TMJ (temporomandibular joint) disorders are a family of problems related to your jaw joint. If you have had symptoms like pain or a "clicking" sound, you'll be glad to know that these problems are more easily diagnosed and treated than they were in the past. These symptoms occur when the joints of the jaw and the chewing muscles (muscles of mastication) do not work together correctly. TMJ stands for Temporomandibular Joint, which is the name for each joint (right and left) that connects your jaw to your skull.
TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. You may have a damaged jaw joint due to injury or disease. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. As a result, the disk, which is made of cartilage and functions as the "cushion" of the jaw joint, can slip out of position. Whatever the cause, the results may include a misaligned bite, pain, clicking or grating noise when you open your mouth or trouble opening your mouth wide.
Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important. No one treatment can resolve TMJ disorders completely and treatment takes time to become effective. DSI specialists can help you have a healthier and more comfortable jaw.
The diagnosis of a TMJ problem can be based on both patient history and diagnostic procedures. Common history questions to address include:
Are you aware of grinding or clenching your teeth?
Do you wake up with sore, stiff muscles around your jaws?
Do you have frequent headaches or neck aches?
Does the pain get worse when you clench your teeth?
Does stress make your clenching and pain worse?
Does your jaw click, pop, grate, catch, or lock when you open your mouth?
Is it difficult or painful to open your mouth, eat or yawn?
Have you ever injured your neck, head or jaws?
Have you had problems (such as arthritis) with other joints?
Do you have teeth that no longer touch when you bite?
Do your teeth meet differently from time to time?
Is it hard to use your front teeth to bite or tear food?
Are your teeth sensitive, loose, broken or worn?
The more times you answered "yes," the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they are treated.
Because there is no known "cure" for TMD, people with TMD manage their
disorder in a way that is similar to how people with arthritis or
diabetes manage their disease. The goals of managing TMD include
decreasing harmful pressure or loading on the jaw joints, restoring
function of the jaw and resuming normal daily activities. These goals
are best achieved by identifying all factors that make your TMD worse
and following a well-defined management program to treat both physical
and emotional or psychological factors.
Managing TMD is similar to other musculoskeletal disorders
found in the body (such as rheumatoid arthritis or carpal tunnel
syndrome). Like many musculoskeletal conditions, the signs and symptoms
of TMD may be temporary without serious long-term effects. For these
reasons, special effort should be made to avoid aggressive or
nonreversible therapy such as surgery, extensive dental treatment or
orthodontic treatment.
Conservative management techniques such as behavior
modification, physical therapy, medication, jaw exercise and orthopedic
appliances (orthotics) have proven to be safe and effective in most
patients with TMD. Most patients suffering from TMD achieve good
long-term relief with conservative therapy. Scientific research
demonstrates that more than 50% of TMD patients treated with
conservative management have few or no ongoing symptoms of TMD.
If you have TMD, there are ways to care for yourself.
Behavioral intervention is often necessary to help people change harmful
behavior or habits that contribute to pain. Maladaptive behavior and
persistent habits such as tooth clenching or nail biting may play a
significant role in making TMD symptoms worse or last longer. You may be
able to control such behavior and habits once you become aware that you
are doing them, but a behavior modification program developed and
monitored by a trained expert often is necessary for long-term control.
Clinical behavior modification programs may include habit reversal
programs, lifestyle counseling, progressive relaxation, autogenic
training, hypnosis and biofeedback. Programs combining comprehensive
stress management, progressive relaxation, lifestyle modification and
biofeedback often yield the best long-term result.
Psychological or emotional conflicts can be a major part of
TMD and chronic pain behavior. Your doctor may refer you to a mental
health professional such as a psychologist or psychiatrist for
evaluation and treatment while you undergo physical treatment.
Physical therapy performed by a licensed physical therapist is well
recognized as an effective and conservative treatment for
musculoskeletal disorders such as TMD. Physical therapy helps in
identifying and reducing contributing factors to musculoskeletal
problems, reducing inflammation, restoring function and promoting repair
and regeneration of injured tissues.
Physical therapy techniques may include spinal, head, jaw and
tongue posture training.
Exercises prescribed by the physical therapist or doctor are
important to maintain normal muscle and joint function and comfort,
improve joint range of motion, increase muscle strength, develop normal
coordination and stabilize the TMJs. Exercises should be specifically
prescribed and monitored by your physical therapist or doctor as
improper or excessive exercise therapy can aggravate TMD symptoms.
