Temporomandibular Joint Syndrome TMJ

Temporomandibular joint (TMJ) syndrome or TMJ joint disorders are medical problems related to the jaw joint. The TMJ connects the lower jaw to the skull under your ear. Certain facial muscles control chewing. Problems in this area can cause head and neck pain, a jaw that is locked in position or difficult to open, problems biting, and popping sounds when you bite. The TMJ is comprised of muscles, blood supplies, nerves, and bones. You have two TMJs, one on each side of your jaw.

Muscles involved in chewing (mastication) also open and close the mouth. The jawbone itself, controlled by the TMJ, has two movements: rotation or hinge action, which is opening and closing of the mouth, and gliding action, a movement that allows the mouth to open wider. The coordination of this action also allows you to talk, chew, and yawn.

TMJ can be caused by trauma, disease, wear due to aging, or habits. TRAUMA such as a punch to the jaw or an impact in an accident can break the jawbone or damage the disc.

TEETH GRINDING as a habit can result in muscle spasms and inflammatory reactions, thus causing the initial pain. Generally, someone who has a habit of grinding his or her teeth will do so mostly during sleep. In some cases, the grinding may be so loud that it disturbs others.

CLENCHING: Someone who clenches continually bites on things while awake. This might be chewing gum, a pen or pencil, or fingernails. The constant pounding on the joint causes the pain. STRESS: is often blamed for tension in the jaw, leading to a clenched jaw.

OSTEOARTHRITIS: Like other joints in the body, the jaw joint is prone to have arthritic changes. These changes are sometimes caused by a breakdown of the joint or normal aging.

RHEUMATOID ARTHRITIS: causes inflammation. As it progresses, the disease can cause destruction of cartilage and erode bone, deforming joints.

TMJ Symptoms

1. Pain in the facial muscles and jaw joints may radiate to the neck or shoulders. Joints may be overstretched. You may experience muscle spasms form TMJ. You may feel pain every time you talk, chew, or yawn. Pain usually appears in the joint itself, in front of the ear, but it may move elsewhere in the skull, face, or jaw.

2. TMJ may cause ear pain, ringing in the ears, and hearing loss. Sometimes people mistake TMJ pain for an ear problem, such as an ear infection, when the ear is not the problem at all.

3. When the joints move, you may hear sounds, such as clicking, grating, and/or popping. Others may also be able to hear the sounds. Clicking and popping are common. This means the disc may be in an abnormal position. Sometimes no treatment is needed if the sounds give you no pain.

4. Your face and mouth may swell on the affected side.

5. The jaw may lock wide open (then it is dislocated), or it may not open fully at all. Also, upon opening, the lower jaw, may deviate to one side. You may find yourself favoring one painful side or the other by opening your jaw awkwardly. These changes could be sudden. Your teeth may not fit properly together, and your bite may feel odd.

6. You may have trouble swallowing because of the muscle spasms.

7. Headaches and dizziness may be caused by TMJ. You may feel nauseous or vomit.

Occasional pain in the jaw joint or chewing muscles is common and may not be a cause for concern. See a doctor if your pain does not go away. Treatment for TMJ should begin when it is in early stages. The doctor can explain the functioning of the joints and how to avoid any action or habit(eg. chewing gum) that might aggravate the joint or facial pain.

EXAMS AND TESTS: A medical history will be done to help the doctor diagnose your jaw problem. The doctor will ask questions about your habits, such as grinding or clenching teeth, chewing gum often, frequent nail biting or chewing on objects such as pens or pencils. He will ask what kind of pain you are having and if the pain is there all the time or just comes and goes.

Physical examination: During the physical examination, the doctor will examine your head, neck, face, and temporomandibular joints, noting any of the following.

1. Tenderness (pain) and it's location.

2. Sounds, such as clicking, popping, or grating.

3. The mandible (lower jaw) range of motion and whether it is easy to open and close and can move from side to side and forward-backward without any pain.

4. Your assessment of pain on a scale from 0 (no pain) to 10.

5. Wear on buccal cusps of the mandibular teeth, especially the canine.

6. The rigidity and or tenderness of the chewing muscles.

7. How your teeth fit together: normal, open, cross bite, overbite, dental restorations, or skeletal deformity.

Imaging; X-rays may be taken of the mouth and jaw. CT or MRI may also be used. The MRI was designed for soft tissue and, therefore will show the location of the TMJ disc in relationship to the jaw and skull bones. That will give the doctor a better idea as to the proper treatment approach.

Most cases of TMJ are temporary thus treatment is usually conservative. You may also be instructed to follow up with a specialist such as an oral and maxillofacial surgeon, a general dentist or a pain specialist physician. Dentists are often the first to diagnose TMJ and are familiar with the conservative treatments.

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