TMJ
/ Bruxism Overview
What is
TMJ?
Temporomandibular
joint (TMJ) syndrome or TMJ joint disorders are medical
problems related to the jaw joint. The TMJ connects the
lower jaw to the skull (temporal bone) under your ear.
Certain facial muscles control chewing. Problems in this
area can cause head and neck pain, a jaw that is locked
in position or difficult to open, problems biting, and
popping sounds when you bite. 
The TMJ is comprised
of muscles, blood supplies, nerves, and bones. You have
2 TMJs, one on each side of your jaw.
Muscles involved in chewing (mastication) also open and
close the mouth. The jawbone itself, controlled by the
TMJ, has 2 movements: rotation or hinge action, which
is opening and closing of the mouth, and gliding action,
a movement that allows the mouth to open wider. The coordination
of this action also allows you to talk, chew, and yawn.
• If you place
your fingers just in front of your ears and open your
mouth, you can feel the joint and its movement. When you
open your mouth, the rounded ends of the lower jaw (condyles)
glide along the joint socket of the temporal bone. The
condyles slide back to their original position when you
close your mouth. To keep this motion smooth, a soft disc
lies between the condyle and the temporal bone. This disc
absorbs shock to the temporomandibular joint from chewing
and other movements. Chewing creates a strong force. This
disc distributes the forces of chewing throughout the
joint space.
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TMJ
CAUSES
TMJ can be caused
by trauma, disease, wear due to aging, or habits.
• Trauma: Trauma
is divided to microtrauma and macrotrauma. Microtrauma
is internal, such as bruxism (grinding the teeth) and
clenching (jaw tightening). This continual hammering on
the temporomandibular joint can change the alignment of
the teeth. Muscle involvement causes inflammation of the
membranes surrounding the joint.
Teeth grinding
(bruxism) and clenching are habits that may be diagnosed
in people who complain of pain in the temporomandibular
joint or have facial pain that includes the muscles involved
in chewing (myofascial pain). Macrotrauma, such as a punch
to the jaw or impact in an accident, can break the jawbone
or damage the disc.
o Bruxism: Teeth grinding as a habit
can result in muscle spasm and inflammatory reactions,
thus causing the initial pain. Changes in the normal stimuli
or height of the teeth, misalignment of the teeth, and
changes in the chewing muscles may cause temporomandibular
joint changes. Generally, someone who has a habit of grinding
his or her teeth will do so mostly during sleep. In some
cases, the grinding may be so loud that it disturbs others.
o Clenching:
Someone who clenches continually bites on things while
awake. This might be chewing gum, a pen or pencil, or
fingernails. The constant pounding on the joint causes
the pain. Stress is often blamed for tension in the jaw,
leading to a clenched jaw.
• Osteoarthritis:
Like other joints in the body, the jaw joint is prone
to have arthritic changes. These changes are sometimes
caused by breakdown of the joint (degeneration) or normal
aging. Degenerative joint disease causes a slow progressive
loss of cartilage and formation of new bone at the surface
of the joint. Cartilage destruction is a result of several
mechanical and biological factors rather than a single
entity. Its prevalence increases with repetitive microtrauma
or macrotrauma, as well as with normal aging. Immunologic
and inflammatory diseases contribute to the progress of
the disease.
• Rheumatoid arthritis: Rheumatoid arthritis
causes inflammation. As it progresses, the disease can
cause destruction of cartilage and erode bone, deforming
joints. It is an autoimmune disease involving the antibody
factor against immunoglobulin G (IgG). Chronic rheumatoid
arthritis is a multisystem inflammatory disorder with
a persistent symmetric joint involvement. Certain
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TMJ
/ Bruxism
TMJ
Symptoms
• Pain in the facial muscles and jaw joints may radiate
to the neck or shoulders. Joints may be overstretched.
You may experience muscle spasms from TMJ. You may feel
pain every time you talk, chew, or yawn. Pain usually
appears in the joint itself, in front of the ear, but
it may move elsewhere in the skull, face, or jaw.
• TMJ may cause
ear pain, ringing in the ears (tinnitus), and hearing
loss. Sometimes people mistake TMJ pain for an ear problem,
such as an ear infection, when the ear is not the problem
at all.
• When the joints
move, you may hear sounds, such as clicking, grating,
and/or popping. Others may also be able to hear the sounds.
Clicking and popping are common. This means the disc may
be in an abnormal position. Sometimes no treatment is
needed if the sounds give you no pain.
• Your face and
mouth may swell on the affected side.
• The jaw may lock
wide open (then it is dislocated), or it may not open
fully at all. Also, upon opening, the lower jaw may deviate
to one side. You may find yourself favoring one painful
side or the other by opening your jaw awkwardly. These
changes could be sudden. Your teeth may not fit properly
together, and your bite may feel odd.
• You may have
trouble swallowing because of the muscle spasms.
• Headache and
dizziness may be caused by TMJ. You may feel nauseous
or vomit.
