What is TMJ?

Many people, even doctors, nurses, and insurance companies, use the term TMJ. But what does this abbreviation mean? The term TMJ is an abbreviation for Temporo-Mandibular Joint, or the jaw joint. In fact, there are really two TMJs, one in front of each ear. The TMJ is the joint formed by the temporal bone of the skull (Temporo) with the lower jaw or mandible (hence, mandibular). These joints move each time we chew, talk or even swallow. The TMJ is actually a sliding joint and not a ball-and-socket like the shoulder. This sliding allows for pressures placed on the joint to be distributed throughout the joint and not just in one area. The TMJ is the most complex joint in the human body. Placed between these two bones is a disc, just like the one between your back bones. This disc is primarily made of cartilage and in the TMJ acts like a third bone. The disc, being attached to a muscle, actually moves with certain movements of the TMJ.

TMJ Diseases/Disorders: Temporomandibular joint diseases and disorders, commonly called TMJ, are a collection of poorly understood conditions characterized by pain in the jaw and surrounding tissues and limitations in jaw movements. Injury and conditions that routinely affect other joints in the body, such as Arthritis, also affect the temporomandibular joint.

Who is Affected by TMJ Diseases/Disorders: The National Institute of Dental and Craniofacial Research (NIDCR) of the National Institutes of Health (NIH) states that over 10 million people in the United States suffer from TMJ problems at any given time. While both men and women experience TMJ problems, the majority of those seeking treatment are women in their childbearing years.

Causes Many TMJ-related symptoms are caused by the effects of physical and emotional stress on the structures around the joint. These structures include the muscles of the jaw, face, and neck; the teeth; the cartilage disk at the joint; and nearby ligaments, blood vessels, and nerves. For example, daily stress can lead you to clench and grind your teeth, both during the day and at night while you sleep. Clenching means you tightly clamp your top and bottom teeth together, especially the back teeth. The stressful force of clenching causes pressure on the muscles, tissues, and other structures around your jaw. Many people who clench also grind their teeth. Grinding is when you slide your teeth over each other, generally in a sideways, back-and-forth movement. This action may wear down your teeth and be noisy enough at night to bother sleeping partners. Poor posture can also be an important factor. For example, holding the head forward while looking at a computer all day strains the muscles of the face and neck. Other factors that might aggravate TMJ symptoms are inability to relax, poor diet, and lack of sleep. All of these stresses can result in "trigger points" -- contracted muscles and pinched nerves in your jaw, head, and neck. Trigger points can refer pain to other areas, causing a headache, earache, or toothache. Other possible causes of TMJ-related symptoms include arthritis, fractures, dislocations, and structural problems present since birth.

Diagnosis: Diagnosing TMJ diseases and disorders can be difficult and confusing. For example, facial pain can be a symptom of many conditions, such as sinus or ear infections, decayed or abscessed teeth, various types of headache, and facial neuralgia (nerve-related facial pain).

At present, there is no widely accepted, standard test to correctly identify all TMJ conditions. In most cases, however, a complete evaluation, including a detailed medical history, the patient’s description of symptoms, and physical examination of the head, neck, face and jaw provide information useful for making a diagnosis.

Tests that are recommended are often intended to rule out other possible medical conditions. A diagnosis of TMJ diseases and disorders may be made only after every other possibility has been considered and eliminated. Many TMJ patients see multiple healthcare providers, such as primary care physicians, dentists, sleep specialists, ear, nose and throat specialists, neurologists, endocrinologists, rheumatologists, pain specialists, chiropractors, etc., in their search for answers.

Progression of TMJ Diseases and Disorders: Some TMJ problems improve on their own, without treatment, within weeks or months with simple home therapy. For others, symptoms worsen over time and develop into long-term, persistent and debilitating pain. Most people with TMJ problems have relatively mild or periodic symptoms.

Symptoms Pain is the most common symptom. TMJ pain is often described as a dull aching pain in the jaw joint and nearby areas, including the ear, which comes and goes. Some people, however, report no pain, but still have problems using their jaws. Other symptoms can include:

Facial pain; jaw joint pain; often in combination with neck, shoulder, back pain and/or headaches
Popping, grating or clicking sounds with movement of the jaw joint,
Pain in the joints of the face when opening or closing the mouth, yawning, or chewing
Swelling on the side of the face and/or mouth
A bite that feels uncomfortable, "off," or as if it is continually changing
Limited opening or inability to open the mouth comfortably
Deviation of the jaw to one side
The jaw locking open or closed

Additional symptoms may include: ringing in the ears, ear pain, decreased hearing, dizziness and vision problems. Keep in mind that occasional discomfort in the jaw joint or chewing muscles is common, and is not always a cause for concern. Many people with certain TMJ problems get better without treatment. Often the problem goes away on its own in several weeks to months. However, if the pain is severe and lasts more than a few weeks, see your healthcare provider.

