TMJ (temporomandibular joint) disorders are a family of problems related to your complex 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. 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. Typically treatment is first directed toward adequate diagnosis followed by conservative nonsurgical medical management utilizing noninvasive physical therapy, sleep management, stress reduction, alleviation of parafunctional habits, anti-inflammatory pain management, and splint therapy. This can be initiated by your dentist or a dentist who treats TMD patients.
Trouble With Your Jaw?
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.
Do You Have A TMJ Disorder?
- 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.
There are various treatment options that one can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, your dentist will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care joined with professional care.
The initial goals are to relieve the muscle spasm and joint pain. Surgical treatment is rarely this first option in treatment. This is usually accomplished with a pain reliever (anti-inflammatory), or muscle relaxant. Steroids can be injected directly into the joints to reduce pain and inflammation. Self-care treatments can often be effective as well and include:
- Resting your jaw
- Keeping your teeth apart when you are not swallowing or eating
- Eating soft foods, avoid chewing gum, ice, chewy/sticky foods
- Applying ice and/or heat
- Avoid opening the mouth excessively wide when eating or yawning (cutting food into smaller bites)
- Exercising your jaw with the aid of a physical therapist
- Practicing good posture and getting adequate restful/deep sleep
Stress management techniques such as biofeedback or physical therapy may also be recommended, as well as a temporary, clear plastic appliance known as a splint. A splint (or nightguard) fits over your top or bottom teeth and helps keep your teeth apart, thereby relaxing the muscles and reducing pain. There are different types of appliances used for different purposes. A nightguard helps you stop clenching or grinding your teeth and reduces muscle tension at night and helps to protect the cartilage and joint surfaces and can be made by your dentist. An anterior positioning appliance moves your jaw forward, relieves pressure on parts of your jaw and aids in disk repositioning. It may be worn 24 hours/day to help your jaw heal if indicated by your dentist. An orthotic stabilization appliance is worn 24 hours/day or just at night to move your jaw into proper position. Appliances also help to protect from tooth wear and may require periodic adjustments.
What About Bite Correction Or Surgery?
If your TMJ disorder has caused problems with how your teeth fit together, you may need treatment such as bite adjustment (equilibration), orthodontics with or without jaw reconstruction, or restorative dental work. Surgical options such as arthroscopy and open joint repair restructuring are sometimes needed, but are reserved for severe cases as a last resort when conservative options have failed. TMJ surgery is not typically considered unless the jaw cannot open, is dislocated and nonreducible, has severe degeneration, or the patient has undergone conservative therapy and appliance treatment unsuccessfully with continued severe unrelenting pain. Dr. Conkin no longer performs surgery on the TMJ and would recommend if surgery is indicated that you see a surgeon with advanced training/fellowship in TMJ surgery who focuses his or her efforts primarily on the treatment of TMJ disorders.