What is the temporomandibular joint?
What are TMJ disorders and how are they caused?
What are the common symptoms of TMJ disorders?
How are patients evaluated when TMJ problems are suspected?
How can TMJ be treated?
What is the temporomandibular joint?
The temporomandibular joint (TMJ) is the area directly in front of the ear
on either side of the head where the upper jaw (maxilla) and lower jaw (mandible)
meet. Within the TMJ there are moving parts that allow the upper jaw to close
on the lower jaw. This joint is a typical sliding "ball and socket"
which has a cartilage disc sandwiched between it. The TMJ is used many hundreds
of times a day in moving the jaw, biting and chewing, talking and yawning.
It is one of the most frequently used of all the joints in the body. The temporomandibular
joints are complex and are composed of muscles, tendons, and bones. Each component
contributes to the smooth operation of the TMJ. When the muscles are relaxed
and balanced and both jaw joints open and close comfortably, we are able to
talk, chew, or yawn without pain.
We can locate the TMJ by putting a finger on the triangular structure in front of the ear. The finger is moved just slightly forward and pressed firmly while opening the jaw. The motion felt is from the TMJ. We can also feel the joint motion if we put a little finger against the inside front part of the ear canal. These maneuvers can cause considerable discomfort to a patient who is experiencing TMJ difficulty, and doctors use them for making the diagnosis.
What are TMJ disorders and how are they caused?
TMJ disorders are a group of complex problems related to the jaw joint. Other
names include myofacial pain dysfunction and Costen's syndrome. Because muscles
and joints work together, a problem with either one can lead to stiffness,
headaches, ear pain, bite problems (malocclusion), clicking sounds, or locked
jaws. The following are behaviors or conditions that can lead to TMJ disorders:
1. Teeth grinding and teeth clenching (bruxism) increase the wear on the cartilage
lining of the TMJ. Patients may be unaware of this behavior unless they are
told by someone observing this pattern while sleeping or by a dental professional
noticing telltale signs of wear and tear on the teeth. Many patients awaken
in the morning with jaw or ear pain.
2. Habitual gum chewing or fingernail biting.
3. Dental problems and misalignment of the teeth (malocclusion). Patients
may complain that it is difficult to find a comfortable bite, or that the
way their teeth fit together has changed. Chewing on only one side of the
jaw can lead to or be a result of TMJ problems.
4. Trauma to the jaws. Previous history of broken jaw or fractured facial
bones.
5. Stress frequently leads to unreleased nervous energy. It is very common
for people under stress to release this nervous energy by either consciously
or unconsciously grinding and clenching their teeth.
6. Occupational tasks such as holding the telephone between the head and shoulder.
What are the common symptoms of TMJ disorders?
TMJ pain disorders usually occur because of unbalanced activity of the jaw
muscles and/or jaw muscle spasm and overuse. Symptoms tend to be chronic,
and treatment is aimed at eliminating precipitating factors. Many symptoms
may not appear related to the TMJ itself. Common symptoms include:
Headache:
80% of patients with a TMJ disorder complain of headache, and 40% report facial
pain. Pain is often made worse while opening and closing the jaw. Exposure
to cold weather or air- conditioned air may increase muscle contraction and
facial pain.
Ear pain:
50% of patients with a TMJ disorder notice ear pain but do not have signs
of infection. The ear pain is usually described as being in front of or below
the ear. Often, patients are treated multiple times for a presumed ear infection,
which can often be distinguished from TMJ by an associated hearing loss or
ear drainage (which would be expected if there really was an ear infection).
Because ear pain occurs so commonly, ear specialists are frequently called
on to make the diagnosis of a TMJ disorder.
Sounds:
Grinding, crunching, or popping sounds, medically termed crepitus, are common
for patients with a TMJ disorder. These sounds may or may not be accompanied
by increased pain.
Dizziness:
40% of patients with a TMJ disorder report a vague dizziness or imbalance
(usually not a spinning type vertigo). The cause of this type of dizziness
is not well understood.
Fullness of the Ear:
33% of patients with a TMJ disorder describe muffled, clogged, or full ears.
They may notice ear fullness and pain during airplane takeoffs and landings.
These symptoms are usually caused by Eustachian tube dysfunction, the structure
responsible for the regulation of pressure in the middle ear. It is thought
that patients with TMJ disorders have hyperactivity (spasms) of the muscles
responsible for regulating the opening and closing of the Eustachian tube.
