TMJ

TMJ stands for temporomandibular joint. It is the joint that connects your jaw to your skull, and it is very unique compared to the other major joints in the human body such as the knee, hip, elbow, and shoulder. The knee and the elbow are hinge joints, meaning they move just like a door hinge. The shoulder and hip have rotational movement to them. The temporomandibular joint is unique in a couple of ways. First, you have to move both joints at the same time and cannot choose to only move one joint. Also, the initial movement of the TMJ is a hinge movement, and that is followed by a translational movement where the jaw comes out of the area where it usually is so it is like an intentional dislocation.

Causes of TMJ

The set of TMJ disorders are complex and have a variety of underlying causes, not all of which are fully known. It is widely accepted among dental professionals that TMJ disorders can usually be traced back to problems with the joint and the muscles involved in opening and closing of the jaw. However, while injury to the jaw area is often seen among TMJD cases, many times symptoms may be present without obvious cause.

According to the Academy of Orofacial Pain, the causes of TMJD are unclear in large part due to the current theory that the condition is actually the result of several factors working together. Possible contributing factors to inflammation of the temporomandibular joint include:

Injury to the jaw, including whiplash or stretching due to insertion of a breathing tube.
Teeth clenching and grinding
Arthritis
Infection
Dental procedures
Auto-immune diseases
Hormones
Genetics

The role of teeth grinding due to stress is also complicated by scientific research that shows many habitual tooth grinders never show symptoms of pain or discomfort of the jaw, while an individual with soreness in the jaw is less likely to grind his or her teeth due to the pain, and that any reported stress can be a result of the painful condition.

One early theory about a possible cause for TMJD was orthodontics, however that belief has been dismissed with scientific evidence. There is current research underway into a possible link between TMJD and hormones because women are more likely than men to experience TMJ pain and soreness.

Disorders of the temporomandibular joint can be categorized in two main groups: myogenous TMJD and arthrogenous TMJD. Myogenous refers to a condition affecting the muscles, usually brought on by overwork or tension in the jaw and supporting muscles. Arthrogenous refers to a joint related condition in either the hard or soft tissues or both, including disc dislocation and arthritis degeneration.

Part of the reason that there is still no agreement among healthcare professionals about the exact causes of TMJD is that TMJ disorders are complex and are likely the result of several circumstances and conditions. Typically a patient will report multiple symptoms as part of the condition and may have experienced more than one of the above listed co-factors.

Ways to Treat TMJ/TMJD

The pain and discomfort associated with TMJD, which stands for temporomandibular joint disorder, can vary from mild and infrequent to severe and debilitating. Depending on the level of pain and associated disability, treatment of TMJD may differ. It can also be addressed through different treatment options based on suspected causes. The important part is to determine what is causing the pain. This is based on getting a good diagnosis, which is what Dr. Tennant does at Florida Craniofacial Institute. Muscles can be the cause of pain, osteoarthritis can be the cause of pain, or it can be caused by other issues such as the ear or some of the facial nerves.

If TMJD symptoms don’t hamper daily activities and the pain can be described as between one and three on a ten-point pain scale, the condition is often manageable through patient self-care. This includes performing any of the following basic treatment activities:

Apply cold and hot packs: An ice pack or cold compress applied to the affected area for 10 to 15 minutes will reduce swelling and inflammation. Moist heat applied to the area between 10 to 15 minutes can also improve circulation to the area and reduce pain.
Do facial stretching and exercises: Dr. Tennant may recommend stretches that can help reduce tension in the jaw. Perform prescribed exercises as directed to stretch the muscles of the jaw and relieve unnecessary muscle tension.
Hinge-Axis exercise: The image to the right is what we call the “hinge axis” exercise. The teeth should not touch and you don’t want to open very wide, and the motion will look like you have a jaw tremor. You should do this exercise 6 times a day for 30 seconds each time. The goal of this exercise is to stimulate the production of fluid inside the TM joint.
Eat soft, small foods: Foods that don’t require much chewing due to small size or soft texture, such as soup, scrambled eggs, cottage cheese, yogurt, cooked beans, diced fruits, and cooked vegetables will be easier to eat than foods that are hard, crunchy, chewy, thick or large. Salad is an example of a food that requires a lot of chewing, and should be avoided with a painful joint. Here is a page with more information about foods to avoid. The bottom line is that if you are eating a food that causes pain, stop eating that food.
Take medicine for pain management: Over-the-counter pain relievers such as naproxen (Aleve) can minimize the experience of pain and reduce inflammation. Dr. Tennant may also prescribe stronger pain medications for pain relief. Prescription muscle relaxants may aid patients who grind their teeth by relaxing the muscles of the jaw. Low doses of antidepressants have also been found to reduce pain.
Avoid high-tension jaw movement: Moving the jaw with excessive force can strain the joint and the muscles that open and close the mouth, and hamper treatments aimed at reducing the pain. Yawning and chewing should be kept to a minimum. Singing or yelling should also be avoided. Proper posture while on the phone or at a computer should be maintained. Avoid clenching the jaw. Practice keeping teeth apart by gently placing the tongue on the roof of your mouth behind your upper front teeth with your teeth slightly separated. Practicing stress reduction techniques to relax muscle tension in the jaw can help alleviate some of the pain and swelling associated with TMJD.
Use corrective oral appliances: Oral appliances may help reduce tension on the jaw muscles and the joint. Permanent changes in the bite through extensive crown or bridge work and orthodontics have not been proven to be effective and may worsen TMJD symptoms. If a contributing factor is teeth grinding or clenching, a splint or night guard can be worn while sleeping. Clenching and grinding cannot be stopped but the oral appliance will help prevent tooth-to-tooth wear. The goal is that TMJD symptoms will be reduced as the affected area experiences a period of reduced irritation and use.

