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What is Temporomandibular Joint Disorder?
Temporomandibular joint disorder (TMD) describes a variety of conditions that affect jaw muscles, temporomandibular joints and nerves associated with chronic facial pain. Symptoms may occur on one or both sides of the face, head or jaw, or may develop after an injury. TMD affects more than twice as many women than men.What is the temporomandibular joint?
The temporomandibular joint (TMJ) is a joint that slides and rotates just in front of your ear, consisting of the temporal bone (side of the skull) and the mandible (lower jaw). Chewing muscles connect the lower jaw to the skull, allowing your jaw to open and close and move forward and sideways.
The joint works properly when the lower jaw and its joint (both the right and left) are synchronized during movement. TMD may occur when the jaw twists during opening, closing or side-motion movements. These movements affect the jaw joint and the muscles that control chewing.
What causes TMD?
Trauma to the jaw or jaw joint sometimes plays a role in TMD, but in most cases the cause of the disorder is unknown. Most experts suggest that certain tasks, either mental or physical, may cause or aggravate TMD, such as stressful situations. Most discomfort is caused from overuse of the muscles, specifically clenching or grinding teeth (bruxism). These excessive habits tire the jaw muscles and lead to discomfort, such as headaches or neck pain.
What TMD symptoms can I experience?
Jaw pain or soreness that is more prevalent in the morning or late afternoon
Jaw pain when you chew, bite or yawn
Clicking when opening and closing your mouth
Difficulty opening and closing your mouth
Locked or stiff jaw when you talk, yawn or eat
Sensitive teeth when no dental problems can be found
An earache without an infection
What can I do to treat TMD?
The majority of cases can be treated by unloading (resting) the joint, taking a non-aspirin pain reliever and practicing stress management and relaxation techniques. Most treatment for TMD is simple, often can be done at home, and does not need surgery. For example, control clenching or grinding during the day by sticking your tongue between your teeth. Eating soft foods and avoiding chewing gum also help relax the muscles.
Most people will experience relief with minor treatment. More severe cases may be treated with physical therapy, ice and hot packs, posture training and orthopedic appliance therapy (splint, or bite guard). When necessary, stronger pain or anti-inflammatory medications, muscle relaxants or antidepressants may help ease symptoms.
Is TMD permanent?
The condition is often cyclical and may recur during times of stress, good or bad. As the patient, you should be active in your treatment by being aware of the causes of your jaw problems after seeing a dentist for a diagnosis regime. Make routine dental appointments, so your doctor can check TMD on a regular basis.
Frequent Headaches? Can't Sleep? Check Your Bite!
The average person swallows 2,000 times per day, causing the upper and lower teeth to come together and push against the skull. People who have a poorly aligned bite or missing teeth can have related health problems, such as frequent headaches or sleep disorders, because their jaw muscles must work harder to bring the teeth together, straining the surrounding muscles.
This strain, know as orofacial pain, is defined as any pain in or around the face. Some people may experience pain in the ears, eyes, sinuses, cheeks or side of the head, while others experience clicking when moving the jaw.
Orofacial pain can also be caused by temporomandibular joint disorder (TMD), stress, nerve disorders or muscle spasms. Serious causes of orofacial pain are tumors in the jaw bone area, oral cancer or referred pain from cardiac disease.
"At the first sign of discomfort, see your general dentist," says Academy of General Dentistry spokesperson Peter G. Bastian, DDS, MAGD. "He or she knows your mouth best and how you handle day-to-day stress."
Sometimes orofacial pain may be difficult to diagnose if its origin is not localized in one area.
"Dr. Chetty will try to diagnose the pain source by conducting tests to rule out a cracked tooth, the need for root canal, gum disease, clenching or tooth grinding," says Dr. Bastian. These factors can cause discomfort in the facial region but can be easily addressed."
Orofacial pain that lasts longer than 10 days to two weeks or is not related to a specific stressful event, such as a car accident, may signal a more serious problem requiring additional tests.
Common symptoms of orofacial pain:
Pain behind the eyes
Sore jaw muscles
Teeth grinding
Clicking or popping of joints
Head/scalp painful to the touch
Earaches or ringing
Neck, shoulder or back pain
Dizziness
Snap, Crackle, Pop: Is That Your Jaw?
Clicking or popping could mean trouble, that is if it comes from your jaw. Joint sound is one of the most recognized signs of temporomandibular joint disorders, commonly referred to as TMD. While not all jaw sounds necessarily point to TMD, they could be an early sign and always should be checked out by Dr. Chetty, urges the Academy of General Dentistry (AGD), an organization for general dentists dedicated to continuing education.
The temporomandibular joints are the points at which the lower jaw (the mandible) attaches to the skull. They are among the most complex joints in the human anatomy. If you place your fingers on the sides of your face, just in front of your ears, and open and close your mouth, you can feel the movement of the mandible in the temporomandibular joints.
Researchers have discovered that sound can be a good tool when diagnosing TMD. Sounds from subjects with TMD had a larger amplitude than sounds from subjects without the disorder.
"Joint sound for some people is normal, but it could still mean trouble," says AGD spokesperson Julie Ann Barna, DMD. "The difference between healthy jaw movement and TMD is said to be only one millimeter."
Dr. Barna says that if TMD is diagnosed, a team approach to therapy by a dentist and physical therapist leads to effective treatment. She advises that patients should contact their dentist as soon as they notice any new joint sound or discomfort in the mouth. "It may be nothing," she says. "But it's better to be safe than sorry."
You may have TMJ symptoms if you experience the following:
Clicking and/or difficulty when opening and closing mouth
Frequent headaches
Neck and/or shoulder pain
Sensitive teeth when no dental problems can be found
Jaw pain or stiff jaw when chewing, biting, eating or yawning
Earaches without an infection
Equilibration May Lessen TMD Pain
If you are one of more than 10 million Americans who suffer from temporomandibular joint disorder (TMD), a condition that causes face, jaw and neck pain, relief may be found in a dental procedure called equilibration, according to Jerry Butler, DDS, FAGD. Equilibration involves the selective reshaping of the top surfaces of the teeth to provide normal balance and to stabilize the jaw joint.
The pain associated with TMD is caused when the temporomandibular joint (the joint that connects the lower jaw to the skull) is damaged or has deteriorated or when the muscles surrounding the joint are malfunctioning, causing an imbalance in the movement of the jaw joint. For instance, TMD can be caused by the impact of an auto accident, an improper bite that causes stress on the chewing muscles or by behaviors associated with stress, such as clenching the jaw or grinding the teeth.
The muscle pain and spasms associated with TMD are often compared to that of a "charley horse" in a runner's leg.
In general, equilibration techniques for the relief of TMD pain and spasms are effective and predictable, and patients like the concept because treatments are painless.
In some cases, equilibration techniques may include the fabrication of a special splint that is worn to reduce stress on the jaw joint. The dentist may also recommend altering the height of canine teeth that are interfering with natural jaw movements.
Equilibration treatment can include the massaging and working of muscles to lessen the pain. Other equilibration treatment can involve physical therapy, including ultrasound, muscle relaxation techniques, a stress management program and an exercise rehabilitation program.
"Equilibration is becoming a more mainstream technique to treat TMD pain," said Dr. Butler. "Many dentists now have information on these techniques. However, it is still important for patients to talk to their dentist about their pain and have a thorough evaluation before beginning any kind of treatment program."
