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TMJ Disorders

Temporomandibular joint and muscle disorders (TMJ disorders) are problems or symptoms of the chewing muscles and joints that connect your lower jaw to your skull.

Times Essentials

REFERENCE FROM A.D.A.M.

 

Alternative Names

TMD; Temporomandibular joint disorders; Temporomandibular muscle disorders

 

Causes

There are two matching temporomandibular joints -- one on each side of your head, located just in front of your ears. The abbreviation "TMJ" literally refers to the joint but is often used to mean any disorders or symptoms of this region.

Many TMJ-related symptoms are caused by the effects of physical stress on the structures around the joint. These structures include:

  • Cartilage disk at the joint
  • Muscles of the jaw, face, and neck
  • Nearby ligaments, blood vessels, and nerves
  • Teeth

 

For many people with temporomandibular joint disorders, the cause is unknown. Some causes given for this condition are not well proven. These included:

  • A bad bite or orthodontic braces
  • Stress and tooth grinding. Many people with TMJ problems do not grind their teeth, and many who have been grinding their teeth for a long time do not have problems with their TMJ joint. For some people, the stress associated with this disorder may be caused by the pain as opposed to being the cause of the problem.

 

Poor posture can also be an important factor in TMJ symptoms. For example, holding the head forward while looking at a computer all day strains the muscles of the face and neck.

 

Other factors that might make TMJ symptoms worse are stress, poor diet, and lack of sleep.

 

Many people end up having "trigger points" -- contracted muscles in your jaw, head, and neck. Trigger points can refer pain to other areas, causing a headache, earache, or toothache.

Other possible causes of TMJ-related symptoms include arthritis, fractures, dislocations, and structural problems present since birth.

 

Symptoms

Symptoms associated with TMJ disorders may be:

  • Biting or chewing difficulty or discomfort
  • Clicking, popping, or grating sound when opening or closing the mouth
  • Dull, aching pain in the face
  • Earache
  • Headache
  • Jaw pain or tenderness of the jaw
  • Locking of the jaw
  • Difficulty opening or closing the mouth

 

Exams and Tests

You may need to see more than one medical specialist for your TMJ pain and symptoms. This may include a primary care provider, a dentist, or an ear, nose, and throat (ENT) doctor, depending on your symptoms.

A thorough examination may involve:

  • A dental examination to show if you have poor bite alignment
  • Feeling the joint and muscles for tenderness
  • Pressing around the head to locate areas that are sensitive or painful
  • Sliding the teeth from side to side
  • Watching, feeling, and listening to the jaw open and shut
  • X-rays or MRI of the jaw

Sometimes, the results of the physical exam may appear normal.

Your doctor will also need to consider other conditions, such as infections, ear infections, or nerve-related problems and headaches, as the cause of your symptoms.

 

Treatment

Simple, gentle therapies are usually recommended first.

  • Learn how to gently stretch, relax, or massage the muscles around your jaw. Your doctor, dentist, or physical therapist can help you with these.
  • Avoid actions that cause your symptoms, such as yawning, singing, and chewing gum.
  • Try moist heat or cold packs on your face.
  • Learn stress-reducing techniques.
  • Exercising several times each week may help you increase your ability to handle pain.

 

Read as much as you can, as opinion varies widely on how to treat TMJ disorders. Get the opinions of several doctors. The good news is that most people eventually find something that helps.

 

Ask you doctor or dentist about medications you can use:

  • Short-term use of acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), or other nonsteroidal anti-inflammatory drugs
  • Muscle relaxant medicines or antidepressants
  • Rarely, corticosteroid shots in the TMJ to treat inflammation

Mouth or bite guards, also called splints or appliances, have been used since the 1930s to treat teeth grinding, clenching, and TMJ disorders.

  • While many people have found them to be useful, the benefits vary widely. The guard may lose its effectiveness over time, or when you stop wearing it. Other people may feel worse pain when they wear one.
  • There are different types of splints. Some fit over the top teeth, while others fit over the bottom teeth.
  • Permanent use of these items may not be recommended. You should also stop if they cause any changes in your bite.

 

Failure of more conservative treatments does not automatically mean you need more aggressive treatment. Be cautious about any nonreversible treatment method, such as orthodontics or surgery, that permanently changes your bite.

Reconstructive surgery of the jaw, or joint replacement, is rarely required. In fact, studies have shown that the results are often worse than before surgery.

 

Support Groups

For more information, see The TMJ Association -- www.tmj.org

 

Outlook (Prognosis)

For many people, symptoms occur only sometimes and do not last long. They will go away in time with little or no treatment. Most cases can be successfully treated. Some cases of pain go away on their own without treatment. TMJ-related pain may return again in the future. If the cause is nighttime clenching, treatment can be very tricky because it is a sleeping behavior that is hard to control.

Mouth splints are a common treatment approach for teeth grinding. While some splints may silence the grinding by providing a flat, even surface, they may not be as effective at reducing pain or stopping clenching. Splints may be effective in the short-term but could become less effective over time. Some splints can also cause changes in your bite. This may cause a new problem.

