For most people, pain in the area of the jaw joint or muscles doesn't signal a serious problem. Generally, discomfort from these conditions is occasional and temporary, often occurring in cycles. The pain eventually goes away with little or no treatment. Some people, however, develop significant long-term symptoms.
What is the Temporomandibular Joint - besides a mouthful?
Image below with key
The Temporomandibular joint connects the lower jaw, called the mandible, to the bone at the side of the head - the temporal bone. If you place your fingers just in the front of your ears and open your mouth, you can feel the joints. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew, and yawn. Muscles attached to and surrounding the jaw joint control its position and movement.
When we open our mouths, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft disc lies between the condyle and the temporal bone. This disc absorbs shocks to the jaw joint from chewing and other movements.
The temporomandibular joint is different from the body's other joints. The combination of hinge and sliding motions makes this joint among the most complicated in the body. (Think of your knees or elbows... both are a pair of separate joints that are controlled individually; whereas the jaw is a pair of joints connected by the mandible, or jaw.) Also, the tissues that make up the temporomandibular joint differ from other load-bearing joints, like the knee or hip. Because of its complex movement and unique makeup, the jaw joint and its controlling muscles can pose a tremendous challenge to both patients and health care providers when problems arise.
What are TMJ Disorders?
Disorders of the jaw joint and chewing muscles - and how people respond to them - vary widely. Researchers generally agree that the conditions fall into three main categories:
- Myofascial pain - the most common temporomandibular disorder, involves discomfort or pain in the muscles that control the jaw function.
- Internal derangement of the joint - involves a displaced disc, dislocated jaw, or injury to the condyle.
- Arthritis - refers to a group of degenerative / inflammatory joint disorders that can affect the temporomandibular joint.
* - To determine which of these three categories your TMJ pain falls into, pinpoint where your pain is located on the diagrams above. Is it the jaw itself? The muscles by your forehead or area close to your ears? Or is it right where you placed your fingers earlier to feel the joint? If it's the jaw bone or muscles along it (including by your forehead/temples), that falls under Myofascial pain. Internal derangement can be associated with pain in the jaw joint and the area close to your ears (where the joint is located). Arthritis pain could be the joint and muscles. Anything sound like it fits? *
People who have a rheumatic (autoimmune) disease, such as rheumatoid arthritis, may develop TMJ disease as a secondary condition. Rheumatic diseases refer to a large group of disorders that cause pain, inflammation, and stiffness in the joints, muscles, and bone. Both rheumatoid arthritis and some TMJ disorders involve inflammation of the tissues that line the joints. The exact relationship between these conditions is not known.
* It's been said that not all those who have TMJ have EDS, but all those who have EDS have TMJ. *
In other words, EDS patients make up a small portion of all those with TMJ.
How jaw joint and muscle disorders progress is not clear. Symptoms worsen and ease over time, but what causes these changes is not known. Most people have relatively mild forms of the disorder. Their symptoms improve significantly, or disappear spontaneously, within weeks or months. For others, the condition causes long-term, persistent and debilitating pain.
SIGNS & SYMPTOMS:
A variety of symptoms may be linked to TMJ disorders. Pain, particularly in the chewing muscles and/or jaw joint, is the most common symptom. Other likely symptoms include:
- radiating pain in the face, jaw, or neck,
- jaw muscle stiffness,
- limited movement or locking of the jaw,
- painful clicking, popping, cracking, or grating in the jaw joint when opening or closing the mouth,
- a change in the way the upper and lower teeth fit together
Physical Therapy options are now available in some areas and there are a variety of specialists who may be able to help. Some self-care practices can also help prevent the spread of pain and lessen the intensity of day to day discomfort:
- eating soft foods
- applying ice packs
- avoiding extreme jaw movements (such as wide yawning, loud singing, and gum chewing)
- learning techniques for relaxing and reducing stress
- practicing gentle jaw stretching and relaxing exercises that may help increase jaw movement. Your health care provider or a physical therapist can recommend exercises if appropriate for your particular condition.
Pain Medications - For many with TMJ disorders, short-term use of over-the-counter pain medicines or nonsterodial anti-inflammatory drugs (NSAIDS), such as ibuprofen, may provide temporary relief from jaw discomfort. When necessary, your dentist or doctor can prescribe stronger pain or anti-inflammatory medications, muscle relaxants, or anti-depressants to help ease symptoms.
Stabilization Splints - Your doctor or dentist may recommend an oral appliance, also called a stabilization splint or bite guard, which is a plastic guard that fits over the upper or lower teeth. Stabilization splints are the most widely used treatments for TMJ disorders. Studies of their effectiveness in providing pain relief, however, have, been inconclusive. If a stabilization splint is recommended, it should be used only for a short time and should not cause permanent changes in the bite. If a splint causes or increases pain, stop using it and see your health care provider.
The conservative, reversible treatments described are useful for temporary relief of pain - they are not cures for TMJ disorders. If symptoms continue over time, come back often, or worsen, tell your doctor.
Irreversible treatments that have not been proven to be effective - and may make the problem worse - include orthodontics to change the bite; crown and bridge work to balance the bite; grinding down teeth to bring the bite into balance, called "occlusal adjustment"; and repositioning splints, also called orthotics, which permanently alter the bite.
Surgery - Other types of treatments, such as surgical procedures, invade the tissues. Surgical treatments are controversial, often irreversible, and should be avoided where possible. There have been no long-term clinical trials to study the safety and effectiveness of surgical treatments for TMJ disorders. Nor are there standards to identify people who would most likely benefit from surgery. Failure to respond to conservative treatments, for example, does not automatically mean that surgery is necessary. If surgery is recommended, be sure to have your doctor explain to you, in words you can understand and relate to, the reason for treatment, the risks involved, and other types of treatment that may be available.
IF YOU THINK YOU HAVE A TMJ DISORDER ...
Remember that for most people, discomfort from TMJ disorders will eventually go away on its own. Simple self-care practices are often effective in easing symptoms. If treatment is needed, it should be based on a reasonable diagnosis, be conservative and reversible and be customized to your special needs. Avoid treatment that can cause permanent changes in the bite or jaw. If irreversible treatments are reccomended, be sure to get a reliable, independent second opinion.
Because there is no certified specialty for TMJ disorders in either dentistry or medicine, finding the right care can be difficult. Look for a health care provider who understands musculoskeletal disorders (affecting muscle, bone and joints) and who is trained in treating pain conditions. Pain clinics in hospitals and universities are often a good source of advice, particularly when pain continues over time and interferes with daily life. Complex cases, often marked by prolonged, persistent and severe pain; jaw dysfunction; co-existing conditions; and diminished quality of life, likely require a team of experts from various fields, such as neurology, rheumatology, pain management and others, to diagnose and treat this condition.
Simply leaving your teeth separated when your mouth is closed, or parting your lips slightly, can relieve some of the pain caused by clenching or grinding teeth together. Your tongue should be resting in a 'floating' position at the roof of your mouth or between the front teeth.
Some exercises you can do are opening and closing your mouth in front of a mirror; stopping when or right before your jaw pops/cracks/makes noise (and thus shifting in appearance). By practicing this movement the correct way, you'll strengthen the muscles around the joint and enable the movement to become more regular. Another way to strengthen these muscles is to place the tip of your tongue to the roof of your mouth and slowly open and close to the extent of your tongue but no farther.
As always with health, exercises, and changes to normal routines, discontinue if problems appear or persist. Consult a healthcare professional with any and all concerns.
(National Institute of Dental and Craniofacial Research - U.S. Department of Health and Human Services, National Institutes of Health)