TMJ / TMD
What Is the Temporomandibular Joint?
When we open our mouths, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft disc lies between the condyle and the temporal bone. This disc absorbs shocks to the TMJ from chewing and other movements.
What Are Temporomandibular Disorders?
myofascial pain, the most common form of TMD, which is discomfort or pain in the muscles that control jaw function, and the neck and shoulder muscles;
internal derangement of the joint, meaning a dislocated jaw or displaced disc, or injury to the condyle;
degenerative joint disease, such as osteoarthritis or rheumatoid arthritis in the jaw joint.
A person may have one or more of these conditions at the same time.
What Causes TMD?
There is no scientific proof that clicking sounds in the jaw joint leads to serious TMJ problems. In fact, jaw clicking is fairly common in the general population. If there are no other symptoms, such as pain or locking, jaw clicking usually does not need treatment.
Researchers believe that most people with clicking or popping in the jaw joint likely have a displaced disc -- the soft, shock-absorbing disc is not in a normal position. As long as the displaced disc causes no pain or problems with jaw movement, no treatment is needed.
TMD Signs and Symptoms
Symptoms such as headaches, earaches, dizziness and hearing problems may sometimes be related to TMD. It is important to keep in mind, however, that occasional discomfort in the jaw joint or chewing muscles is quite common and is generally not a cause for concern.
Because most TMD problems are temporary and do not get worse, simple treatment is all that is usually needed to relieve discomfort. Self-care practices, for example, eating soft foods, applying heat or ice packs, and avoiding extreme jaw movements (such as wide yawning, loud singing and gum chewing) are useful in easing TMD symptoms. Learning special techniques for relaxing and reducing stress may also help patients deal with pain that often comes with TMD problems. Other conservative, reversible treatments include physical therapy you can do at home, which focuses on gentle muscle stretching and relaxing exercises, and short-term use of muscle-relaxing and anti-inflammatory drugs.
The Dentist may recommend an oral appliance, also called a splint, bite plate, or night guard, which is a plastic mold that fits over the upper or lower teeth. The splint can help reduce clenching or grinding, which eases muscle tension. An oral splint should not cause permanent changes in the bite. If a splint causes or increases pain, stop using it and see your dentist.
The conservative, reversible treatments described are useful for temporary relief of pain and muscle spasm -- they are not "cures" for TMD. If symptoms continue over time or come back often, check with your doctor.
There are other types of TMD treatment, such as surgery or injections, that invade the tissues. Some involve injecting pain relieving medications into painful muscle sites, often called "trigger points." Surgical treatments are often irreversible and should be avoided where possible.
If You Think You Have TMD...
Assisted Opening - Place two fingers on lower front teeth, slowly open as wide as is comfortable while pushing down with your fingers. Repeat ten times.
Resisted Opening - Cup palm under chin, open jaw slowly, and gently resist opening with hand under chin. Repeat ten times.
Midline Exercise - Look in mirror, bite teeth together, and look at position of two center teeth on lower jaw (central incisors). Open slowly while watching these two teeth and attempt to keep lower jaw "centered" as you open. Repeat ten times.
Simple Opening/Stretch - Open jaw slowly ten times as wide as is comfortable.
Lateral Movement Exercise - Open jaw about one inch from clenched bite. Move lower jaw as far to the right (straight to the right without opening more) as is comfortable. Repeat ten times and then do the same on the left side.
Neck Stretch - Attempt to touch ear to shoulder by bending neck and not raising shoulder. Repeat ten times and then do ten more on the other side.