Techniques to manually move the jaw (mobilize) may be helpful
for people with decreased range of motion and pain related to jaw muscle
contracture, disc displacement and adhesion in the joints. A patient
usually has to use pain relievers and muscle relaxation techniques
before his or her physician can mobilize the jaw.
Other types of physical treatment options for TMD management
include:
Medications can be very effective in reducing pain and inflammation. The
most effective drugs for managing pain related to TMD include
All medications have specific benefits and side effects. The
extended use of opioid medications and sedative psychotropic drugs such
as Valium, Xanax, and Ativan may lead to depression, drug tolerance and
addiction, although addiction is rare. Use of these medications, which
often give temporary relief from pain, is discouraged for long-term pain
management.
Occlusal therapy involves changing the bite to reduce pressures in the
joint. These therapies include orthodontics, surgery, placing multiple
crowns or other dental restorations, or selective grinding on the teeth
(equilibration). Since poor occlusion is not a common cause of TMD,
using irreversible bite changes to treat TMD is usually not necessary,
and not well supported by research. There are cases, however, that
require permanent bite changes in order for their joints to stabilize.
Oral orthopedic appliances are routinely used in TMD management. Oral
orthopedic appliances are commonly referred to as occlusal splints,
orthotics, night guards or bruxism appliances. Oral orthopedic
appliances are usually made from hard acrylic, are removable and cover
the upper or lower teeth. Oral orthopedic TMD appliances are designed to
redistribute the occlusal forces (the bite), prevent wear, reduce
mobility of teeth, reduce bruxism/clenching, reduce jaw muscle pain and
alter structural relationships within the TMJ.
All oral orthopedic appliances should be periodically checked
and adjusted by an experienced dentist as the potential exists for
harmful changes to the teeth and jaws if improperly used. Complications
such as dental caries, gingival inflammation, mouth odors, speech
difficulties, tooth movement and psychological dependence on the
appliance can occur with excessive or incorrect use of oral orthopedic
appliances.
Arthrocentesis is also known as joint aspiration, a procedure during
which a specially trained dentist uses a sterile needle and syringe to
drain fluid from a joint. TMJ arthrocentesis consists of using a pain
reliever to numb (anesthetize) the affected TMJ with local anesthetic
and then flushing the joint with a sterile solution such as Lactated
Ringers Solution. The effect of TMJ arthrocentesis is to lubricate the
joint surfaces and reduce inflammation. Corticosteroids or other
anti-inflammatory agents can be injected into the joint following
arthrocentesis. Gentle manipulation of the jaw is often utilized
following arthrocentesis to improve the jaw range of motion and in some
cases break fibrous adhesions that limit normal jaw opening.
TMJ surgery can be an effective treatment for specific joint disorders
for some patients. The complexity of surgical techniques, potential for
serious complications, frequency of behavioral and psychological
contributing factors and the availability of non-surgical approaches
make TMJ surgery a procedure that should be used on very select
patients. TMJ surgery should only be considered after reasonable
reversible treatment techniques have been tried without success.
TMJ surgical procedures include closed surgical techniques
(arthroscopy) and open surgical techniques (arthrotomy), as well as
total joint replacements.
TMJ arthroscopy may be effective in treating painful joint
hypomobility secondary to displaced discs, fibrous adhesions and
arthritis. TMJ arthroscopic surgery has significant limitations related
to the limited size of the arthroscopic instruments and limited space
within the joint. Recent studies suggest that TMJ arthrocentesis may be
as effective as TMJ arthroscopic surgery.
TMJ arthrotomy (open joint surgery) may be required in severe
fibrous adhesion removal, ankylosis (bony or fibrous), tumor removal,
chronic dislocation, painful non-reducing disc dislocation and severe
osteoarthritis that have not responded to less invasive treatments such
as medications and physical therapy. TMJ arthrotomy may range from
simple removal of adhesions, disc repair or replacement to total joint
replacement using cartilage and bone grafts or vitallium metal implants.
Patients with TMD should be aware that there is no guarantee for
successful surgical outcome and should seek several expert opinions
before deciding on TMJ surgery.
Total joint replacement is available for advanced cases of
TMD with considerable joint damage.
This information was produced by the
American Academy of Orofacial Pain (www.aaop.org).
Adapted and printed with permission of the American Academy of Orofacial
Pain.