TMJ DISORDER:


Known as TMJ, TMD or TMJD, temporomandibular disorder is a condition affecting the temporomandibular joint (TMJ) , which connects the mandible or the lower jaw to the temporal bone of the skull, which is located in front of the ear. The TMJ includes the muscles surrounding the jaw, blood vessels, bones and nerves. A person will have two TMJs, one located on each side of the jaw.

The TMJ mainly works to coordinate movements of the jaw, like chewing and biting. Any disorder in this area will therefore affect the flexibility of the jaw. You may notice pain while talking, yawning or chewing, and even while the jaw is at rest. TMJ disorder can cause intense pain, which can be intermittent, or can be constant and last for many years.

Symptoms of TMJ disorder

The most common symptom of TMJ disorder is pain, with intense discomfort not just in the face and jaw joint, but also the neck and shoulders.

You may experience an overstretched feeling in your joints, and may also suffer from muscle spasms.

There is pain during jaw movements like talking or yawning.

There can also be ear paining, tinnitus or ringing in the ears, or even hearing loss.

You may even hear a clicking or popping sound when you move the joint. The sounds may be audible to other people also.

There may be swelling of the face and mouth.

There may be a shifting in the position of the teeth, or a change in the bite.

You may find it hard to open the jaw fully, or the jaw may shift to one side after opening.

You may experience trouble while swallowing.

There could be nausea, headache or dizziness.

Diagnosis of TMJ Disorder

Since TMJ is accompanied by an onset of pain, your dentist will gauge the intensity of pain by administering a “clench” test. If you experience pain in any one tooth or all teeth or the jaw when you bite down, your dentist will diagnose it as TMJ. To confirm this diagnosis and to evaluate the position of the temporomandibular joint, your dentist will create mold impressions of your bite, and mount these on an articulator. Through this, your dentist can determine if there is a structural disorder inside the joint, or other factors like uneven teeth are affecting the joint.

Treatment of TMJ Disorder

Very few TMJ cases are severe enough to need surgery. Most bite problems can be corrected through restoration or orthodontic treatment.

Dental appliances

If there is no structural disorder in the joint, but your dentist notices interferences that affect the bite, he may suggest correcting the problem using an appliance.

Occlusal equilibration

Occlusal equilibration is the most frequently used option to remove deflective interferences, and enable the jaw to close down properly. It involves the reshaping of the teeth surfaces that are involved in biting. Your dentist will examine the occlusion and the joints, before he recommends a particular treatment.

Mouth guards

The dentist may fit you with a plastic shield that acts like a mouth guard to protect your upper or lower teeth. This guard or splint can protect your teeth against teeth grinding when worn at night. If the splint causes pain, discontinue use.

Surgical treatment

If your dentist believes that your problem is caused by a structural disorder, and if your pain is not relieved through occlusal equilibration or the use of splints, then he will recommend an X-ray. He may also recommend an MRI (Magnetic Resonance Imaging) to have a look at the soft tissue that surrounds the joint. In some cases, he may even order a CT scan to check the bony parts of the jaw. Finally, he may recommend orthodontia, an intra-oral appliance or maxillofacial surgery, depending on the results of the scans. He will refer you to an oral surgeon or a maxillofacial surgeon.

What to expect during surgery

Surgery is performed under local anesthesia. Here, two needles are inserted into the temporomandibular joint, one connected to a syringe containing a cleansing solution, and the other acting as an exit for the fluid. This procedure is used to wash out the joint. In some cases, your surgeon will make use of a scalpel like tool to remove any tissue adhesions in the joint.

Orthroscopy

Another type of surgery to treat TMJ is orthroscopy, in which an incision is made at the temple to insert an endoscope into the area. Using images provided by the endoscope, your surgeon will remove adhesions, or reposition the disc.

Open joint surgery

Open joint surgery is the only option that allows access to any tumors, scarring or worsening bone structure.

First aid for TMJ

To treat intense pain before you meet with your dentist, try the following self help remedies.

Apply hot and cold packs to the side of the face to lessen the pain. The pack should be applied for 10-minute durations.

Avoid yawning or other extended jaw movements, and limit the amount of pressure you place on your jaw.

Eat only soft foods, and avoid foods that require heavy chewing

If you are under any dental treatment for tooth decay, continue with the treatment.

Massages and biofeedback can also offer some relief from TMJ.

Anti-inflammatory drugs, anti-anxiety drugs and anti depressants can provide relief from intense pain.

Dental appliances like mouth guards can reduce teeth grinding which can enhance your bite, enabling your lower jaw to fit properly into the TMJ socket.

Remember that any TMJ treatment should only be provided by a dental specialist who is highly experienced in this area.

Alternative Treatments for TMJ

Alternative treatments for TMJ include TENS (Transcutanaous Electrical Nerve Stimulation), radiowave therapy and ultrasound. Radiowave therapy and TNS work by sending radiowaves or low-intensity energy waves to the affected region to stimulate the flow of blood to the area. These alternative treatments do not work to treat the causes of TMJ, and can only be relied on for temporary relief.

Treatment follow-up

After TMJ treatment, follow your dentist’s instructions, including prescribed medication, hot and cold compresses or jaw exercises. If you are required to make a follow up visit with the surgeon, remember to do so.

Prevention of TMJ disorder

If you notice jaw pain occasionally, avoid eating hard foods, chewing gum or biting on hard objects. Support your lower jaw with your hand when you yawn. If you find yourself grinding your teeth or clenching your jaw at night, consult your dentist - he may be able to design a splint for you to protect your teeth.

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