Temporomandibular Joint (TMJ) Disorders

What Is TMJ?

The TMJ or the temporomandibular joint connects the lower jaw to the sides of your head. This joint is the main reason that enables us to chew, yawn, and even talk owing to its smooth gliding and closing movements. There are muscles attached to this joint that control our jaw positions. The rounded ends of the lower jaw fit into the socket of the joint, and in between, there is a cushion-like soft disc (TMJ disc) that absorbs any shock from the jaws while chewing or any other jaw movements. The joint is also covered for protection by cartilage tissue on either side.

It is a complicated joint in the human body, as it is both a hinge and a sliding joint. When the mouth is open, the rounded ends of the lower jaw (condyles) glide along with the socket of the temporal bone of the face. This gliding motion when we talk, chew, eat, and drink makes the TMJ a sliding joint. When the mouth is closed or in a resting position, the rounded ends of the jaw just firmly fit into the joint socket. This makes the TMJ a hinge joint.

What Are the Signs and Symptoms of TMJ Disorders?

For many people, symptoms of TMJ pain start without any obvious reasons. You need to visit your healthcare provider or dental surgeon if the following symptoms persist for a while:

• Pain in the facial and jaw muscles when you chew food or talk.

• Stiffness of the jaw or facial muscles.

• Limited mouth opening or jaw movements (when you notice you are not able to fully stretch the jaw muscles as before). The joint would also be locked, making it difficult to perform any jaw movements, mainly opening and closing the mouth smoothly.

• A change in your biting or the way your upper and lower teeth fit together.

• Painful clicking, popping, or grating sounds of the jaw joint when you open or close your mouth.

• Pain in one or both of the joints.

• Aching pains in and around your ears.

What Are the Causes of TMJ Disorders?

Research usually shows more prevalence of TMJ disorders in women than in men, as there might be (according to scientists) a potential link between female hormones and TMJ. But, there is no evidence yet to prove this link. The most common causes include:

1. Trauma to the joint.

2. Sleep disturbances.

3. Fatigue.

4. Bruxism or clenching disorders or habitual grinding habits.

5. Rheumatic arthritis or bone disorders in elderly and middle-aged patients usually over 45 to 50 years of age, with the incidence peaking at around 70 to 75 years.

Rheumatic arthritis or any rheumatic disease is responsible for causing the body’s own immune system to attack the joints, bones, muscles, and organs. Rheumatic diseases are more prevalent in women again with a ratio of 3:1. These diseases being inflammatory and painful, usually get more progressive and worse over time if left untreated and thus contribute to TMJ pain disorders often in the elderly population.

Painful conditions can further occur, especially when one of the following factors pose a risk to the joint cartilage that covers the sides of the temporomandibular joint or to the TMJ disc that acts as a shock absorber between the joint socket and the lower jaw rounded ends (mandibular condyle head):

• If the disc is malaligned or out of position or it would be eroded.

• The joint cartilage is damaged because of trauma or forceful impact to the joint.

• The joint disc might have been dislocated from its original position due to trauma and force.

• Arthritis and rheumatic diseases destroy the joint cartilage.

What Are the Treatment Options for TMJ Disorders?

For many people with TMJ disorders, injuries and pain, the physician or dentist would recommend the use of over-the-counter pain medicines or NSAIDs (nonsteroidal anti-inflammatory drugs) that relieve pain for short-term use to provide temporary relief from jaw discomfort. When the symptoms of pain persist longer in the patient without any apparent cause, then muscle relaxant medications or stronger painkillers, or even antidepressants would be advised to ease severe discomfort.

Suppose the temporomandibular joint problem is diagnosed as only temporary. In that case, simple treatments that are very conservative (home remedies) will be advised to prevent discomfort or strain on the jaws for a few days.

Home Remedies:

1. Eating soft food.

2. Applying ice packs to the swollen or stiff joint area.

3. Any extreme jaw movements like chewing hard substances like gum should be avoided.

4. Similarly, loud forms of yawning, singing, or deliberate habitual grinding should be avoided (Night grinding, also commonly known as bruxism, maybe an unconscious or a conscious habit).

Gentle jaw stretching and relaxing exercises or stress management techniques like deep relaxation and meditations coupled with time management and proper exercise have also proved temporary relief from TMJ pains.

Stabilization splints may also be recommended by your dental surgeon that would prove to be effective if used for a short span of time. These splints are plastic guards, which are a kind of oral appliance that fits over the upper and lower teeth to stabilize the jaw movements.

When Is Surgery Required for TMJ Disorders?

Surgical procedures or maneuvers are not always recommended by the dental surgeon or your healthcare provider unless the joint is fractured or dislocated. In case of the lower jaw or condylar fractures, TMJ fracture or dislocations, surgical approaches might be suggested. If surgery is recommended, then let the doctor explain to you the risks involved or about the other types of treatment to wait and watch for your TMJ pain to subside. Magnetic resonance imaging (MRI scans) may also be useful or advised by the doctor for diagnosing soft tissue injuries of the joint.

Surgical replacement of jaws in severe cases with implants or orthodontic treatment to reposition or change the bite dentally (occlusal adjustment and splints) has proven to be ineffective by researchers so far in regard to temporomandibular joint problems as it may further worsen the jaw and bite force.

Conclusion:

Consulting your doctor is of pivotal importance to rule out other major causes of facial pain, such as sinus infections, neuralgias, or ear infections. The signs and symptoms of TMJ pain should not be ignored; thus as the doctor can help you understand the conservative treatment modalities firstly to ease TMJ pain, and if the pain is persistent, your dentist or physician may opt for other treatment strategies.