Temporomandibular joint dysfunction

 

 

Introduction

The temporomandibular joints (TMJ) connect your lower jaw to your skull. There are two matching joints, one on each side of your head, just in front of your ears. They let your jaw move up and down and from side to side.

The abbreviation "TMJ" refers to the joint but is often used to refer to any problems with the joints. Such problems include:

Popping sounds in your jaw

Not being able to completely open your mouth

Jaw pain

Headaches

Earaches

Toothaches

Other types of facial pain

Most people with TMJ problems have pain that comes and goes, but some have chronic (long-term) pain.

 

Signs and Symptoms

TMJ problems often cause the following symptoms:

Pain, particularly in the chewing muscles or jaw joint or an ache around your ear

Limited movement or locking of the jaw

Pain in the face, neck, or shoulders, or near the ear

Clicking, popping, or grating sounds when opening your mouth

Trouble chewing

Headache

A sudden change in the way your upper and lower teeth fit together

Also, sometimes earaches, dizziness, and hearing problems

 

What Causes It?

Sometimes TMJ dysfunction can be caused by an injury, such as a heavy blow, to the jaw or temporomandibular joint. But in other cases there may not be a clear cause. Other possible causes include:

A bad bite, called malocclusion

Orthodontic treatment, such as braces and the use of headgear

Wearing away of the disk or cartilage in the joint

Stress or anxiety. People with TMJ problems often clench or grind their teeth at night, which can tire the jaw muscles and lead to pain.

 

Who is Most At Risk?

The risk for TMJ problems may be higher with these factors:

Gender: more women than men seek treatment

Age: people ages 30 to 50 have the most problems

Children and adolescents with arthritis

Grinding teeth, clenching jaw

Malocclusion (bad bite)

High stress levels

 

What to Expect at Your Provider's Office

 

Your health care provider will check muscles in the area of the TMJ, and will:

Look for asymmetry or inflammation in your face

Listen for joint clicking or scraping sounds

Test the range of motion in your jaw

Look at your teeth for evidence of jaw clenching or teeth grinding

If you are having any neurological symptoms, such as numbness, your provider will give you a neurological exam. Your provider may also order imaging tests, such as an x-ray, computerized tomography (CT) scan, or magnetic resonance imaging (MRI) scan to look for degenerative disease or disk problems.

 

Treatment Options

 

Prevention

Reducing stress and keeping yourself from grinding your teeth or clenching your jaw may help prevent TMJ problems or lessen the symptoms.

 

Treatment Plan

In many cases, you can treat TMJ dysfunction at home. Your doctor may:

Ask you to change your eating habits: cut food into small pieces, avoid too much chewing, and stop chewing gum.

Give you exercises that stretch the muscles around your jaw.

Your doctor may also recommend:

If your bite is out of alignment, your dentist may suggest you wear a biteplate over your teeth to help bring your upper and lower jaw into alignment.

If you grind your teeth in your sleep, you may be asked to wear a night guard over your teeth.

If stress is causing you to clench your jaw, your doctor may suggest stress reduction techniques or cognitive behavioral therapy to help you manage anxiety and tension.

 

Drug Therapies

Your doctor may recommend the following medications:

Nonsteroidal anti-inflammatory drugs (NSAIDs): to relieve pain. These drugs include ibuprofen (Advil, Motrin) and naproxen (Aleve).

Minor tranquilizers or muscle relaxants at bedtime to reduce spasms and pain.

Injections of a local anesthetic.

Corticosteroid injections, for severe cases.

Botox (botulinum toxin A) injections: can reduce muscle spasms

 

Surgical and Other Procedures

In some cases, removing fluid from the joint may help reduce pain, especially for people whose jaws lock. When other measures have failed, surgery may be needed to repair or take out the disk between the temporal bone and the jaw.

 

Complementary and Alternative Therapies

A comprehensive treatment plan for TMJ dysfunction may include a range of complementary and alternative therapies (CAM). Work with a health care provider who has experience treating TMJ and be sure to tell all of your doctors about any medications, herbs, and supplements you are taking. Treatments, including physical medicine, may help.

 

Nutrition and Supplements

The following nutritional tips may help prevent or reduce symptoms of TMJ dysfunction:

Eat soft foods high in flavonoids, such as cooked fruits and vegetables. Flavonoids are plant-based antioxidants that may help decrease joint pain.

Avoid saturated fats, fried foods, and caffeine. These foods may increase inflammation.

DO NOT chew gum.

