The TMJs or temporomandibular joints – it’s pronounced “tem-puh-roe-mun-DIB-u-lur” – work like a hinge on each side of your jaw, connecting your skull and jawbone. TMJ disorders can cause severe pain in your jaw and in the muscles that control it. It can be tough to determine the reason behind someone’s TMJ disorder, and usually, there are multiple causes; injuries, genetics, and arthritis are the usual suspects. Some surveys suggest that more than ten million of us in the United States are affected by TMJ disorders. More women than men are affected. For most people, a TMJ disorder is not a serious medical problem – but it can be.
The temporomandibular joint allows for both a hinge motion and a sliding motion. The bone parts that interact in the joint are cartilage-covered and separated by a tiny disk that functions as a shock absorber to keep the hinge and sliding movement smooth. A serious TMJ disorder can be caused by the erosion of the disk or by movement of the disk from its correct alignment, by arthritis damaging the cartilage, or by an injury or blow to the jaw, chin, or mouth. Frequently, the direct cause of a temporomandibular joint disorder is never determined definitively.
WHAT SYMPTOMS ARE ASSOCIATED WITH TMJ DISORDERS?
Many people with TMJ disorders grind their teeth, but others who grind their teeth never struggle with TMJ disorders. Some TMJ disorders can cause a clicking noise or a grinding sensation when you chew or talk. For most patients, TMJ-related discomfort and pain is short-term, and no surgery is required. Surgery is typically a last resort when other measures have failed. If your temporomandibular joint pain is recurring or severe, discuss your treatment options with an experienced San Diego family dentist. The symptoms of a TMJ disorder include but are not necessarily limited to:
- aching facial pain
- tenderness or pain in your jaw
- tenderness or pain in and around your ear
- pain in one or both TMJs
- difficulty or pain while chewing or talking
- locking of the joint, with pain, when opening or closing the mouth
Arthritis, and especially rheumatoid arthritis and osteoarthritis, heighten the risk that a patient will suffer a TMJ disorder. Any injury to the jaw, chin, or mouth increases the risk. So does chronic clenching of the jaw or grinding of the teeth. Connective tissue diseases may cause problems that impact the temporomandibular joint. And fibromyalgia, a chronic pain condition that affects ligaments and tendons, also has side effects that may include TMJ pain.
The symptoms of temporomandibular joint disorders are often quite temporary and frequently fade away within three or four days without any treatment. If your symptoms persist or recur, or if the pain becomes serious, get some medical help. In Southern California, an experienced San Diego family dentist can discuss the possible causes of your TMJ disorder, explain the options for treatment, and refer you to a temporomandibular joint specialist if necessary.
WHAT ARE THE TYPICAL TREATMENT OPTIONS FOR TMJ DISORDERS?
If over-the-counter pain relievers do not alleviate temporomandibular joint pain, your doctor or dentist may recommend prescription-strength versions of the same or similar medications. In the past, tricyclic antidepressants like amitriptyline have been prescribed mainly to treat depression, but tricyclic antidepressants are now sometimes also prescribed for pain relief. Muscle relaxants may also sometimes be prescribed to relax the jaw and ease the pain of a TMJ disorder.
Sometimes, TMJ disorders can be alleviated by wearing a device over the teeth – a mouth guard or an oral splint – although it is not exactly clear why these devices are sometimes helpful. In some cases, alternating moist heat with ice is helpful. Other patients benefit from exercises to strengthen and stretch the jaw muscles, and still other patients benefit from counseling regarding the behaviors that can exacerbate temporomandibular joint pain, such as biting the fingernails or grinding the teeth. When these measures are not helpful, your family dentist might recommend one of these more aggressive procedures:
- Injections: Corticosteroid injections into the temporomandibular joint help some patients. Injecting botulinum toxin type A into the jaw muscles may also alleviate the discomfort associated with TMJ disorders.
- Arthrocentesis: Arthrocentesis is a procedure that inserts small needles into the TMJ to remove inflammatory byproducts and debris.
- TMJ arthroscopy: A thin tube (cannula) is placed into the joint space and an arthroscope is then inserted and small instruments are used to perform surgery.
- Modified condylotomy: This is surgery to the mandible rather than the temporomandibular joint itself, but it can relieve pain and sometimes alleviate joint locking.
- Open-joint surgery. If other approaches fail, and if a TMJ disorder appears to be the result of a structural problem in the joint, your dentist or physician may at that point suggest open-joint surgery. Open-joint surgery is somewhat riskier than other treatments. If surgery is recommended, consider and discuss all of the possible risks and benefits, and be sure that you are familiar with all of your alternatives.
WHAT ABOUT “ALTERNATIVE” MEDICAL TECHNIQUES?
Many patients today also seek and sometimes find relief from TMJ disorders by pursuing alternative medical treatments and practicing some rather unconventional techniques. Patients have reported success with acupuncture treatments, the use of biofeedback devices, and even with the breathing and relaxation exercises associated with yoga. Simply becoming more aware of tension-related habits – chewing pencils or fingernails, clenching your jaw, or grinding your teeth – will help. You can also reduce some symptoms of TMJ disorders by eating soft food cut into small pieces and by avoiding “chewy” food, candy, and chewing gum.
If you have a TMJ disorder, do not forget that for most people, the discomfort soon goes away on its own. The simple, self-care practices mentioned above are often effective. If treatment for a TMJ disorder is required, it should be based on a full diagnosis by your family dentist and customized to your personal needs. In extremely rare instances, if a patient suffers prolonged and severe TMJ pain, a team of doctors from several fields may be required to diagnose and treat the condition. Let’s hope that’s not you, but if TMJ pain recurs or persists, make that appointment with your family dentist. There is no reason to live with unnecessary discomfort or pain.
