CONDITIONS
Temporomandibular joint disorders
What is temporomandibular joint disorder (TMD)?
Temporomandibular joint (TMJ) disorder refers to conditions affecting the muscles of the jaw, temporomandibular joints, and the nerves causing persistent facial pain.
The National Institute of Dental and Craniofacial Research categorizes TMJ disorder in the following ways:
- Myofascial pain: This is the most common type of TMJ disorder caused by tightness in the muscles individuals use to chew. People notice pain in front of the ear or pain when chewing.
- Internal derangement of the joint: Also known as acute or trauma related TMJ disorder, it can occur due to various reasons such as sports injuries, car accidents, or direct impact to the face or chin. These incidents can damage the TMJ structure and result in acute inflammation. Additionally, clenching or grinding of the teeth can also cause acute trauma to the TMJ.
- Degenerative joint disease. This is the most severe form and is commonly caused by structural changes in the jaw. As a result, this can lead to teeth shifting to the left or right, changing the alignment of the upper and lower teeth. This ultimately results in intense pain while biting or chewing.
It is possible to have one or more of these issues at the same time.
What are temporomandibular joints?
The temporomandibular joint is also called the jaw joint. This joint connects the mandible (lower jaw) to the skull. Specifically, the joint can be found in front of each ear and consists of the mandible (lower jaw) and the temporal bone (side and base of the skull). Together with various muscles, they enable the mandible to move in multiple directions, including up and down, side to side, and forward and back. Proper alignment of the mandible and the TMJs allows smooth muscle actions such as chewing, talking, yawning, and swallowing.
However, when these structures, including muscles, ligaments, jawbone, and temporal bone, are not in the right position or do not move together properly, it can lead to various issues.
What causes TMJ disorders?
The TMJ disorder is often associated with a range of factors rather than just one single cause. These may include:
- Physical injury to the jaw or TM joint
- Arthritis affecting the jaw joint
- Regular teeth grinding or clenching
- Structural jaw abnormalities from birth, as well as growth disorders
What are the symptoms of TMD?
Common symptoms of temporomandibular joint disorder include:
- Jaw pain
- Pain that radiates to the face or neck
- Jaw stiffness
- Headache
- Restricted movement or jaw locking
- Toothache
- Painful clicking, popping, or grating sounds when opening or closing the mouth
- Ringing in the ears, hearing loss, dizziness,
- Alterations in the alignment of the upper and lower teeth
How are TMJ disorders diagnosed?
Diagnosing TMJ disorders can be difficult as there are no standardized tests available for most conditions falling under this category. A doctor might recommend consulting a dentist or an ear, nose, and throat (ENT) specialist for an accurate diagnosis of the condition.
The doctor will examine the head, neck, face, and jaw for tenderness, jaw clicking or popping, and feel around the jaw joints while the individual opens or closes their mouth. They may also take imaging tests to examine jaw joints and structures around them closely. These imaging tests may include:
- Dental X-rays
- CT (computed tomography) scans
- MRI (magnetic resonance imaging)
Who treats TMJ disorder?
TMJ specialists involve a range of professionals, including oral surgeons, orthodontists, otolaryngologists, and prosthodontists. These experts possess the necessary expertise and knowledge to diagnose and treat TMJ disorders. Oral surgeons are skilled in surgical interventions, while orthodontists focus on correcting misalignments of the teeth and jaws. Otolaryngologists specialize in ear, nose, and throat conditions, including TMJ disorders. Lastly, prosthodontists, who are dentists specializing in dental prostheses and appliances, can provide effective solutions for TMJ-related issues.
How is TMJ disorder treated?
The TMJ treatment depends on the root cause and intensity of pain. Noninvasive alternatives like medications or nonsurgical therapies are tried initially. If symptoms fail to alleviate, jaw surgery may be necessary.
Self-care practices at home
In many instances, self-care practices at home can effectively address the symptoms of TMJ disorders, which include:
- Consuming soft foods
- Applying ice to decrease swelling
- Limiting jaw movements
- Refraining from chewing gum and hard foods
- Implementing stress-reducing techniques
- Incorporating jaw-stretching exercises to enhance jaw mobility
Medications
If TMJ dysfunction symptoms are not relieved by home treatments, some medications are prescribed by a doctor, which may provide more relief.
Some of these medications include:
- Pain relievers (Like acetaminophen)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
- Muscle relaxers (Beneficial for individuals who clench or grind their teeth)
- Antidepressants (Alter the way the body perceives pain)
A doctor will help decide which medication is best based on the individual’s personal condition and health history.
Nonsurgical treatment
Nonsurgical treatment options include:
- Mouth guards: Dental appliances like oral splints and mouth guards are utilized to adjust the position of the jaw or minimize the consequences of grinding and clenching. Obtaining a custom mouth guard from a dentist rather than purchasing over the counter is recommended.
- Physical therapy: TMJ exercises help to relieve jaw pain and strengthen the muscles surrounding the jaw joint.
- Trigger point injections: This involves dry needling or injecting substances into painful muscle knots in the jaw such as corticosteroids or botulinum toxin.
- Ultrasound therapy: Sound waves are used to deliver deep heat into the tissues, increasing blood flow and promoting muscle relaxation.
- Transcutaneous electrical nerve stimulation (TENS): Low-level electrical currents are utilized to relax the jaw muscles.
- Behavioural changes: This includes improving posture and avoiding chewing on ice.
Surgical treatment
If medications and nonsurgical therapies are ineffective, surgery may be necessary. Options for TMJ surgery include:
- This procedure is commonly used to determine the cause of jaw joint pain. In addition to diagnosing the issue, a dentist or oral surgeon can use a needle to extract fluid from the joint, alleviating symptoms.
- TMJ arthroscopy. A surgeon creates a small incision in front of the ear and inserts a thin tube equipped with a light and camera. This minimally invasive procedure allows for the insertion of surgical instruments to reshape bone, eliminate scar tissue, or reposition the joint.
- Open-joint surgery. In cases where arthroscopy is not feasible, open-joint surgery may be performed. This involves a larger incision to access the jaw joint directly.
Is it possible to prevent TMJ dysfunction?
TMJ dysfunction cannot always be prevented as some risk factors are unavoidable. However, wearing a mouth guard at night if clenching or grinding teeth, wearing a mouth guard during contact sports, practicing good posture, and engaging in meditation, mindfulness, or other stress reduction techniques can help reduce the risk.
In summary, TMJ disorder affects each person differently, potentially resulting in temporary discomfort or long-lasting jaw pain. While diagnosing the condition may be difficult, there are treatment options that can help alleviate symptoms. While some individuals may find relief through self-care methods such as improving posture or managing stress, others with conditions like arthritis may require additional interventions. There are numerous treatment options available to alleviate arthritis symptoms. Lifestyle adjustments, coupled with pain-relieving medications, are typically effective in managing most cases of TMJ disorder, with aggressive treatments rarely necessary.
References
- Cleveland Clinic. Temporomandibular joint (TMJ) disorder. Available from: https://my.clevelandclinic.org/health/diseases/15066-temporomandibular-disorders-tmd-overview. Accessed on 7th May 2024
- Johns Hopkins Medicines. Temporomandibular disorder (TMD). Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/temporomandibular-disorder-tmd. Accessed on 7th May 2024
- National Institute of Dental and Craniofacial Research. TMD (Temporomandibular Disorders). Available from: https://www.nidcr.nih.gov/health-info/tmd. Accessed on 7th May 2024
- Temporomandibular Joint (TMJ) Disorders. Available from: https://www.healthline.com/health/tmj-disorders#causes. Accessed on 7th May 2024