 

Possible Complications

  • Chronic face pain
  • Chronic headaches

      

When to Contact a Medical Professional

See your health care provider right away if you are having trouble eating or opening your mouth. Keep in mind that a wide variety of possible conditions can cause TMJ symptoms, from arthritis to whiplash injuries. Experts who are specially trained in facial pain can help diagnose and treat TMJ.

 

Prevention

Many of the home-care steps to treat TMJ problems can prevent such problems in the first place:

  • Avoid eating hard foods and chewing gum.
  • Learn relaxation techniques to reduce overall stress and muscle tension.
  • Maintain good posture, especially if you work all day at a computer. Pause often to change position, rest your hands and arms, and relieve stressed muscles.
  • Use safety measures to reduce the risk of fractures and dislocations.

 

References

Beuscher JJ. Temporomandibular joint disorders. Am Fam Physician . 2007;76(10):1477

Hampton T. Improvements needed in management of temporomandibular joint disorders. JAMA . 2008;299(10):1119-1121.

Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med . 2008;359:2693-2705.

 

The New York Times

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Assessment & Treatment
  • Assessment Process
  • Treatment Process
  • Only Dental Professionals
  • Assessing DMSD
  • Bite Force Analysis
  • Mandibular Range of Motion
  • Cervical Range of Motion

Only Dental Professionals

In many cases, only dental professionals can help the estimated 80 million Americans suffering from the painful symptoms caused by improper dental forces, called dentomandibular sensorimotor dysfunction (DMSD).

READ MORE "...it is imperative to include the training for orofacial pain, particularly those from temporomandibular joint and musculoligamentous tissues.” JADA Cover Story, 10/2015, Vol. 146, Issue 10, Pg. 721-728

Assessing DMSD

20% of your existing patients suffer from DMSD, as do 20% of all Americans. Your team members quickly assess patients for "red flags" (which indicate DMSD), utilizing TruDenta's patented technologies.

The National Institutes of Health estimate that over 80 million Americans suffer from one or more of the symptoms of DMSD, including:
• Chronic Headache
• Migraine
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Bite Force Analysis

TruDenta uses digital force measurement technology, powered by Tekscan®, for evaluating the amount of bite force that is present during closure, at closure, and while chewing. The technology is so advanced that it actually calculates the bite force and motion on a tooth-by-tooth basis. This digital exam literally shows a movie of the bite force in action revealing abnormal forces in the nerves, muscles and ligaments that are often the cause of symptoms.

Bite balance is also calculated to identify potential issues within the overall chewing system. READ MORE

Mandibular Range of Motion

A normal opening for an adult is 53 mm to 57 mm. Limited or restricted range of motion (less than 40 mm) is a reduction in an individual’s ability for normal range of movement. Along with opening movement, an individual should be able to slide their jaw to the left and to the right at least 25 percent of their total mouth opening in a symmetrical fashion.

When restricted movement exists, an imbalance in the system is present, and breakdown of the system is likely to occur. READ MORE

Cervical Range of Motion

The TruDentaROM is a system of hardware and software that digitally measures cervical range of motion (ROM) impairment based upon AMA guidelines. This directly affects the proprioceptive feedback system of the dental occlusion, TMJ, and the muscles of mastication.

ROM impairment is another “red flag” which assists doctors in accurately diagnosing symptoms that are often dental force related. This data enhances medical insurance collections and the collaboration with referring medical doctors. READ MORE

  • Doctor Chair Time
  • Therapeutic Ultrasound
  • Microcurrent Stimulation
  • Low-Level Cold Laser

Less Than One Hour Doctor Chair Time

A typical case requires less than one hour of doctor time in the diagnosis and minor occlusal adjustments during the rehabilitation period.

Treatments are performed by a trained team member once per week, in less than one hour. The most severe cases require 12 treatments. Therapies are spa-like, non-invasive and require no drugs or needles. Most patients report dramatic results after the very fist treatment. Note: The majority of patients utilize an orthotic only during the treatment period, up to a maximum of 12 weeks. READ MORE

Therapeutic Ultrasound

The goal of therapeutic ultrasound treatment is to return circulation to sore, strained muscles through increased blood flow and heat. Another goal is to break up scar tissue and deep adhesions through sound waves.

Therapeutic exposure to ultrasound reduces trigger point sensitivity and has been indicated as a useful clinical tool for managing myofacial pain. Additionally, ultrasound also has been shown to evoke antinociceptive effects on trigger points. READ MORE

Microcurrent Stimulation

Sub-threshold microcurrent stimula¬tion reduces muscle spasm and referral pain through low electrical signal. It also decreases lactic acid build-up and encourages healthy nerve stimulation. In particular, microcurrent electrotherapy has been shown to help increase mouth opening significantly.

• Reduces muscle spasm and referral pain through low electrical signal
• Decreases lactic acid build-up
• Encourages healthy nerve stimulation
• Increases mouth opening significantly
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Low-Level Cold Laser

Low level laser/light therapy is one of the most widely used treatments in sports medicine to provide pain relief and rehabilitation of injuries. Over 200 randomized clinical trials have been published on low level laser therapy, half of which are on pain.

Low level laser/light therapy decreases pain and inflammation, accelerates healing of muscle and joint tissue 25 to 35 percent faster than without treatment, and reconnects neurological pathways of nerves to the brain stem, thereby inhibiting pain. READ MORE

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