Tmj Is Temporomandibular Joint Often Involved In Jaw Pain & Headaches
TMJ disorders are problems or symptoms of the chewing muscles and joints that connect the lower jaw to the skull.
There are two temporomandibular joints, one on each side of the head, just in front of the ears. TMJ refers to the joint, however, it is often used to mean any disorders or symptoms in this region. It is lately usually called TMD – temporomandibular joint dysfunction.
What are the causes?
Most temporomandibular joint symptoms are caused by physical stress on the structures around the joint. These structures are, the cartilage disc at the joint, muscles of the jaw, face, and neck, surrounding ligaments, blood vessels, and nerves and teeth
For many people the cause is not known. Some causes are believed to be a bad bite or orthodontic braces, stress and tooth grinding, however, many people with TMJ/TMD do not grind their teeth, and many who grind their teeth for a long time do not have problems. For some, the stress may be a result of temporomandibular joint pain as opposed to stress being the cause of the problem.
Poor neck posture can be a factor in TMJ symptoms. Holding the head forward while looking at a computer for long periods of time strains the muscles of the face and neck. Additional factors that might make symptoms worse are stress, poor diet, and lack of sleep.
Many people have muscular strain from contracted muscles in the jaw, head, and neck. These areas of muscle strain can refer pain to other areas, causing a headache, earache, or toothache. Other possible causes are osteoarthritis or rheumatoid arthritis in the joint, fractures, dislocations, whiplash symptoms and structural or congenital problems present since birth.
- A 2021 review in Frontiers in Endocrinology indicates muscle-bone crosstalk, which has been regarded as biomechanical, is also considered biochemical. Muscles and bones are considered secretory tissues capable of releasing soluble molecules to regulate each other.
The structures of the masticatory apparatus present biochemical, structural, and functional characteristics that make them physiologically different from other musculoskeletal components and have a high rate of remodeling well into adulthood.
Molecules called myokines or osteokines have been noted to express in the masticatory apparatus. The levels of these are altered in use/disuse of the masticatory apparatus, as well as in pathophysiological conditions in humans. Due to the large biomass of the masticatory muscles, it is highly probable they contribute through myokines in the cause of temporomandibular disorders. Molecules elevated in the synovial fluid of individuals affected by TMJ have been associated with chondrocytes or inflammatory cells, could well arise from masticatory muscles. Similarly, molecules that mediate bone resorption associated with periodontitis could cross-affect masticatory muscles and contribute to the loss in their volume.
What are the symptoms?
Symptoms may include biting or chewing difficulty or discomfort, clicking, popping, or a grating sound when opening or closing the mouth, dull, aching pain in the face, ear pain, headaches, jaw pain or tenderness, locking of the jaw and difficulty opening or closing the mouth, limited ability to open the mouth very wide. Jaws that get stuck or lock in the open or closed mouth position, clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth, difficulty chewing or a sudden uncomfortable bite as if the upper and lower teeth are not fitting together properly (occlusion).
What are signs and tests?
More than one medical specialist may be needed. This may include a primary care provider, a dentist specialist, or an ear, nose, and throat (ENT) doctor. An examination may include a dental examination for poor bite alignment, feeling and pressing the joint and muscles for pain and tenderness, sliding the teeth from side to side, watching, feeling, and listening to the jaw open and shut, x-rays or MRI of the jaw. Other conditions may be considered, such as infections, ear infections, or nerve related problems and headaches.
What are treatments for TMJ
Simple, gentle therapies are usually recommended first. Learn how to gently stretch, relax, or massage the muscles around your jaw. Avoid actions that cause your symptoms. Try moist heat or cold packs. Learn stress reducing techniques. Exercising several times each week may help increase the ability to handle pain. Research as much as you can, as opinion varies widely on how to treat the condition. Get second opinions from doctors. Most people eventually find something that helps and there are many new therapies available.
Medications may be helpful. Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), or other nonsteroidal anti-inflammatory drugs may help alleviate TMJ pain. Sometimes, muscle relaxant medicines or antidepressants are prescribed for temporomandibular joint pain relief.
Mouth or bite guards, also called splints or appliances, have been used to treat teeth grinding and clenching and the benefits vary widely. The guard may lose its effectiveness over time or when removed, while some may feel more pain when they wear one. Some appliances fit over the top teeth, while others fit over the bottom teeth. Permanent use of these items may not be recommended. Stop use if it causes any changes in your bite.
Sometimes, corticosteroid shots are used to treat inflammation, however, failure of more conservative treatments does not automatically mean you need more aggressive treatment. Caution should be advised about any nonreversible treatment method, such as orthodontics or surgery, that permanently changes your bite. Reconstructive surgery of the jaw or joint replacement is rarely required. Studies have shown that the results are often worse than before surgery.
What are the expectations or prognosis?
Usually, symptoms are infrequent and do not last long and will go away in time with little or no treatment. Pain may return in the future. If the cause is nighttime clenching, treatment can be difficult because it is a sleeping behavior that is hard to control.
- A 2020 Review in the Journal of Oral Rehabilitation found an association exists between painful jaw pain and sleep quality. The presence of pain strongly impacted the sleep quality in TMJ patients.
Many of the home care steps can prevent temporomandibular joint dysfunction in the first place. Avoid eating hard foods or chewing gum. Learn relaxation techniques to reduce overall stress and muscle tension. Maintain good posture, especially if you work all day at a computer and you can see how to set up a work area for sitting properly at a computer. Take frequent mini-breaks to change position, rest your hands and arms, and relieve stressed muscles. Don’t rest your chin on your hand or hold the telephone between your shoulder and ear. Keep your teeth slightly apart as often as you can to relieve pressure on the jaw. To control clenching or grinding during the day, place your tongue between your teeth. Use safety measures to reduce the risk of accidents that may result in fractures and dislocations.
- A 2019 study indicates habits like nail biting, teeth grinding, biting of lips and other objects as well as mouth breathing are significantly associated with signs and symptoms of temporomandibular disorders.
These are called parafunctional habits and the three most common were chewing gum, mouth breathing and biting of objects respectively. These are modifiable habits and countermeasures should be taken. Some are obvious, however, breathing exercises can be helpful. We were taught in KungFu to keep the tong up and slightly touching the upper soft palate to promote relaxation as well as salivation.
Are there TMJ support groups?
For support group information, please visit The TMJ Association.
An interesting 2020 article in the journal Bioscience indicates what they call “The Jaw Epidemic” as jaw shrinkage since the agricultural revolution. This has led to an epidemic of crooked teeth, lack of space for wisdom teeth, and constricted airways, a major cause of sleep-related stress like sleep apnea. The authors indicate this has occurred in the last few centuries resulting smaller jaws and less toned muscles of the face and oropharynx. The resting oral posture has been disrupted in societies no longer hunting and gathering. They indicate this also relates to jaw symptoms which would include tmj problems.
A 2020 study in the journal Cranio found a significant relationship between temporomandibular disorders and tinnitus with the authors concluding patients should be evaluated evaluated for otological symptoms.