Living with TMJ/TMJD

A person with a TMJ disorder may experience a progression of symptoms. It’s unknown why symptoms may worsen and improve over time. When a person is affected by symptoms related to the TMJ, the condition is usually manageable with common pain treatments such as over-the-counter pain relievers, exercises, and rest. In most cases, symptoms disappear within weeks.

Those suffering from more persistent symptoms related to disorder, disease or dysfunction of the temporomandibular joint can take steps to reduce painful and disruptive symptoms through basic daily tasks. By making and following a reliable self-treatment schedule, one can provide basic self-care tasks that may improve the condition. For example, regularly performing exercises as recommended by a doctor or physical therapist often improve the symptoms of TMJD.

It’s also recommended that a person with TMJD undertake daily activities meant to reduce tension and stress. Yoga, meditation and breathing exercises may release stress and tightness in the muscles of the face, neck, shoulders and back.

Maintaining good posture at work, while driving, while at home and during recreational activities is also important to the relief of muscle and joint tension in the jaw, neck, back and head. A person should avoid holding the phone between the shoulder and ear and instead hold a phone with a hand to the ear, or use a headset to avoid crunching the muscles of the neck and shoulder and causing unnecessary strain.

Yawning, yelling, singing and other activities that may cause a person to have to open his or her jaw wide should be avoided. If a yawn is imminent, place your tongue on the roof of your mouth and slide it back to limit the opening of the jaw. Avoiding opening the mouth wide to eat is also recommended. Keep food in small and bite-sized pieces, and also opt for softer foods, such as scrambled eggs, mashed potatoes, yogurt, and cooked and diced fruits and vegetables, to avoid aggravating the condition. Crunchy and chewy foods such as salads, nuts, certain breads, and steaks should be avoided.

Support groups such as the TMJ Association helps educate patients on how to minimize the effect of painful and disabling symptoms, updates members on the latest research and news in TMJD studies, and offers those with TMJD a supportive and understanding community to ask questions and share experiences.

Signs and Symptoms of TMJD

The primary symptom of temporomandibular joint disease or disorders is pain in the jaw joint, on either one or both sides, or the closely surrounding areas. Other symptoms include:

Soreness or aching around the ear
Stiffness in the jaw
Locking of the jaw joint or limited movement so that it is difficult to open or close the mouth
Headaches or aching in the face, head, neck, shoulders or back
Radiating pain in the face, jaw or neck
Difficulty chewing, swallowing, eating, speaking or breathing
Painful clicking or popping in the jaw joint during jaw movement
Altered, uncomfortable or uneven bite

Occasional mild to moderate pain in the chewing muscles is not uncommon and should not be cause for concern. Popping or clicking noise in the jaw joint is also normal and need not be addressed unless accompanied by pain, discomfort or limitation of movement.

Patients with TMJD frequently experience more than one of the above signs of the condition. However, it may be difficult to diagnose a TMJ disorder because these symptoms are also common of a number of other conditions including cavities, abscess in the mouth, or sinus or ear infection.

Some other diseases are commonly experienced along with TMJD. Other conditions including arthritis, myofascial pain, fibromyalgia, hypermobile joints, irritable bowel syndrome, sleep disorders, Lyme disease, scleroderma, dystonia, or Ehlers-Danlos syndrome, are thought to have an effect on, perpetuate or worsen TMJD symptoms.

If TMJD is suspected, an individual may want to keep a record of any symptoms that occur so that they may share them with a doctor. Take note of any activities that may trigger the pain, any trouble sleeping, the range of symptoms experienced, any recent dental procedures and new activities or stress that may be occurring in your life. Also observe changes to the range of motion in the jaw, any changes in alignment of the jaw, and any points of pain or discomfort to the touch.

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