Ringing in the Ear - Tinnitus:
For unknown reasons, 33% of patients with a TMJ disorder experience noise
or ringing (tinnitus). Of those patients, half will have resolution of their
tinnitus after successful treatment of their TMJ.
How are patients evaluated when TMJ problems are
suspected?
A complete dental and medical evaluation is often necessary and recommended
to evaluate patients with suspected TMJ disorders. During the diagnostic process,
one or more of the following conditions/tests is evaluated. Damaged jaw joints
are suspected when there is popping, clicking, and grating sounds associated
with movement of the jaw. Chewing may become painful, and the jaw may lock
or not open widely. The teeth may be worn smooth, as well as a loss of the
normal bumps and ridges on the tooth surface. Ear symptoms are very common.
Infection of the ear, sinuses, and teeth can be discovered by medical and
dental examination. Dental x-rays and computer tomography (CT) scanning help
to define the bony detail of the joint, while Magnetic Resonance Imaging (MRI)
is used to analyze soft tissues. How can TMJ be treated? The mainstay of treatment
for acute TMJ pain is heat & ice, soft diet, and anti-inflammatory medications.
How can TMJ be treated?
Jaw Rest:
It can be beneficial to keep the teeth apart as much as possible. It is also
important to recognize when tooth grinding is occurring and devise methods
to cease this activity. Patients are advised to avoid chewing gum or eating
hard, chewy, or crunchy foods such as raw vegetables, candy, or nuts. Foods
that require opening the mouth widely, such as a big hamburger, are not recommended.
Heat & Ice Therapy:
Assists in reducing muscle tension and spasm. However, immediately after an
injury to the TMJ, treatment with cold applications is best. Cold packs can
be helpful for relieving pain.
Medications:
Anti-inflammatory medications such as aspirin, ibuprofen (Advil, and others),
naproxen (Aleve, and others), or steroids can help control inflammation. Muscle
relaxants, such as diazepam (Valium), aid in decreasing muscle spasms but
do not eliminate TPs.
Physical Therapy:
Passively opening and closing the jaw, massage, diathermy and electrical stimulation
help to decrease pain and increase the range of motion and strength of the
joint.
Trigger Point Therapy:
Trigger points develop in the muscles surrounding the TMJ. Specific areas
to treat on most patients are those directly in front of the ear from the
cheekbone (zygomatic arch) down to the curve of the lower jaw (mandible) and
deep in the groove directly below and behind the ear. For those behind the
ear it's best to use a finger tip but use mild pressure instead of hard pressure.
Stress Management:
Stress support groups, psychological counseling, and medications can also
assist in reducing muscle tension. Biofeedback helps patients recognize times
of increased muscle activity and spasm and provides methods to help control
them.
Occlusal Therapy:
A custom made acrylic appliance which fits over the teeth is commonly prescribed
for night, but may be required throughout the day. It acts to balance the
bite and reduce or eliminate teeth grinding or clenching (bruxism).
Correction of Bite Abnormalities:
Corrective dental therapy, such as orthodontics, may be required to correct
an abnormal bite. Dental restorations assist in creating a more stable bite.
Adjustments of bridges or crowns act to ensure proper alignment of the teeth.
Surgery:
Surgery is indicated in those situations where medical therapy has failed.
It is done as a last resort. TMJ arthroscopy, ligament tightening, joint restructuring,
and joint replacement are considered in the most severe cases of joint damage
or deterioration. TMJ At A Glance The temporomandibular joint (TMJ) is the
site where the upper jaw (maxilla) and lower jaw (mandible) meet. TMJ disorders
are a group of complex problems with many possible causes. Symptoms of TMJ
disorders include headache, ear pain, dizziness, and fullness or ringing in
the ear. There are many treatment options for TMJ disorders.
Cycura Corporation:
The reason for this companies specific inclusion is that they hold the patent
and are the only manufacturer to our knowledge for a unique conditional change
system. They have coupled a normal appliance (night mouth guard) with an electronic
system designed to be worn comfortably at night. The mouth guard has a small
tube which leads to an very small ear piece. When the teeth begin to clench
at night a minimal tone is created in the ear piece which doesn't wake the
person but does disturb the sleep cycle. Over a few weeks the nighttime habit
of bruxism is effectively corrected and that underlying cause is eliminated.
To contact them http://cycura.com/index.html