-rays will be taken. These full face X-rays allow your dentist to view the entire jaws, temporomandibular joint, and teeth to make sure other problems aren't causing theTMD symptoms. Sometimes, other imaging tests, such as magnetic resonance imaging (MRI) or a computer tomography (CT), are needed. The MRI views the soft tissue such as the TMJ disc to see if it is in the proper position as the jaw moves. A CT scan helps view the bony detail of the joint.
How is TMD Treated?
TMD treatment protocols vary greatly depending on the stage of degeneration or level of dysfunction. From something as simple as hot/cold packs or eating “soft foods” to radical surgical procedures that involve the removal of part of the jawbone. The complexity of the joint and its movements have been the subject of a wide variety of treatment protocols.. Although it is widely proven that oral appliances are the easiest, safest and most successful form of treating TMD, many other modalities continued to be used by a variety of practitioners. We have listed the majority of treatment options below to give you a better understanding of the importance of choosing the right protocol for your condition.
Some basic, conservative treatments for TMD include:
Apply moist heat or cold packs. Apply an ice pack to the side of your face and temple area for about 10 minutes.
Eat soft foods. Eat soft foods such as yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans, and grains. In addition, cut foods into small pieces to decrease the amount of chewing required. Avoid hard and crunchy foods (like hard rolls, pretzels, raw carrots), chewy foods (like caramels and taffy) and thick and large foods that require your mouth to open wide to fit.
Take medications. To relieve muscle pain and swelling, try nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen (Advil, Motrin, Aleve).
Low-level laser therapy. This is used to reduce the pain and inflammation, as well as increase range of motion to the neck and in opening the mouth.
Avoid extreme jaw movements. Keep yawning and chewing (especially gum or ice) to a minimum and avoid extreme jaw movements such as yelling or singing.
Don't rest your chin on your hand or hold the telephone between your shoulder and ear. Practice good posture to reduce neck and facial pain.
Learning relaxation techniques to help control muscle tension in the jaw.
Physical Therapy performed by a licensed physical therapist is recognized as a conservative treatment for musculoskeletal disorders. Physical therapy aids in identifying and reducing contributing factors to musculoskeletal problems, reduces inflammation, restores function and promotes repair and regeneration of injured tissues.
Transcutaneous electrical nerve stimulation (TENS). This therapy uses low-level electrical currents to provide pain relief by relaxing the jaw joint and facial muscles.
Ultrasound. Ultrasound treatment is deep heat that is applied to the TMJ to relieve soreness or improve mobility.
Radio wave therapy. Radio waves create a low level electrical stimulation to the joint, which increases blood flow.
Oral Orthopedic Appliances are routinely used to to manage and control TMD pain and physical effects. The appliance’s are usually removable and cover the lower arch, although in some rare cases they are used on the upper arch. They are designed to gently redistribute the occlusal forces and return the joint to its normal function. The appliances are usually made of a very lightweight, thin acrylic material.
More aggressive and radical treatments include:
Trigger-point injections. Pain medication or anesthesia is injected into tender facial muscles called "trigger points" to relieve pain.
Undergo corrective dental treatments. Corrective treatments including replacing missing teeth and using crowns, bridges, or braces to balance the biting surfaces of your teeth or to correct a bite problem.
Arthocentesis consists of anesthetizing the affected TMJ with local anesthetic followed by flushing the joint with a sterile solution such as Lactated Ringers Solution in an attempt to lubricate the joint surfaces and reduce swelling. Corticosteroids or anti-inflammatory’s can also be injected into the joint following Arthocentesis.
Surgery can be performed on the joint in a variety of manners. Arthroscopy, to remove fibrous adhesions and arthritis. Disk repositioning, surgery to re-stitch the joint cartilage back in place. Discectomy is the complete removal of the cartilage relying on scar tissue to prevent the bones of the joint from rubbing directly together. Articular Eminance Recontouring, to shorten and smooth out the joint or even joint replacement surgery using a piece of bone from your rib or hip to completely replace the joint. Since there is so little scientific research and data the TMJ, invasive procedures like surgery continue to be controversial.
The fact still remains the same, to get the proper care you deserve and need, you must have the right professional guiding your care. We encourage you to educate yourself further and to contact any of our members with questions you may have. Temporomandibular Joint Dysfunction has been labeled the “Great Imposter” by the medical community due to its ability to display symptoms reflecting so many other medical conditions. It is the goal of ITSMN to help you find the right practitioner for your needs.