TMJ & TMD
What is TMJ / TMD?
Do you ever experience a clicking or popping sound when opening or closing your mouth? Have you been suffering from headaches or pain in your jaw muscles and no one seems to be able to help you? Have you been taking pain medicine for facial pain and would like to stop taking it?
These are just a few of many symptoms that might be associated with TMD, or Temporomandibular Dysfunction, a common condition affecting the jaw joint or Temporomandibular Joint (TMJ).
TMJ or The Temporomandibular Joint
There are two jaw joints on the right and left sides of your head, very near your ears, that work together when you chew or speak. They connect the lower jaw to the temporal bone of your skull with ligaments and muscles. A small cartilage disc lies between the jaw bone and the temporal bone. If you place your fingers just in front of your ears and open your mouth, you can feel joints move on each side of your head. Because these joints are flexible, the jaw can move smoothly up and down, side to side, and forward and back enabling us to talk, chew and yawn, etc. When the TMJ is not functioning normally it creates a condition called TMD, or Temporomandibular Dysfunction.
To help diagnose a TMJ disorder, we look for the following symptoms that are generally related to TMD.
- Jaw Pain
- Jaw Clicking
- Jaw Popping
- Grinding sound in the joints
- Limited Mouth Opening
- Jaw Locking
- Jaw deviation when opening and closing
- Face Pain
- Eye Pain
- Ear Pain
TMD falls into three main categories
Myofascial pain. Myofascial pain is inflammation and discomfort in the muscles that control jaw functions and sometimes the neck and shoulder muscles.
Internal derangement of the joint. This involves a damaged or displaced disc, stretched or torn ligaments, and injury to the condyle (the round end part at the end of the jaw bone), or the bony socket the condyle sits in.
Degenerative joint disease. Osteoarthritis or Rheumatoid Arthritis in the jaw joint can cause inflammation and damage to the bony portion of the jaw joints just like other joints of the body.
Headaches and Jaw muscle pain
If you suffer from frequent head or facial pain, an incorrect bite may be the cause due to constant cranial muscle strain. Headaches from dental stress are a type of muscle tension headache. A tension headache may be on one or both sides of your head and feels like a dull, non-throbbing ache that can rarely be relieved by aspirin. Over time, an uncorrected “bad bite” can lead to TMD.
When you swallow, talk or chew your upper and lower jaw muscle and ligaments must hold your jaw firmly against the skull. The jaw muscles can overwork when talking, chewing and swallowing with a poorly aligned bite, causing muscle strain, which in turn leads to a headache. Many people who suffer from chronic headaches clench their jaws in an unbalanced, eccentric, position. This causes extremely intense muscular contraction, and strain on the jaw. With other people, nighttime jaw clenching and grinding usually goes unnoticed but also sets the stage for chronic headache pain. Imagine holding two heavy weights with your arms extended all day and night. It wouldn’t take long for your overworked muscles to start hurting, the same happens with the muscles in your jaw.
Causes Of TMD
Before beginning treatment it is essential to determine the proper diagnosis. There are many causes for TMD such as:
- Unbalanced occlusion or 'Bad Bite'
- Stress (emotional or work/school related)
- Injury or trauma (this could have been an injury as obvious as a blow to the jaw with a fist or something as subtle as a whiplash injury with direct trauma to the head or jaw.)
- Teeth grinding or Bruxism
A 'Bad Bite' could be caused by any of the following:
- Missing teeth
- Crowded or 'crooked' teeth
- Worn down or fractured teeth
- Old crowns and bridges
- Unbalanced dentures
When teeth are missing, or out of alignment, it causes the jaw to shift positions and the muscles to work harder to chew, swallow, bite, etc. and eventually will cause muscle spasms, tension and pain. Muscle tension caused by clenching and grinding can cause the TMJ disc to be pulled out of place which will result in pain, clicking and popping in the TMJ. If a disc is displaced for a long time, it is more difficult to reposition and the bones can start rubbing against each other and some damage to the bone can occur. Damage to the bone may be evident on the x-rays.
In the treatment of TMD our goal is to obtain the proper position and orientation of the TMJ, disc, ligament and muscles. Once that position is determined, we place the orthotic on the upper or lower teeth to help keep the TMJ in that position. When the jaw is in its proper position with a balanced bite, the muscles will relax and pain will resolve in most cases.
Orthotics usually are worn for 4-6 months or until most of the symptoms are relieved. Once an orthotic is in use, the symptoms should start gradually disappearing until we reach a point that both the doctor and the patient are satisfied, then we can begin permanent treatment.
Permanent treatment involves:
- Wearing a long term removable orthotic, full-time or part-time.
- Replace missing teeth with implants, bridges or dentures.
- Reposition teeth with orthodontics.
- Restore all the lower and/or upper teeth with crowns and veneers to preserve the optimal occlusion (bite) that was achieved with the orthotic. in phase I.
- Reshaping the top surfaces of the teeth into the proper position to achieve an ideal bite, this is call equilibration.
- Removing non restorable teeth
Each patient is different, but most of the time, one treatment will have advantages, but some cases involve a combination of the above, depending on the patients’ preferences and financial capability. If you are currently suffering from TMD, it is important to first get you out of your pain and symptoms, then determine the cause of the pain, then determine the best solution to correct the cause. For complex cases we work with highly trained specialists in our area who are experts in their field, to provide top care for our patients.
Bite Splints (Orthotics)
Bite splints are precision acrylic resin devices that fit over the teeth and resemble the mouth guards athletes wear to protect their teeth. The difference is that bite splints are made of a hard resin to resist the forces that the jaw and muscles apply to the teeth.
When teeth do not mesh properly, a bite splint is placed over the top of the teeth of either arch. We can then, with great precision, adjust the splint where the teeth contact it to establish a perfect bite. If the malocclusion is the cause of the pain, use of the split should make the symptoms disappear. If they don’t resolve, there may have another cause. If the splint is discontinued the symptoms will re-appear. In this way we use the splint to help diagnose the problems in a conservative manner without altering the teeth or bite until our diagnosis and ready to begin treatment.
Night guards are a special type of orthotic. They are used on patients who grind their teeth at night (bruxism). In some people, poorly aligned teeth can cause them to grid their teeth at night when they are asleep, causing fractures and excess wear on their teeth. The night guard covers up the chewing surface of either the upper or lower teeth and acts like a splint eliminating the malocclusion and preventing the grinding response.
Other people grind their teeth for other reasons. In these patients, the night guard protects the teeth and TMJ from the damage caused by grinding.
Denture Patients With TMJ/TMD
Many patients complain that when they received their dentures, they started noticing pain in their jaw, headaches, ear problems and other symptoms. Sometimes taking the dentures out will relieve those symptoms.
If dentures are not made to the correct bite, or vertical dimension it could be the cause of these symptoms. Simple adjustments could get rid of these symptoms, but sometimes a whole new set of dentures must be made to get rid of your headaches or jaw pain.