On TMJ and TMDs

Pacific Dental Care

TMJ or TMJ pain is a term used by many to describe a disorder of the jaw, when in fact all the term does is label the joint. The temporomandibular joints are the two joints which connect the jawbone to the skull. It gets its name because it is a complicated system which involves bilateral synovial articulation between the temporal bone of the skull and the mandible.

Temporomandibular disorders (TMDs) are problems affecting your TMJ (or jaw joint). TMDs also affect muscles of the face involved with chewing.

Your TMJ is considered a small, ball-and-socket joint consisting of 3 parts:

• The condyle (the “ball” itself)
• The glenoid fossa (or socket)
• A small, fibrous disk between the ball and socket

Who is Susceptible to TMDs?

Studies show fairly consistently that 20% to 30% of the population live with TMD symptoms. Women are 3 times more likely to develop TMDs than men. Hormones like estrogen may play a role. Women’s TMJ discs are also held together by collagen that is structurally different compared to men’s, which might be another factor.

TMD is a broad term; it does not connote a specific condition. TMDs come in many manifestations, each bearing its own name and set of symptoms.

TMD causes are not yet fully understood, but there are some contributing factors which can lead to or aggravate TMDs, including:

• Jaw trauma. Can be caused by direct or indirect injury, or by long-term clenching and teeth grinding (also called bruxism)
• Anxiety, tension or stress, which causes muscle spasms
• Misaligned teeth (malocclusion)
• Arthritis (rheumatoid arthritis or osteoarthritis, for instance)
• Tumors of the jaw joint

TMDs Symptoms Include:

• Pain or tenderness in front of the ear while chewing, speaking or opening your mouth wide
• Jaw sticking (open or closed)
• Facial muscle spasms
• Clicking, popping or cracking in the jaw
• Grating sensation in the jaw when opening or closing the mouth
• Headaches (beginning by the ear and spreading to head and neck)

If you experience these symptoms, it may be time to get a professional involved. Typically, you will need to enlist the help of a dentist, preferably one who specializes in treating TMDs.

Your dentist will take a look at:

• Jaw movement
• Tooth wear, as well as signs of habitual behavior (clenching or grinding)
• The TMJ itself as well as the muscles of the jaw and neck

Dentists might use additional tools (like a stethoscope) which help them listen for joint sounds which may suggest disorders involving the disk or bones of the temporomandibular joint.

Generally, your dentist is tasked with determining whether the problem is a muscle disorder or if it’s a disorder of the bones or disk. Standard X-rays or a panoramic X-rays can usually rule out serious disorders within the joint.

For difficult cases, a more detailed view of the joint is available through MRI (magnetic resonance imaging), or CT (computed tomography) scan.

TMD treatment will always depend on cause of disorder. By and large, TMDs are related to soreness of associated muscles which sometimes spasm as a result. TMDs often respond to conservative methods, but sometimes more invasive, surgical measures are necessary.

Below are some measures you and your dentist might incorporate into your TMD treatment plan.

• Soft diets can help. Avoiding hard, crunchy, or sticky foods. Cutting foods into smaller portions and chewing those portions with your back teeth often helps.
• Physical therapy (heat application, massage and/or ultrasound).
• Occlusal guard (or splint), which helps curb teeth grinding and jaw clenching.
• Stress reduction therapy (often involves biofeedback and can also involve psychological counseling).
• Pain relievers (over-the-counter varietals).
• Prescription drugs (anti-inflammatory).
• Prescription drugs (muscle relaxants).
• Bite adjustment. Might include reshaping teeth slightly.
• Replacement of missing teeth (dental implants).

If none of these measures prove effective, surgery might be necessary. Arthroscopic surgery is the most common surgical procedure performed for TMDs. Arthroscopic surgery involves two to three small incisions around the TMJ. One incision serves as an entry point for a high tech camera to be inserted. Surgical instruments are then inserted through the other one or two incisions. The process involves inflamed tissue removal. Afterwards, the joint is rinsed.

Those who believe they live with TMD or are experiencing problems with their temporomandibular joint should consult with a dentist immediately. Your dentist can diagnose your condition and determine the best course of action to suit your needs.

Don’t make the mistake of waiting until the pain and inconvenience becomes intolerable. With proper treatment TMD symptoms should go away, some cases in less than a month’s time. More complicated and severe cases (like arthritis or long-standing bruxism) can take considerably longer. Contact Dr. Marine, a dentist serving Pasadena, Glendale, and Burbank, for additional information on diagnosing and treating TMD.

Read More

• TMJ
• What is TMJ Pain?