Temperomandibular Joint (TMJ) Disorders

The word periodontal literally means “around the tooth.” Periodontal diseases are serious bacterial infections that destroy the attachment fibers and supporting bone that hold your teeth in your mouth. Left untreated, these diseases can lead to tooth loss. The following are various forms of periodontal disease:

Temporomandibular disorders (TMD) consist of more than one condition and it not only affects the Temporomandibular joint (TMJ) but also the chewing muscles. This condition more often causes acute pain and the pain can be categorized as follows:

  • Myofascial pain
  • Derangement of the joint internally
  • Degenerative joint diseases – Osteoarthritis, Rheumatoid arthritis of the jaw joint.

Research carried out by the National Institute of Dental and Craniofacial Research in USA has indicated that women are more affected by TMJ disorders than men.

The Temporomandibular joint or TMJ is located just in front of both the ears wherein the lower jaw or mandible meets the upper jaw or maxilla. There are number of moving parts at this joint which facilitate the upper jaw to close on the lower jaw. This is a sliding ball and socket joint with a disc sandwiched between it. The TMJ is required for chewing, biting, yawning, talking etc. and hence its usage is continuous.

This is a complex joint and consists of tendons, muscles, bones etc. and for painless chewing, talking, yawing etc. if the muscles have to be in a relaxed and balanced condition when you close or open the joints.

The group of problems of the jaw joint that are complex is called TMJ disorders. Since the joints and muscles have to work in unison any problem with either of them could lead to side effects such as head ache, stiffness, malocclusion, ear pain, clicking sounds and jaws getting locked.

This disorder could result because of any of the following conditions/ behaviors:

  • Biting fingernail or chewing gums constantly
  • Bruxism or teeth grinding/ clenching – can cause wear out of the TMJ cartilage lining that causes jaw or ear pain.
  • Chewing on only one side of the jaw
  • Occupational hazard – people who constantly hold telephone between their head and shoulder could be affected by this disorder.
  • Problems of biting because of teeth misalignment
  • Stress causes nervous energy that has not been not released
  • Trauma to the jaws
  • Poor posture – holding the head forward while working on the computer for long time causes muscle strain on the face and neck
  • Arthritis, dislocations fractures and structural problems present since birth

It is very important to see a periodontist for periodontal evaluation under the following circumstances.

Most of the TMJ problems are caused by the physical stress on the joint structures – Cartilage disk at the joint, teeth, jaw, face and neck muscles and nearby ligaments, blood vessels, and nerves.

The following are the symptoms that are associated with TMJ disorders:

  • Biting/ Chewing difficulty or discomfort
  • Clicking, crunching, grating, grinding or popping sound while opening or closing the mouth
  • Difficulty in opening/ closing the mouth
  • Dizziness – occurs in 40% of the patients
  • Earache – occurs in 50% of the patients
  • Ear fullness or clogging, Ear Ringing or tinnitus – occurs in 33% of the patients
  • Facial ache – occurs in 40% of the patients
  • Headache – occurs in 80% of the patients
  • Jaw pain or tenderness, Jaw stiffness and Jaw locking
  • Malocclusion
  • Neck pain
  • Reduced ability to open or close the mouth

Persons having TMJ disorders may have to undergo both medical and dental evaluation depending on the symptoms they show. This may involve examination by your doctor, ENT specialist and dentist.

If the movement of the jaws is accompanied by popping, clicking, and grating sounds you could suspect jaw joint damage. It will be very painful to chew and the jaw may neither lock nor open fully. The teeth might become smooth and there won’t be any bumps or ridges in the surface area.

Ear problems like ear infection, sinuses etc. could occur.

X-rays and CT scan will define bone details at the TMJ joint and MRI will help in analyzing soft tissues.

The main treatment for TMJ pain when it is acute is – application of heat or ice, soft diet and use of anti-inflammatory drugs.

Various treatment methods to be followed are as follows:

  • Heat and ice therapy – will reduce tension in the muscles and also relieve muscular spasm. Applying cold pack immediately after injury will give the best results including relieving of pain.
  • Jaw rest – make sure you keep the teeth apart. Take action to prevent tooth grinding. Avoid chewing gums. Make sure that the food you eat soft, less chewy or crunchy. Avoid eating foods that require opening your mouth wide.
  • Occlusal therapy – wherein a custom-made acrylic appliance (mouth guard) is fitted over the teeth to avoid bruxism.
  • Managing Stresses – with the help of stress support groups, stress medications and counseling will reduce muscle tension.
  • Medications – Anti-inflammatory medications like ibuprofen, aspirin, naproxen or steroids are useful for controlling inflammation. Muscle spasms can be reduced by taking valium which is a muscle relaxant. There are circumstances wherein injection of cortisone preparations will help.
  • Physical therapy – in order to increase the range of motion and reduce the pain the physical therapy exercises such as closing and opening of the jaw in a passive manner, massaging and stimulating electrically will be of considerable help.
  • Corrective dental therapy – abnormal bite situation can be corrected with orthodontics.
  • Surgery – has to be resorted to only when the above measures fail. In severe cases you may have to undergo TMJ arthroscopy, tightening of ligaments, restructuring the joint and replacement of joint.

The following precautions might avoid the occurrence of TMJ disorders.

  • Refrain from eating harder foods and chewing gum.
  • Learn to relax so as to reduce the overall stress level and muscle tension.
  • Maintain good posture while working on computer for long periods so as to avoid stressing of muscles
  • Take necessary safety measures to avoid the risk of fractures and dislocations.