With all of the focus on teeth and gums, many patients do not realize that dentists also can help with disorders of the jaw. One common disorder is commonly called “TMJ”, a disorder of the temporomandibular joint, which is responsible for moving your jaw up and down. The name is derived from the two bones connected by the joint and facial tendons.
The most common of these disorders occurs when the joint cracks and pops when moved, and can be quite unsettling or uncomfortable for many patients. This normally occurs when the disc that articulates the joint is displaced and creates air bubbles, friction of the bone, and unnecessary tension on the joint. However, it is an easily treated disorder — and with proper care and supervision of an oral specialist or dentist, you can be free of this annoying and painful condition.
Symptoms of TMJ
Upon opening your mouth, you may hear a pop or click which will then echo when you close your mouth. This causes pain, inflammation, not to mention the sound is highly irritating given the proximity of the bone to your ear.
Other symptoms may also include, but are not limited to:
- Tenderness of the jaw and area around the jaw.
- Pain in or around your ear.
- Difficult chewing or discomfort when chewing.
- Joint-lock, making it difficult to open and close your mouth.
- General facial pain due to tension on facial muscles.
If you experience persistent pain in your jaw, or cannot open and close your mouth properly, seek medical attention immediately. While not life-threatening, you should not suffer any longer than absolutely necessary.
Causes of TMJ
Unlike many joints, the TMJ combines sliding and hinge motions. However, like the majority of our major joints, the TMJ is coated in cartilage and has a shock absorbing disk, which keeps the motions smooth and keeps chewing, speaking, and general function of the mouth comfortable. While the causes of TMJ are well known, the exact cause of each individual case can be unclear.
The most common causes of painful TMJ disorders are:
- The disk erodes or is displaced.
- The joint is damaged by inflammation and arthritis.
- Traumatic damage caused by falls, physical contact, accidents, or other impacts.
TMJ disorders happen most frequently in adults between the ages of 20 and 40 and is more prevalent in women.
Treatments for TMJ Disorders
Most treatments for TMJ are non-surgical and involve either the use of pain medication or occlusal splints in the form of a bite guard. These devices can be adjusted to your bite and particular needs. Treatment can also reduce conditions such as nocturnal bruxism (grinding and clenching) and snoring. Other treatments may include stretching and motion exercises to help stretch and strengthen your jaw muscles, as well as advice on how to cope with maladaptive behaviors such as nail biting or teeth clenching that may be aggravating your joints.
In extreme cases, you may need surgery, irrigation of the joint with needles, or injection of corticosteroids to reduce inflammation. However, surgical approaches are seen as a last resort and we recommended our patients avoid this route. Depending on your case, Dr. Zadeh will let you know what your treatment options are.
My Jaw Really Hurts
If you are experiencing pain, or if Dr. Zadeh notices irregularities in the motion and feeling of your jaw, he will likely test you for telltale signs of TMJ. If Dr. Zadeh suspects there is an issue after your initial assessment, he will then take images of your jaw and skull with X-Rays and his ConeBeam CT Scan Machine. This will help isolate the problem area and inform your treatment.
Is There Anything I Can Do To Ease My Symptoms or Prevent Them?
There are a few lifestyle changes you can make to either reduce your symptoms or outright prevent them. If you suspect your have TMJ or may be susceptible to TMJ, try some of these techniques:
- Eat soft foods, avoid chewing gum and excessively chewy foods (like taffy), and cut your food into small pieces.
- Stretching and massage to ease your symptoms.
- Alleviate pain by using over-the-counter painkillers like Motrin or Tylenol, or use hot and cold compresses on the side of your face.
- Relaxation techniques such as conscious breathing and meditation can help ease the tension that is aggravating your jaw muscles and joints.
TMJ disorder is a common and easily treated problem. If you have tried some of our suggestions and they have not worked, do not hesitate to call us at (310) 273-2020 or email our appointment coordinator to set up your complimentary consultation today. Life is too short to suffer with annoying, recurring pain, so you owe it to yourself to come in!
