About the condition: The temporomandibular joint (TMJ) is the site where the upper jaw (maxilla) and lower jaw (mandible) meet in front of the ear. The temporomandibular joints are complex and are composed of muscles, tendons, and bones. Each component contributes to the smooth operation of the TMJ. When the muscles are relaxed and balanced and both jaw joints open and close comfortably, we are able to talk, chew, or yawn without pain.
Temporomandibular joint (TMJ) syndrome is pain in the jaw joint that can be caused by a variety of problems. These include:
Teeth grinding and teeth clenching (bruxism) that increases the wear on the cartilage lining of the TMJ. Those who grind or clench their teeth may be unaware of this behaviour unless they are told by someone observing this pattern while sleeping, or by a dental professional noticing tell tale signs of wear and tear on the teeth. Many patients wake in the morning with jaw or ear pain. Habitual gum-chewing or fingernail-biting causing inflammation of the joint and surrounding structures and dental problems and misalignment of the teeth (malocclusion) can all cause TMJ pain. Patients may complain that it is difficult to find a comfortable bite or that the way their teeth fit together has changed. Chewing on only one side of the jaw can lead to or be a result of TMJ problems. Trauma to the jaws: Previous fractures in the jaw or facial bones can lead to TMJ disorders. Stress is a very common cause of TMJ disorder. It is very common for people under stress to release this nervous energy by either consciously or unconsciously grinding and clenching their teeth. Occupational tasks such as holding the telephone between the head and shoulder may contribute to TMJ disorders.
Symptoms:
Headache: Approximately 80% of patients with a TMJ disorder complain of headache, and 40% report facial pain. Pain is often made worse while opening and closing the jaw. Exposure to cold weather or air-conditioned air may increase muscle contraction and facial pain.
Ear pain: About 50% of patients with a TMJ disorder notice ear pain and do not have signs of ear infection. The ear pain is usually described as being in front of or below the ear. Often, patients are treated multiple times for a presumed ear infection, which can often be distinguished from TMJ disorder by an associated hearing loss or ear drainage (which would be expected if there really was an ear infection). Because ear pain occurs so commonly, ear specialists are frequently called on to make the diagnosis of a TMJ disorder.
Sounds: Grinding, crunching, or popping sounds, medically termed crepitus, are common for patients with a TMJ disorder. These sounds may or may not be accompanied by increased pain.
Dizziness: Of patients with a TMJ disorder, 40% report a vague sense of dizziness or imbalance (usually not a spinning type vertigo). The cause of this type of dizziness is not well understood.
Fullness of the ear: About 33% of patients with a TMJ disorder describe muffled, clogged, or full ears. They may notice ear fullness and pain during airplane takeoffs and landings. These symptoms are usually caused by eustachian-tube dysfunction, the structure responsible for the regulation of pressure in the middle ear. It is thought that patients with TMJ disorders have hyperactivity (spasms) of the muscles responsible for regulating the opening and closing of the eustachian tube.
Ringing in the ear (tinnitus): For unknown reasons, 33% of patients with a TMJ disorder experience noise or ringing in the ears (tinnitus). Of those patients, half will have resolution of their tinnitus after successful treatment of their TMJ disorder.
Treatment: TMJ pain disorders usually occur because of unbalanced activity, spasm, or overuse of the jaw muscles. Symptoms tend to be chronic, and treatment is aimed at eliminating the precipitating factors.
Jaw rest: It can be beneficial to keep the teeth apart as much as possible. It is also important to recognise when tooth grinding is occurring and devise methods to cease this activity. It is advisable to avoid chewing gum or eating hard, chewy, or crunchy foods such as raw vegetables, candy, or nuts. Foods that require opening the mouth widely are also not recommended.
Heat and ice therapy: These assist in reducing muscle tension and spasm. However, immediately after an injury to the TMJ, treatment with cold applications is best. Cold packs can be helpful for relieving pain.
Physical therapy including chiropractic: Passively opening and closing the jaw, massage, mobilisation, muscle release techniques and specific exercises help to decrease pain and increase the range of motion and strength of the joint.
Medications: Anti-inflammatory medications such as aspirin, ibuprofen or steroids can help control inflammation. Muscle relaxants, such as diazepam (Valium), aid in decreasing muscle spasms. In certain situations, local injection of cortisone preparations into the TMJ may be helpful.
Stress management: Stress support groups, psychological counselling, and medications can also assist in reducing muscle tension.
Occlusal therapy: A custom-made acrylic appliance which fits over the teeth is commonly prescribed for night but may be required throughout
the day. It acts to balance the bite and reduce or eliminate teeth grinding or clenching (bruxism).
Correction of bite abnormalities: Corrective dental therapy, such as orthodontics, may be required to correct an abnormal bite. Dental restorations assist in creating a more stable bite. Adjustments of bridges or crowns act to ensure proper alignment of the teeth.
Surgery: Surgery is indicated in those situations in which medical therapy has failed. It is done as a last resort. TMJ arthroscopy, ligament tightening, joint restructuring, and joint replacement are considered in the most severe cases of joint damage or deterioration.
“TMJ problems can often be very painful and severely affect every day life, when it’s hard to chew, eat or even talk because of the pain. There are a variety of gentle and effective techniques to help ease TMJ pain. Initially as with most injuries rest, ice and some gentle work on the muscles and TMJ itself will settle the pain. Once pain levels have decreased, further techniques to mobilise the jaw, stretch and loosen the muscles and eventually try to re-train and re-educate the jaw function are used to prevent the problems recurring as the jaw is one of the most used joints in the body”, Dr Alex explains.
