Known as TMJ, TMD or TMJD, temporomandibular disorder is a condition affecting the temporomandibular joint (TMJ), which connects the mandible or the lower jaw to the temporal bone of the skull, which is located in front of the ear. The TMJ includes the muscles surrounding the jaw, blood vessels, bones and nerves. Every person has two TMJs, one located on each side of the jaw.
The TMJ mainly works to coordinate movements of the jaw, like chewing and biting. Any disorder in this area will therefore affect the flexibility of the jaw. You may notice pain while talking, yawning or chewing, and even while the jaw is at rest. TMJ disorder can cause intense pain, which can be intermittent, or can be constant and last for many years.
Diagnosis of TMJ disorder
Since TMJ is accompanied by an onset of pain, your dentist will gauge the intensity of pain by administering a “clench” test. If you experience pain in any one tooth or all teeth or the jaw when you bite down, your dentist will diagnose it as TMJ. To confirm this diagnosis and to evaluate the position of the temporomandibular joint, your dentist will create mould impressions of your bite, and mount these on an articulator. Through this, your dentist can determine if there is a structural disorder inside the joint, or other factors like uneven teeth are affecting the joint.
There are two temporomandibular joints, one in front of each ear that connect the lower jaw to the skull. These joints allow all the mobility needed for biting, chewing and talking, making it one of the most used joints in all of the human body. Many people suffer with some type of TMJ disorder. There is little research about preventing TMJD but following these tips can help avoiding TMJ problems.
- Reduce stress. Stress has been known to cause pain in the TMJ joint, possibly as a result of the pressure caused by clinching your teeth.
- Wear a mouth guard when sleeping to prevent grinding of your teeth. This grinding motion has been shown to cause additional stress on the joint resulting in pain and possible inflammation.
- Practice self-care if you experience pain in the joint. If you notice jaw pain occasionally, avoid eating hard foods, pain and discomfort can be minimized by eating soft foods.
- Apply cold or heated compresses when the TMJ joint feels agitated.
- Avoiding gum chewing or biting on hard object. This motion only increases the sliding movement that the TMJ joint goes through.
What Are the Symptoms of TMJ – Tempo Mandibular Joint Disorders?
It should be considered that there are many symptoms of TMJ disorder. Everyone is different, therefore the disorder can and does manifest itself in a variety of ways. Although this is by no means an exclusive list, the following are symptoms a patient with TMJ disorder might experience.
Eye Pain and Eye Problems:
- Bloodshot eyes
- Blurring of vision
- Eye pain above, below and behind eye
- Pressure behind eyes
- Light sensitivity
- Watering of the eyes
Head Pain, Headache Problems, Facial Pain:
- Forehead pain
- Cluster headaches
- “Sinus Type” headache
- Hair and/or scalp painful or sensitive to touch
- Headaches at the back of the head, with or without shooting pain
Teeth and Gum Problems:
- Clenching during the day or at night
- Grinding teeth at night (bruxism)
- Tooth pain
- Sensitive teeth
Mouth, Face, Cheek, and Chin Problems:
- Discomfort or pain to any of these areas
- Pain in cheek muscles
- Uncontrollable tongue movements
- Jaw and Jaw Joint Problems
- Limited opening
- Inability to open the jaw smoothly or evenly
- Jaw deviates to one side when opening
- Inability to find the correct bite with teeth
- Clicking or popping jaw joints
- Uncontrollable jaw movements
Ear Pain, Ear Problems:
- Hissing, buzzing, ringing, or roaring sounds
- Diminished hearing
- Clogged, “stuffy”, itchy ears
- Feeling of fullness
- Ear pain without infection
- Balance problems, vertigo, dizziness
- Swallowing difficulties
- Tightness of throat
- Sore throat with no infection
- Voice fluctuations
- Tongue Pain
Neck and Shoulder Problems:
- Neck pain
- Tired, sore neck problems
- Shoulder aches
- Back pain (upper and lower)
- Arm and finger tingling, numbness, and/or pain
It is very important to keep in mind that everyone is different. Please visit your dentist for a consultation and a thorough examination before making any conclusions.
Very few TMJ cases are severe enough to need surgery. Most bite problems can be corrected through restoration or orthodontic treatment.
If there is no structural disorder in the joint, but your dentist notices interferences that affect the bite, he may suggest correcting the problem using an appliance.
Occlusal equilibration is the most frequently used option to remove deflective interferences, and enable the jaw to close down properly. It involves the reshaping of the teeth surfaces that are involved in biting. Your dentist will examine the occlusion and the joints, before he recommends a particular treatment.
The dentist may fit you with a plastic shield that acts like a mouth guard to protect your upper or lower teeth. This guard or splint can protect your teeth against teeth grinding when worn at night. If the splint causes pain, discontinue use.
If your dentist believes that your problem is caused by a structural disorder, and if your pain is not relieved through occlusal equilibration or the use of splints, then he will recommend an X-ray. He may also recommend an MRI (Magnetic Resonance Imaging) to have a look at the soft tissue that surrounds the joint. In some cases, he may even order a CT scan to check the bony parts of the jaw. Finally, he may recommend orthodontia, an intra-oral appliance or maxillofacial surgery, depending on the results of the scans. He will refer you to an oral surgeon or a maxillofacial surgeon.
What to expect during surgery
Surgery is performed under local anaesthesia. Here, two needles are inserted into the temporomandibular joint, one connected to a syringe containing a cleansing solution, and the other acting as an exit for the fluid. This procedure is used to wash out the joint. In some cases, your surgeon will make use of a scalpel like tool to remove any tissue adhesions in the joint.
Another type of surgery to treat TMJ is orthoscopy, in which an incision is made at the temple to insert an endoscope into the area. Using images provided by the endoscope, your surgeon will remove adhesions, or reposition the disc.
Open joint surgery
Open joint surgery is the only option that allows access to any tumours, scarring or worsening bone structure.
First aid for TMJ
To treat intense pain before you meet with your dentist, try the following self-help remedies.
- Apply hot and cold packs to the side of the face to lessen the pain. The pack should be applied for 10-minute durations.
- Avoid yawning or other extended jaw movements, and limit the amount of pressure you place on your jaw.
- Eat only soft foods, and avoid foods that require heavy chewing
- If you are under any dental treatment for tooth decay, continue with the treatment.
- Massages and biofeedback can also offer some relief from TMJ.
- Anti-inflammatory drugs, anti-anxiety drugs and anti-depressants can provide relief from intense pain.
- Dental appliances like mouth guards can reduce teeth grinding which can enhance your bite, enabling your lower jaw to fit properly into the TMJ socket.
Remember that any TMJ treatment should only be provided by a dental specialist who is highly experienced in this area.
Alternative treatments for TMJ
Alternative treatments for TMJ include TENS (Transcutaneous Electrical Nerve Stimulation), radio wave therapy and ultrasound. Radio wave therapy and TNS work by sending radio waves or low-intensity energy waves to the affected region to stimulate the flow of blood to the area. These alternative treatments do not work to treat the causes of TMJ, and can only be relied on for temporary relief.
After TMJ treatment, follow your dentist’s instructions, including prescribed medication, hot and cold compresses or jaw exercises. If you are required to make a follow up visit with the surgeon, remember to do so.