A. TMJ Pain/Syndrome
When people say they have “TMJ”, that usually means they have TMJ Pain/Syndrome. The TMJ Pain/Syndrome is a combination of various signs and symptoms that emanate from this joint: pain upon opening, chewing, clicking, or locking, limited mouth opening, deviation to one side opening, or any combination of the above can be an indication of past or current TMJ problems.
B. TMJ Clicking
Many individuals have a clicking sound from opening the mouth, closing the mouth, or both. The clicking could be accompanied by pain but is usually painless. The cause of the clicking is usually an internal derangement of the joint disk. The joint disk is a cartilaginous membrane that sits on the lower jaws condyle and slides with the lower jaw forward during function. When the smooth movement of this disk is hampered for one reason or another, the lower jaw slips over this disk rather than moves with it. This slipping on and off the disc produces the “clicking” sound that patients feel upon opening and closing the mouth.
While TMJ Clicking should not and need not be treated per se, clicking is a sign of underlying trouble with the jaw joint. A patient with clicking must get a thorough TMJ exam and if they are stressing factors such as an uneven bite, they must be addressed to limit further degradation and damage to the joint.
C. Repositioning Splint
A dental splint is an appliance made up of hard acrylic that is made to “even out” and neutralize the teeth interferences in the jaw movement. An occlusal splint differs from a night guard in that it has a precise shape that is designed to take advantage of physiological features of the teeth. A night guard however, is an appliance that prevents direct contact of lower and upper teeth and hence protects the teeth when the patient engages in grinding or clenching.
A mouth guard is a soft appliance that is made to go between upper and lower teeth to protect the teeth against impact. A mouth guard is for waking hours only and must not be worn at night.
D. Splint Therapy
When teeth interferences have made the TMJ muscles compensate and deform, a splint therapy is needed to gradually reform the tissues and muscles to their physiological shapes and positions.
E. Full Mouth Bite Adjustment
A full mouth bite adjustment is the most difficult and challenging dental procedure there is. Many factors go into a physiologically acceptable bite, but some of the factors are ignored or overlooked when teeth are restored. These discrepancies trigger the muscles of mastication and can give rise to clenching/grinding and muscle spasm pain that can even be mistaken with migraine pain. Thorough examination and diagnosis of the head and neck area must be performed by a knowledgeable dentist to rule out/diagnose/treat any bite discrepancies.
F. Neuromuscular Dentistry
Neuromuscular Dentistry refers to a school of thought in dentistry that the muscles of the jaw must determine the position of the jaw rather than the jaw joint. While this concept may be applicable in a very limited number of patients, the majority of the profession believes the joint should be the determinant of the bite and practices the older well established concept of “centric” bite.
G. Bruxism & Clenching
Bruxism refers to grinding of the lower teeth against the upper teeth and clenching refers to squeezing the lower teeth against the upper teeth. These are called parafunctions because during regular function, the lower teeth have no business touching the upper teeth. During mastication (chewing), there is food between upper and lower teeth and the teeth do not touch each other directly. During swallowing, teeth get very close to each other but do not touch. During speech, upper and lower teeth never contact each other. Therefore, when the teeth do touch in an excessive way such as during bruxism and clenching, they are called parafunctions. Both grinding and clenching are often experienced together and are very deleterious to the longevity of teeth. Excessive grinding can totally wear out the enamel of the teeth to a point that only small knobs of the teeth are left. Clenching can crack the teeth through the root systems and break the veneers or crowns.
Causes of Grinding and Clenching
There are multiple causes of grinding and clenching:
- Some parafunction occurs physiologically during sleep and can be harmless.
- Some bite discrepancies encourage grinding
- Emotional stress and anxiety amplify the force of grinding and clenching
- Even after removal of causes, grinding and clenching may have become a “habit” and the individual may continue to damage the teeth
As you can see, bruxism and clenching are very complex conditions to understand and even more complex to treat. A thorough consultation with your dentist is necessary to try and configure a solution.