Everything You Need to Know About TMJ

Looking to learn about temporomandibular joint (TMJ) disorder in NJ? Struggling with headaches? Jaw pain? Facial swelling? You’re not alone.

What is the TMJ?

The area around the connection from the lower to the upper jaw is known as the temporo- mandibular joint. The name arises from the two parts of the skull and the jawbone. The jawbone is named the mandible (hence mandibular), and the part of the skull the mandible rotates and sits into is the temporal bone of the skull. The two bones are the location of the joint, and the bones are separated by a capsule or envelopes like the meniscus of the knee. This capsule is help in place by ligaments on the sides. These ligaments help keep the capsule, which acts like a pillow to cushion the bones, in its proper place.

What are TMJ problems?

Although frequently misdiagnosed as other medical issues, this joint can cause a multitude of symptoms including headaches, eye pain, blurred vision, dizziness, ringing or pressure in the ears, ear aches, nausea, facial and jaw pain, neck aches, chest pain, hoarseness, a sensation of objects in the throat, difficulty swallowing and even numbness.

There are different types of problems that affect the TM joint, which include both chronic and acute symptoms. Some chronic symptoms may be problems with opening or closing the mouth. Sometimes the mouth can’t open wide, and sometimes the mouth is stuck open, and the teeth can’t touch correctly, feeling lopsided or one sided. When disease like rheumatoid arthritis, osteoarthritis or connective tissue disease affect the joint or when an opening in the capsule is created by overuse, then the joint itself may become painful by bone to bone friction. Some problems occur because the joint is only a few millimeters from the inner ear mechanism. As the jaw opens and closes pressure can be transmitted to the inner ear and cause variations in the vestibular apparatus which becomes nausea or dizziness. Sometimes clicking or grinding noises are heard from the joint during use. When a problem affects the joint, the syndrome is called Temporo-mandibular dysfunction syndrome or TMD for short.

What causes you to clench or grind your teeth?

Most people clench or grind their teeth more or less, especially during stressful occasions. In some cases, no damage is done. In other cases, exaggerated wear of the teeth, and indented tongues can be seen. Some people clench and grind very heavily entirely unconsciously. Tooth damage from this can be serious enough to require root canals, crowns or extractions. Sometimes the teeth are not very affected, but the TM joint becomes painful or dysfunctional.

The main reasons the joint becomes affected and has symptoms is overuse injury caused by subconscious habits of stress related clenching and /or grinding the teeth. This is an age-old problem even cited in historical texts as painful “gnashing of the teeth” during stress.

Since some symptoms are muscular in nature, muscle spasms can be painful and affect opening and closing the mouth, and become trigger points for pain to radiate to other areas of the head and neck.

How are painful TMD problems treated?

When a TMD occurs, it can be short or long lived. Treatment can depend on the duration of symptoms and can be varied. The first step is to identify the contributing causes which means becoming aware of clenching and grinding behaviors even though they are subconscious. By reducing these behaviors during the day, some symptoms can be eliminated. Other causes may occur during nighttime clenching or grinding. In the absence of other problems, a properly fitted night guard can help reduce pain upon waking.

For short term or acute symptoms temporary appliances to cushion the teeth together with anti-inflammatory and analgesic medications are helpful. A soft diet, avoiding chewing gum, and wide mouth opening is very helpful. Some muscle relaxants can help reduce painful spasm and allow normal blood flow and promote healing. The application of ice 20 minutes on and 20 minutes off for up to 5 days after the acute episode can be helpful. A physical or massage therapist can help with healing. Since most acute problems are muscular in origin, their TMD symptoms are self-limiting, so they may go away in a few days.

If symptoms persist beyond a few days, then the complete examination process begins, and the source of the problem must be discerned. A comprehensive exam followed by x rays of the teeth and joints is taken. An evaluation of the amount of opening and whether the joint deviates upon opening to the left or the right is examined. A cone beam or CT scan helps to determine the shape of the joint and the shallow pit or fossa into which it sits, as well as the amount of space between the joint and the fossa. This its to determine if the pillow or capsule is out of position, and either stuck ahead of or behind the mandible, preventing normal function and limiting or restricting opening and closing.

If there is any hard or soft tissue damage, this is noted, and fractures are ruled out.

For long term problems there is a sequence of treatment that is carried out. An MRI may be needed to diagnose whether the capsule has become stuck in a dysfunctional position. A special appliance that holds the teeth in a healing position may help reposition or recapture a capsule that has wandered out of position due to loosened ligaments.

Some dysfunctional causes revolve around teeth that are crooked or in ‘malocclusion”. In some cases, straightening the bite may prove helpful. Experience has shown that these non-surgical therapies can be effective in the vast majority of cases if treatment is initiated early.

In cases where non-surgical care has not been effective, then surgery to reposition the capsule or correct osteoarthritis may be required. This is required in very few cases, and non-surgical theories are recommended as a first approach.

In all cases, consult with your dentists at the first signs and symptoms of TMD to quickly heal and to avoid prolonged pain or the need for surgical care.

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Robert Korwin DMD, MICOI, MAGD is an award-winning dental expert who has served the Middletown-Red Bank-Monmouth County area for over 35 years. His practice offers a full range of general, reconstructive and cosmetic dental procedures with an emphasis on patient comfort.  Advanced Dentistry with a Gentle Touch, includes sedation dentistry, and the practice works with individuals to maximize their dental health, ensure their comfort and minimize financial concerns. For more information, please call (732) 219-8900 or book an appointment with Dr. Robert Korwin.