Treatment: Simple, gentle therapies are usually recommended first. If those don't work, mouth guards and more aggressive treatments may be considered. Surgery is generally considered a last resort. Fortunately, there are many steps you can take at home long before that point. Try massaging the various muscles that may be involved. Probe all of the muscles of the face, shoulders, and back of the neck. (Avoid the area around the throat.) Press on the muscles to identify extremely painful points. Massage the painful spot with hard, slow, short strokes. Do this several times a day until the muscle is no longer painful when pressed. To massage the masseter muscles on each side of your jaw, place your thumb inside your mouth and squeeze the thick muscle in your cheek (toward the back of your mouth) with your fingers. To get at the harder-to-reach jaw muscles inside your mouth, use your index finger to probe for tender areas behind the teeth, and use the finger to massage these spots. Here are some other steps to consider:

* Maintain good posture while working at a computer, watching TV, and reading. Take frequent breaks to relieve stressed muscles.
* Make a habit of relaxing your facial and jaw muscles throughout the day.
* Avoid eating hard foods, like nuts, candies, and steak.
* Drink plenty of water every day and get plenty of sleep.
* Learn relaxation techniques to reduce overall stress and muscle tension in your back, neck, and body.

Other home-care therapies are useful for some people, such as moist heat or cold packs on the face, vitamin supplements, or biofeedback. Exercising several times each week may help you relax, strengthen your body, increase flexibility, and increase your pain threshold. Read as much as you can, as opinion varies widely on the management of TMJ disorders. Get several clinical perspectives. The good news is that most people eventually find something that helps.

MOUTH GUARDS Mouth guards, also called splints or appliances, have been used since the 1930's to treat teeth grinding, clenching, and TMJ disorders. Many people have found them to be useful, but the benefits vary widely. The guard may lose its effectiveness over time, or when you stop wearing it. Other people may feel worse pain when they wear one. There are different types of splints. Some fit over the top of the teeth, some on the bottom. They may be designed to keep your jaw in a more relaxed position, inhibit clenching, or provide some other function. If one type doesn't work, another may. For example, a new type of splint is called the NTI-tss. It fits over just a couple of top, front teeth. The idea is to keep all of your back teeth completely separated, under the theory that most clenching is done by these back teeth. With the NTI splint, the only contact is between the tiny splint and one bottom front tooth.

MORE AGGRESSIVE TREATMENT Be cautious about any non-reversible treatment method that permanently alters your bite. However, if a mouth guard doesn't work, your dentist may recommend orthodontics to help re-align your teeth. Reconstructive surgery of the jaw is rarely required. In fact, studies have shown that the results are often worse than before surgery. Muscle relaxant medications may help. Nonsteroidal anti-inflammatory medications (NSAIDS) help reduce inflammation in the jaw stemming from arthritis or other causes of inflammation.

When to Contact a Medical Professional See your health care provider immediately if you are having trouble eating or opening your mouth. Keep in mind that a wide variety of possible conditions can cause TMJ symptoms, from arthritis to whiplash injuries. Experts who are specially trained in facial pain can help diagnose and treat TMJ. TMJ problems do not fall clearly into one medical discipline. There are a wide variety of treatment approaches. If you are interested in a massage-based approach, look for a massage or physical therapist trained in trigger point therapy, neuromuscular therapy (NMT), clinical massage, or pain relief, particularly as it applies to TMJ pain. Dentists who specialize in evaluating and treating TMJ disorders will typically perform x-ray exams and may use a kinesiograph or EMG (electromyography). They may give the patient a mouth guard. Surgery is now considered a last resort by most TMJ experts.

Prevention Many of the home-care steps to treat TMJ problems can prevent such problems in the first place:

* Maintain good posture, especially if you work all day at a computer. Pause frequently to change position, rest your hands and arms, and relieve stressed muscles.
* Learn relaxation techniques to reduce overall stress and muscle tension.
* Avoid eating hard foods and chewing gum.
* Drink plenty of water every day and get plenty of sleep.
* Use safety measures to reduce the risk of fractures and dislocations.

Additional information, two excellent books are Taking Control of TMJ by Robert Uppgaard and The Trigger Point Therapy Workbook by Clair Davies.

Outlook (Prognosis) Most cases can be successfully treated, although initially it may be difficult to diagnose the problem and find an effective solution. Some cases of pain go away on their own without treatment. TMJ-related pain tends to be cyclical and may return again in the future. If the cause is nighttime clenching, treatment can be particularly tricky because it is a sleeping behavior that is hard to control. Mouth splints are a common treatment approach for teeth grinding. While some splints may silence the grinding by providing a flat, even surface, their effectiveness at reducing pain or stopping clenching is more controversial. Splints may be effective in the short-term but could become less effective over time. Splints can also cause changes in your bite.
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