 

Some supplements that may help:

Glucosamine: may reduce pain and help rebuild cartilage in the joint, which helps improve range of motion. Some studies show that glucosamine helps reduce pain in people with arthritis, which involves painful joints. One study found that glucosamine worked as well as ibuprofen (Advil, Motrin) for relieving pain and other TMJ symptoms. Glucosamine is often combined with chondroitin sulfate. Glucosamine may increase the risk of bleeding, especially if you also take blood thinners like warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Some doctors think glucosamine might interfere with medications used to treat cancer. Ask your doctor before taking glucosamine and chondroitin.

Vitamin C: is also used by the body to make cartilage. It may improve range of motion in your joints, including your jaw, although there are no scientific studies investigating vitamin C for TMJ problems. Vitamin C supplements may interact with other medications, including chemotherapy drugs, estrogen, warfarin (Coumadin), and others.

Calcium and magnesium: may help the jaw muscle relax, although there are no scientific studies using them for TMJ problems. Magnesium and calcium interact with several medications, herbs, and supplements. They can also affect your heart and blood pressure, so be sure to tell your doctor before you take them.

 

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects, and can interact with other herbs, supplements, or medications. For this reasons, take herbs with care, under the supervision of a health care provider.

Cramp bark (Viburnum opulus) and lobelia (Lobelia inflata) may help reduce muscle spasms, although there are no scientific studies to support using them for TMJ problems. Rub 5 drops tincture of each herb into joint. Use on the skin only and do not apply to broken skin. DO NOT take these herbs by mouth (orally).

 

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of TMJ dysfunction based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Causticum: for burning pains

Hypericum perforatum: for sharp, shooting pains

Ignatia: for tension in the jaw

Kalmia: for face pain, especially with other joint pains or arthritis

Magnesia phosphorica: for muscle cramps

Rhus toxicodendron: for pains that feel better in the morning and in dry weather, and worse after movement or in wet weather

Ruta graveolens: for pains from overuse or injury

Physical Medicine

Contrast hydrotherapy, which is alternating hot- and cold-water applications, may:

Lower inflammation

Provide pain relief

Speed healing

Use hot packs and ice wrapped in a clean, soft cloth and apply to area. Alternate 3 minutes hot with 1 minute cold. Repeat 3 times for 1 set. Do 2 to 5 sets per day.

 

Acupuncture

Very good evidence suggests dry needling can treat TMJ dysfunction. Several well-designed studies found that needling therapies can relieve pain long term for TMJ problems.

 

Manipulation

There is some Evidence that Cervical manipulation as well as manipulation to the TMJ as well can help with TMJ dysfunction and restore range of motion

 

Craniosacral Therapy

This therapy is a very gentle form of body work. Practitioners use their hands to get rid of restrictions in the craniosacral system, the fluid and membranes surrounding the spine and brain. Although there are not many studies, some people say they feel better after craniosacral therapy. Find a practitioner who has training and experience with TMJ problems. You can interview several practitioners before deciding which one is right for you.

 

Massage

Some types of massage and chiropractic manipulation may help:

Reduce muscle spasms

Provide pain relief

Prevent symptoms from coming back

 

 

Biofeedback

Biofeedback teaches you how to reduce muscle tension through relaxation and visualization techniques. At first, sensors are placed on your jaw, and a machine shows the amount of tension in your muscles. Using relaxation and visualization techniques, you learn to reduce the amount of tension around your jaw while the machine provides instant feedback so you can see how you are doing. Once you have mastered the technique, you can do the relaxation and visualization techniques anywhere, without the machine.

Improving posture

Two types of movement therapy can sometimes help treat TMJ problems: the Alexander technique and the Feldenkrais method.

The Alexander technique teaches you how to properly align your head, neck, and spine, and move your body. It can help relieve tension in your head and jaw muscles, which may reduce the symptoms of TMJ dysfunction.

The Feldenkrais method teaches you to recognize bad posture habits and movements that cause your body to tense. It is a gentle therapy aimed at making you more aware of how your body moves, and helping you develop an inner awareness of your body. Feldenkrais is popular with dancers and musicians, who often do repetitive motions that can lead to overuse injuries.

 

Prognosis and Possible Complications

About 75% of people with TMJ problems who follow a treatment plan with more than one treatment find relief. In rare cases, long-term teeth clenching or grinding, injury, infection, or connective tissue disease may cause degenerative joint disease or arthritis. If you have severe grinding, a nighttime bite guard worn inside your mouth may help.

 

Following Up

You may need to see your health care provider regularly to make sure your treatment plan is working for you.