Things You Should Know!

It might be helpful for you to have some information concerning the jaw joint or T.M.J (temporo-mandibular joint).  The T.M.J. is the joint where the lower jaw is hinged to the skull. The joint allows and controls the movement of the muscles attached to the lower jaw. This movement is needed for biting, chewing, swallowing, speaking and yawning.

Normally, you can move your jaw up and down, side to side and forward and back.

Pain or dysfunction of the temporomandibular joint is commonly referred to as "TMJ", when in fact, TMJ is really the name of the joint, and Temporomandibular joint disorder (or dysfunction) is abbreviated TMD.  If you place your fingertips in your ears and open and close your mouth, you can feel the movement of the T.M.J.  If this is painful, that might be a sign of a problem.

How can things go wrong with the TMJ?

Unbalanced occlusion.    Dentists use the word 'occlusion' to describe the way the teeth meet (and bite) together. They can describe a 'perfect occlusion', in which the teeth fit perfectly and don't stress the TMJ.  Few people, however, have a perfect occlusion and yet most do not get TMJ problems. 
If your occlusion is thought to contribute to your TMJ symptoms, your dentist will be able to discuss the treatment options with you.  For example, an orthodontist can re-align teeth to give a more balanced occlusion - or you might need new dentures.

Most of us feel anxious and even depressed at some time in our life. 
Apart from the effect on our mood and energy levels we can get other symptoms including headaches, migraine, eczema and TMJ problems. 
Treatment of the underlying condition can be sufficient to reduce the TMJ symptoms.

If you habitually clench or grit or grind your teeth, you increase the wear on the cartilage lining of the joint. Many persons grind their teeth and they do not know it unless an observant roommate tells them so. If you habitually chew gum much of the day, again, you increase the wear and tear on the joint and you give it little opportunity to recover between meals, as it ought to have.

The TMJ can be affected by any general (systemic) illness that involves the joints, for example arthritis.

Some patients have TMD symptoms but we can't find the cause - we call this idiopathic ('don't know').

T.M.J. disorders have been called The Great Impostor because they can mimic many other problems. For example: severe headaches, ringing in the ears, shoulder pain, hearing loss, back and leg pain. If left alone the condition may go away, but often it worsens without treatment.

How does TMJ dysfunction feel?

The pain may be sharp and searing, occurring each time you swallow, yawn, talk or chew; or it may be dull, constant and boring. The usual focus of pain is over the joint, immediately in front of the ear, but pain can also radiate elsewhere. The pain often causes spasm in the adjacent muscles, which are attached to the bones of the skull, face, and jaws. Therefore, pain can be felt at the side of the head (the temple), the cheek, the lower jaw, and the teeth. Some people have attributed migraine, sinus trouble and backaches to the TMD, but that would be difficult to explain with our present-day knowledge of anatomy and physiology.

A very common focus of pain is in the ear. Many patients come to the ear specialist quite convinced their pain is from an ear infection. When an earache is not associated with a hearing loss, and the eardrum looks normal, the doctor will consider the possibility that the pain comes from TMJ dysfunction.

There are a few other symptoms besides pain that TMJ dysfunction can cause. In some patients the TMJ’s make popping, clicking or grinding sounds when the jaws are opened widely. Or they can lock wide open (dislocated), or, at the other extreme, they can prevent the jaws from fully opening up. Some people get ringing in their ears from TMJ trouble, which is an exaggeration of the ear ringing that most people can normally produce by clenching their teeth together hard.

What can be done for TMJ symptoms?

Treatment varies from case to case.

TMJ disorders have many and various causes, some of which will decrease over time on their own.

It is useful to know what is causing the TMD symptoms and especially to make sure that they are not signs of other (more treatable or more serious) conditions.

Often the symptoms will be temporary and/or can be treated and prevented by following simple advice including:

Taking only a soft diet that doesn't require too much chewing (at least until the symptoms have passed).

Avoiding opening your mouth too wide. 

For example when yawning, try putting your hand under your chin to stop yourself opening too wide. Try cutting up fruit into pieces rather than biting off big chunks.

Avoid habits that can stress your TMJ such as chewing gum, biting pen/or pencil tops or biting your nails.

Use simple painkillers as required. 

Your dentist, doctor or oral and maxillofacial surgeon might prescribe some pain control for you. Ibuprofen (sold as Advil) is one of the best types of analgesic for TMD symptoms - however, do not take medication if your doctor or pharmacist has advised you against it.

Jaw exercises can be helpful. 

Your dentist or oral and maxillofacial surgeon should shown you some if necessary - practice them regularly to train your joints and muscles.

Placing a warm towel over the painful area often helps relieve the pain.

Treating the cause of your anxiety:  
some doctors will prescribe a type of anti-depressant for TMJ pain - these can reduce muscular tension and therefore TMJ pain.

Physiotherapists, as advised by your oral and maxillofacial surgeon can help some types of TMD symptoms.

Often a plastic appliance is constructed (T.M.J. Splint or Orthotic) which frees the jaw movements from abnormal guidance by malpositioned teeth. This allows the affected joints to return to their normal position. Healing can then begin to take place. However problems do not occur overnight and neither does healing.

Appliances are usually worn from three to six months. During this time further evaluation can be done to determine if rehabilitative procedures are necessary to give long-term relief.

In a very small number of cases, surgery on the joint by an oral and maxillofacial surgeon is a treatment of TMD symptoms. This is usually only after trying the other measures.

We hope this information is helpful. If it raises any new questions we will be happy to answer them!