Temporomandibular Joint (TMJ) Disorders
About ten million Americans who suffer from
such seemingly disparate symptoms as
headaches, earaches, tenderness of the jaw
muscles, or dull, aching facial pain often
share a common problem. They all suffer from
what has come to be known as
temporomandibular joint (TMJ) disorders. These
disorders can have a variety of
causes and are believed to result when the
chewing muscles and jaw joints do not
work together correctly. In many cases, TMJ
disorders can be successfully treated.
HOW THE CHEWING MUSCLES AND JAW JOINTS WORK
The structures that make it possible to open
and close the mouth are very specialized
and work together when you chew, speak and
swallow. These structures include the
muscles, ligaments, bones and joints of the
jaw.
Five pairs of muscles allow you to open and
close your mouth. They also control
forward, backward, and side-to-side movements
of the lower jaw. Also involved in
these movements are the temporomandibular
joints. Each of these important joints
has two sections, connected by a disk, that
make possible the hinge and gliding actions
needed to open the mouth widely .
Any problem that prevents this complex system
of muscles, ligaments, bones, and
joints from working together properly may
result in a TMJ disorder.
SIGNS AND SYMPTOMS OF TMJ DISORDERS
TMJ disorders have many signs and symptoms.
Some of the most common include
the following:
Pain in or around the ear. This pain often
spreads to the face.
Tenderness of the jaw muscles.
Clicking/popping noises when one opens or
closes the mouth.
Difficulty in opening one's mouth.
Jaws that get stuck, lock, or go out.
Pain brought on by yawning, chewing, or
opening the mouth widely.
Certain types of headaches or neck aches.
Your dentist can determine the cause of your
symptoms by conducting a series of
diagnostic tests. These may include a complete
medical history, a clinical examination,
X-rays, and casts of your teeth. Your dentist
may refer you to a physician or to
another dentist. This procedure may seem
time-consuming, but proper diagnosis is
an important step before treatment. It can
save time and money by ensuring that you
receive the treatment appropriate for your
particular problem.
CAUSES OF TMJ DISORDERS
TMJ disorders often result when the chewing
muscles and the temporo-mandibular
joint do not work together correctly. When
this occurs, the muscles often cramp. This
spasm can then become part of a cycle that
results in tissue damage, pain and
muscle tender-ness .
Although accidents such as injuries to the
jaw, head or neck, or diseases such as
arthritis, may result in some TMJ problems,
factors relating to the teeth and bite are
also believed to be common causes of TMJ
disorders.
Among these factors are the following:
Oral habits such as clenching the teeth or
grinding the teeth. These habits can tire
the muscles and cause them to go into spasm.
The spasm causes pain, which in turn
causes more spasm. The end result of this
spasm-pain-spasm cycle may eventually
be a TMJ disorder. Many people unconsciously
"clench" their teeth during the day,
often in response to unperceived environmental
stressors.
Problems in the way the teeth fit together or
bite. Improperly aligned teeth can
sometimes place the chewing muscles under
stress and cause them to go into spasm,
thus setting off the harmful cycle described
above.
Oral habits and problems with the bite often
work together to cause TMJ disorders.
Example 1: Paula is under a great deal of
pressure from work. She develops a habit
of grinding her teeth while sleeping. This
causes a muscle spasm and, eventually,
pain and tenderness in her jaw muscles.
Because of these problems, a slight change
in the position of Paula's jaw occurs, and her
teeth no longer fit together correctly.
She develops a new chewing pattern and this
increases the muscle spasm.
Example 2: Ever since he was a boy, David's
teeth have not fit together correctly
when his mouth is closed. This never seemed to
be much of a problem for him, but
now his bad bite triggers teeth clenching and
causes his chewing muscles to function
incorrectly. A muscle spasm occurs, and pain
limits the normal range of David's jaw
movements. As a result, David's chewing
pattern changes and this contributes to his
TMJ symptoms.
TREATMENT FOR TMJ DISORDERS
Since the teeth, chewing muscles and
temporomandibular joints all can be involved
in
a TMJ disorder, treatments vary. Your dentist
will decide what type of treatment is
needed for your particular problem. Often,
treatment will involve a series of phases.
This step-by-step plan is in your best
interest because only minor corrective
treatment
may be needed. If pain and other symptoms
persist, a more involved treatment, such
as changing the way your teeth fit together,
or even surgery, may be needed.
However, surgery is recommended only when a
precise cause of the disorder has
been pinpointed and usually should not be
undertaken until more conservative
treatments of the disorder have been tried
first.
Some common methods of treating TMJ disorders
are listed below:
Elimination of Spasms and Pain
- This can be done by applying moist heat to
the
face, using prescribed muscle relaxants or
other medications, massaging the muscles,
and eating soft, non-chewy foods. These are
especially helpful for acutely painful
flares. Bite plates or occlusal (bite) splints
can also be made. This treatment helps to
eliminate the harmful effects of clenching or
grinding the teeth. Bite guards/splints are
more helpful over time to prevent acute
flares.
Counseling or Biofeedback/Relaxation
Training
- Many times counseling is used
along with other forms of treatment. If
emotional stress is the factor that causes
clenching or grinding of the teeth, that
stress should be reduced or eliminated.
Biofeedback, a relaxation technique that
teaches people to control tension throughout
various parts of the body with the aid of an
electronic monitoring device, can also be
helpful in reducing muscle tension in the jaw.
Such mind/body techniques as the
Alexander Method can be helpful in muscle
re-education.
Correcting the Way the Teeth Fit
Together
- If your bite is incorrect or uneven, it
can be adjusted by selective grinding of the
teeth. Orthodontic appliances (braces)
and other dental procedures may also be used
to reduce problems caused by
improperly aligned teeth.
Surgery
- If muscle spasms have occurred for long
periods, the TMJ itself may
become injured or arthritic. In addition the
bones and soft tissues of the TMJ may slip
out of normal position because of trauma such
as a blow to the head, or some other
cause. Occasionally, in cases such as these,
surgery may be needed to correct the
TMJ problem.
Your dentist and other health professionals
who provide treatment for TMJ disorders
care about your health and comfort. Follow the
recommendations they give you and
discuss with them any concerns you may have.
Remember, in many cases the pain,
headaches, and other symptoms associated with
TMJ disorders can be successfully
treated.
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