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TMJ
/ Bruxism Seeking Medical Help
TMJ disorder
treatment
Proper diagnosis
is critical to make sure you receive treatment for your
particular condition. At The Smiles Dr we will only recommend
treatment after conducting a thorough health history, clinical
exam, taking appropriate X-rays, and perhaps confirming
the condition through other diagnostic tests.
At The Smiles Dr
we may prescribe a multiple-phase treatment plan. Simple
and painless techniques are available to decrease discomfort.
Here are a few of the treatments we offer:
- Taking a non-aspirin pain reliever or prescription medications
such as muscle relaxants, analgesics, or anti-inflammatory
drugs
- Eating soft foods
- Avoiding chewing gum
- Applying moist heat or ice
- Physical therapy
- Teaching relaxation techniques to control muscle tension
- Stress management training techniques
- Posture training
- Wearing bite plates to eliminate the harmful effects of
clenching or grinding the teeth, and a better positioning
of the jaws
- Adjusting the bite, known as "occlusal equilibration"
involving removing interferences when the teeth touch
- Replacement of defective restorations that prevent the
jaws from meeting properly
- Orthodontics, to put the teeth in proper position
- Surgery
- TENS- Transcutaneous Electrical neural Stimulation
- Trigger Point Injections
- Physical Exercises for the Jaw
- Appliance Therapy (An acrylic, retainer type of device)
In most cases we treat the symptoms related to TMJ disorders
can be successfully treated to reduce or eliminate your
discomfort. Postponement of treatment usually results in
more damage to the joint, muscles, or teeth.
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EXAMS
& TESTS
• Medical
history: In diagnosing your jaw problem, the dentist
will ask the following questions:
o What kind of pain
do you have?
o Is it an ache or a throbbing pain or a sharp stabbing
pain?
o Is the pain continuous or intermittent?
o Can you outline the area of pain on your face with your
finger?
o What helps to alleviate the pain? What aggravates the
pain?
o Do you grind or clench your teeth? Do you bite your nails
or chew on any objects, such as pens or pencils?
o Do you hold the telephone with your shoulder against your
ear for a long time?
o Do you chew gum often? For how long?
o Do you have any oral habits that you have not mentioned?
• Physical examination: During the physical
examination, your doctor will examine your head, neck, face,
and temporomandibular joints, noting any of the following:
o Tenderness (pain)
and its location
o Sounds, such as clicking, popping, grating
o The mandible (lower jaw) range of motion and whether it
is easy to open and close and can move from side to side
and forward-backward without any pain
o Your assessment of pain on a scale from 0 (no pain) to
10
o Wear on buccal cusps of the mandibular teeth, especially
the canine
o The rigidity and or tenderness of the chewing muscles
o How your teeth fit together: normal, open bite, crossbite,
overbite, dental restorations, or skeletal deformity
• Imaging: X-rays may be taken of the mouth
and jaw. CT or MRI may also be used. The MRI was designed
for soft tissue and, therefore, will show the location of
the TMJ disc in relationship to the jaw and skull bones.
That will give the doctor a better idea as to the proper
treatment approach.
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TMJ
disorder and headaches
One out of every
15 Australians suffers from chronic headaches, and they
spend over millions of dollars every year for over-the-counter
medications to relieve their pain. They never imagine that
their headaches may be caused by TMJ, and that their pain
is the result of a bad bite.
At The Smiles Dr
we know a bad bite can put your jaw-to-skull relationship
out of alignment.
When this happens,
TMJ symptoms occur. This cluster of symptoms can include:
headaches, earaches, ear ringing, loud jaw clicking, even
stiffness and pain in the jaw, neck, shoulders and back.
This cluster has puzzled doctors in the past. Now we can
put a name to it: TMJ.
The two most common
forms of headaches are Tension type (TTHA) and Migraine.
The tension type is commonly a symptom of TMJ, but both
tension and migraine types of headaches overlap when patients
have had pain for long periods of time.
Many TMJ sufferers
have been involved in a motor vehicle accident resulting
in neck and back pain. Tension of the muscles of the face
and head also contributes to the occurrence of facial and
head pain, as does clenching and grinding of the teeth.
Another common symptom involves the ears since the temporomandibular
joint is very close to the ear. An evaluation of the TMJ,
facial, and cervical muscles can help these patients.
Dentists are often
the first to diagnose TMJ. They are familiar with conservative
treatments. Specially trained facial pain experts can be
helpful in diagnosing and treating TMJ.
|Prevention|
If you tend to have occasional bouts with jaw pain, avoid
chewing gum or biting on objects, such as pens or fingernails.
Avoid eating hard or chewy food. When you yawn, support
your lower jaw with your hand.
See your dentist if you grind your teeth at night or find
yourself clenching your jaw. The dentist can make a splint
for you.
|Outlook|
Most people do well
with conservative therapy, such as resting the jaw or using
a mouth splint. The success of treatment depends on how
severe the symptoms are and how well you comply with treatment.
Only about 1% of
patients require joint replacement.
