The ABC's of TMJ

This article was authored by Dr. Streif and was originally published in the May 2005 edition of Minnesota Health Care News

Assessments:

Probably the most used and least understood joint in the human body is the temporomandibular joint (TMJ). Most used is apt, because whenever we talk, chew, or swallow we are moving the joint. Least understood also applies because of the location (in front of the ear) makes it difficult to see and appreciate this joint. Despite the low profile of the TMJ we certainly depend on the joint (together with the complicated muscles and nerves that control jaw movement) to perform essential functions for survival.  

TMJ disorders (or dysfunction) arise when the structural components of the joint become damaged, misaligned, or poorly coordinated during function. Often, muscles and nerves in the region become involved which leads to greater challenges when evaluating and treating these conditions. 

Symptoms of TMJ dysfunction include - 

  • Noises in the TMJ (click, pop, crunch, etc)

  • Locking (difficulty opening or closing smoothly)

  • Pain (jaw, face, ear, teeth, headache, neck)

  • Bite discomfort (bite or occlusal changes)

Noises in the TMJ are very common, and TMJ structural abnormalities are estimated to be present in approximately 35% of the adult population. TMJ injury can result from a blow to the jaw or face. However, many TMJ problems begin quite innocently during normal function which implies that a structural abnormality has been present but until that time asymptomatic. These problems that have no observable causation are therefore thought to be caused by genetic factors or accumulated wear and tear. 

When symptoms are present, it is important to know that certain habits can negatively impact the smooth functioning of the jaw system, which leads us to a discussion of: 

Behaviors:

Detrimental behaviors include - 

  • Clenching the teeth

  • Grinding the teeth (if during sleep is called bruxism and is involuntary)

  • Chewing on hard objects (pens, pencils, fingernails, etc.) 

  • Gum chewing

  • Sleeping on stomach (causes increased pressure and tension in the neck and jaw)

  • Excessive use of caffeine together with stress, poor nutrition, sleep disturbances, lack of exercise, etc. - all these can negatively impact TMJ dysfunction and any pain condition. 

Care:

Temoporomandibular joint care should be focused on rest and relaxation of the jaw starting with a soft food diet and placing hot packs or cold packs if the pain is severe. Avoid any activities that can aggravate the joints or muscles of the jaw. Everyday events can perpetuate pain: Talking, yelling chewing, yawning, or playing a musical instrument involving the mouth. Poor posture can trigger jaw pain or tension headaches for some people. 

Before proceeding with any treatment, a comprehensive evaluation should be completed first. This involves giving history of the pain or dysfunction together with a clinical examination by a dentist with training in TMJ disorders. Evaluation will likely include x-rays of the jaw and possibly MRI of the temporomandibular joints. Serious conditions need to be first ruled out before the final diagnosis can be established and treatment can begin. Be sure your treating dentist has outlined specific details of your treatment plan to best target the bothersome symptoms and improve dysfunction. 

Treatment can involve anti-inflammatories and muscle relaxants which are prescribed by a dentist or physician. Medication should only be used over a specific period of time as prescribed by the doctor. If the desired results have not been achieved, then the doctor should be notified so that changes can be made to the treatment plan.  

A common therapy is appliance or splint therapy for the jaw. An acrylic overlay appliance is fabricated (after making tooth impressions) by a dentist. The appliances should be carefully fitted and adjusted for comfort and effectiveness. The appliance is designed to rest the joints and muscles and protect from clenching or bruxism (nighttime grinding). 

Physical therapy can be very effective to decrease joint inflammation and reduce muscle tension. Jaw flexibility can be improved with specific exercise programs. 

Fortunately, most TMJ conditions resolve with conservative treatment. In certain more advanced cases, TMJ surgery may be an appropriate and very effective remedy for the pain and dysfunction. However, it is recommended that a thorough and comprehensive non-surgical approach as outlined above is pursued for a period of 3-6 months before a final decision on TMJ surgery can be reached. As with many musculoskeletal pain conditions TMJ dysfunction is a self-limiting condition whereby the patient is able to correct or manage many or all of the problems without aggressive intervention.

It is important to note that many TMJ symptoms are mild, self-limiting, and do NOT require treatment if comfort or functions are basically normal. By controlling stress, reducing body tension, improving sleep quality, and regular exercise these conditions will often begin to improve.