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TMJ / TMD

What Is the Temporomandibular Joint?
The temporomandibular joint connects the lower jaw, called the mandible, to the temporal bone at the side of the head. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of your head. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. Muscles attached to and surrounding the jaw joint control its position and movement.

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?
Today, researchers generally agree that temporomandibular disorders fall into three main categories:

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?
We know that severe injury to the jaw or temporomandibular joint can cause TMD. A heavy blow, for example, can fracture the bones of the joint or damage the disc, disrupting the smooth motion of the jaw and causing pain or locking. Arthritis in the jaw joint may also result from injury. Other causes of TMD are less clear. Some experts suggest that stress, either mental or physical, may cause or aggravate TMD. People with TMD often clench or grind their teeth at night, which can tire the jaw muscles and lead to pain.

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
A variety of symptoms may be linked to TMD. Pain, particularly in the chewing muscles and/or jaw joint, is the most common symptom. Other likely symptoms include:

• limited movement or locking of the jaw,
• radiating pain in the face, neck or shoulders,
• painful clicking, popping or grating sounds in the jaw joint when opening or closing the mouth.
• a sudden, major change in the way the upper and lower teeth fit together.

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.

Treatment
The key words to keep in mind about TMD treatment are "conservative" and "reversible." Conservative treatments are as simple as possible and are used most often because most patients do not have severe, degenerative TMD. Conservative treatments do not invade the tissues of the face, jaw or joint. Reversible treatments do not cause permanent, or irreversible, changes in the structure or position of the jaw or teeth.

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...
Many practitioners, especially dentists, are familiar with the conservative treatment of TMD. Because TMD is usually painful, pain clinics in hospitals and universities are also a good source of advice and second opinions for these disorders. Specially trained facial pain experts can often be helpful in diagnosing and treating TMD. Simple self-care practices are often effective in easing TMD symptoms. If more treatment is needed, it should be conservative and reversible. Dr. Fitzpatrick can fit you for a night guard or splint and recommend at home exercises to help with this problem.

TMJ Exercises

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.