Dr David Wilmot

TMJ pain

The temporomandibular joint (TMJ) is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull. Temporomandibular disorders (TMD) occur as a result of problems with the jaw, jaw joint, and surrounding facial muscles that control chewing and moving the jaw.

The cause of TMD is not clear, but symptoms probably arise from problems with the muscles of the jaw or with the parts of the joint itself.

Injury to the jaw, temporomandibular joint, or muscles of the head and neck such as from a heavy blow or whiplash can cause TMD. Other possible causes include:

• Grinding or clenching the teeth, which puts a lot of pressure on the TMJ
• Dislocation of the soft cushion or disc between the ball and socket
• Presence of osteoarthritis or rheumatoid arthritis in the TMJ
• Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth

What Are the Symptoms of TMD?

People with TMD can experience severe pain and discomfort that can be temporary or last for many years. More women than men experience TMD and TMD is seen most commonly in people between the ages of 20 and 40.

Common symptoms of TMD include:

• Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak or open your mouth wide
• Limited ability to open the mouth very wide
• Jaws that get "stuck" or "lock" in the open- or closed-mouth position
• Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain)
• A tired feeling in the face
• Difficulty chewing or a sudden uncomfortable bite as if the upper and lower teeth are not fitting together properly
• Swelling on the side of the face

Other common symptoms include toothaches, headaches, neck aches, dizziness, earaches and hearing problems.

How Is TMD Diagnosed?

Because many other conditions can cause similar symptoms including a toothache, sinus problems, arthritis, or gum disease, a careful patient history and clinical examination will be carried out to determine the cause of your symptoms.

This will include a careful examination of your temporomandibular joints for pain or tenderness; listening for clicking, popping or grating sounds during jaw movement; looking for limited motion or locking of the jaw while opening or closing the mouth; and examining the bite and facial muscle function. Sometimes panoramic X-rays will be taken. These full face X-rays allow a view of the entire jaws, TMJ, and teeth to make sure other problems aren't causing the symptoms.

Sometimes other imaging tests, such as magnetic resonance imaging (MRI) or a computer tomography (CT), are needed. The MRI views the soft tissue such as the TMJ disc to see if it is in the proper position as the jaw moves. A CT scan helps view the bony detail of the joint.

What Treatments Are Available for TMD?

Treatments range from simple self-care practices and conservative treatments to injections and surgery. Most experts agree that treatment should begin with conservative, non-surgical therapies first, with surgery left as the last resort. Many of the treatments listed below often work best when used in combination.

Basic Treatments

• Apply moist heat or cold packs. Apply an ice pack to the side of your face and temple area for about 10 minutes. Do a few simple stretching exercises for your jaw. After exercising, apply a warm towel or washcloth to the side of your face for about 5 minutes. Perform this routine a few times each day.
• Eat soft foods. Eat soft foods such as yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans and grains. In addition, cut foods into small pieces to decrease the amount of chewing required. Avoid hard and crunchy foods (like hard rolls, or french bread, nuts, raw carrots etc), chewy foods (like caramels and toffee) and thick and large foods that require your mouth to open wide to fit (eg biting into apples).
• Take medication. To relieve muscle pain and swelling, try nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, which can be bought over-the-counter. Sometimes other prescription only drugs for pain, such as narcotic analgesics, are required or very low dose anti-depressants to break the cycle of chronic pain. Muscle relaxants, especially for people who grind or clench their teeth, can help relax tight jaw muscles. Anti-anxiety medications can help relieve stress that is sometimes thought to aggravate TMD. Antidepressants, when used in low doses, can also help reduce or control pain. Muscle relaxants, anti-anxiety drugs and antidepressants are available by prescription only.
• Wear a splint. A Michigan Splint is a plastic appliance that fits over the upper teeth. It corrects the bite by positioning the teeth in their most harmonious and least traumatic position where the jaw joints are at rest, so preventing interferences and reducing the tendency to grind the teeth. 
• Undergo corrective dental treatments. Replace missing teeth; use crowns, bridges or braces to balance the biting surfaces of your teeth or to correct a bite problem.
• Avoid extreme jaw movements. Keep yawning and chewing (especially gum or ice) to a minimum and avoid extreme jaw movements such as yelling or singing.
• Don't rest your chin on your hand or hold the telephone between your shoulder and ear. Practice good posture to reduce neck and facial pain.
• Keep your teeth slightly apart as often as you can to relieve pressure on the jaw. To control clenching or grinding during the day, place your tongue between your teeth.
• Learn relaxation techniques to help control muscle tension in the jaw. Consider physical therapy or massage, as well as stress reduction therapy.