Millions encounter this condition each year and chances are at some point, you have, too. And daily, explains V. Glenn Orion, this particular joint is agitated an estimated 2,000 times as you chew, talk, or yawn. On top of these jaw-dropping statistics is that, if untreated, it could have serious ramifications on your overall health.
IF you’ve woken up with inexplicable pain in your neck, ringing in your ears, and a toothache despite finding no new cavities during your last dentist visit, then you could likely be one of the million others suffering from temporomandibular joint dysfunction.
Also known as TMD, its symptoms are vastly diverse, both in nature and severity. TMD occurs as a result of problems with the jaw, specifically the temporo-mandibular joint, and surrounding facial muscles responsible for moving the jaw during actions such as chewing or talking. Ideally, you should be able to experience its full range of motion for instance yawning without any pain or discomfort.
The temporomandibular joint acts like a hinge that connects the lower jaw or mandible to the temporal bone of the skull, which is immediately in front of the ear on each side of your head. Muscles attached to and surrounding the jaw joint control the position and movement of the jaw. The temporomandibular joint combines a hinge action (up and down) with sliding motions (side to side). The parts of the bones that interact in the joint are covered with cartilage and are separated by a small shock-absorbing disk, which keeps the movement smooth.
The cause of TMD is not clearly defined but dentists believe injury to the temporomandibular joint or jaw, grinding or clenching of the teeth, or improperly aligned teeth or bite are the main contributors. Grinding or clenching the teeth, especially, puts extra stress on the jaw.
Other causes listed by dentists include:
-Dislocation of the soft cushion or disc between the ball and socket
-Presence of osteoarthritis or rheumatoid arthritis in the jaw joint
-The joint is damaged by a blow or other impact
-The muscles that stabilize the joint become fatigued from overwork, which can happen if you habitually clench or grind your teeth
Stress is another factor, adds Dr. Agnes Claros, a DMD who specializes in Comprehensive Aesthetic Restorative Dentistry. Grinding can also be related to stress, especially clenching. When you’re really anxious or tense about something, or even furious, it has something to do with stress, too. Many don’t realize the debilitating effects grinding and clenching have on the teeth and jaw such that its subconscious practice continues as a daily habit.
Diagnosing TMD can be tricky because it often mimics symptoms of other conditions. Patients may disregard headaches or facial pain as independent of TMJ issues. Only when they are involved in an accident or experience trauma to the side of the face do they identify a specific event to the TMD experienced later on.
Further research reveals that TMD may be related to fibromyalgia, a chronic musculoskeletal pain and fatigue disorder that causes pain in the muscles, ligaments and tendons, according to a report in the March/April 2003 issue of General Dentistry, the clinical, peer-reviewed journal of the Academy of General Dentistry (AGD).
Both TMD and fibromyalgia produce similar painful symptoms in the muscles of the neck, shoulders, back, face and head. Dizziness and sleep disturbances are also symptoms both conditions share.We’ve found that many patients suffering with TMD problems also suffer later in life from fibromyalgia, says Thomas Sollecito, DMD and lead author of the report. Typically thought of as unrelated, this potential connection is being further explored.
Many people wake with a headache each morning or have tension and pain in the muscles on the back of their neck, while others can’t open their mouths very wide without pain. Some people continually break teeth that are not weakened by decay and others exhibit excessive wear on their teeth. When some patients come in, says Dr. Claros, sometimes we don’t even need them to tell us their problem because the condition of their teeth is already apparent. I’ll think to myself, Oh, grinder ito ah.
The most common symptoms are migraine-like headaches, which seem to come from behind the eyes or the side of the head just above the ears. The pain has been described to often radiate down into the shoulders or upper back. Another type of headache associated with TMJ dysfunction may occur in the area of the cheekbones, resembling a sinus headache.
Women experience TMD more than men and the age bracket is usually between 20 and 40 years. Dr. Claros explains further, Children have mixed-dentition where their grinding and clenching of the teeth is normal because of the difference in the height of baby teeth in the arch. For adults, as we grow older, we get cavities, wear braces or dentures, have crowns and caps put in all these contribute to the imbalance that we acquire over time. As we live with that imbalance in our mouth, the temporomandibular joint also reacts to that imbalance.
More common and likely to come in waves are popping sensations or clicking sounds in the jaw when chewing or yawning. Here are a few more symptoms dentists consider to indicate the onset of TMD:
-Pain or tenderness in the jaw
-Aching pain in and around the ear
-Limited ability to open the mouth very wide
-Difficulty chewing or discomfort while chewing
-Aching facial pain or tired feeling in the face
-Locking of the jaw joint, making it difficult to open or close the mouth
-Uncomfortable bite, as if the upper and lower teeth are not fitting together properly
-Swelling on the side of the face
Better understanding of the factors leading to TMD as well as to the sites involved has led to considerable refinement in the treatment of this condition. That’s what comprehensive dentistry is all about, comments Dr. Claros who took her postgraduate studies at The Pankey Institute located in Florida. You start with one tooth, then you look at the entire structure that is around the teeth. So the gums, the bones, and how they come together and where they are located on the arch, upper and lower joints, how the TMJ makes them come together, and how the muscles relate with all of that that’s why there’s a field of TMD specialists.
Initial therapy is directed at relief of the painful muscle spasm and involves use of heat, massage, and muscle relaxing therapy. Self-care practices could include applying ice or cold packs, avoiding crunchy or chewy foods, and taking over-the-counter anti-inflammatory drugs to relieve muscle pain and swelling. For many patients one or two weeks of such treatment is sufficient to eliminate the symptoms.
For those with tooth grinding or clenching habits the dentist may sometimes construct a plastic appliance that separates the teeth and makes such activity more difficult, if not impossible. We aim to either stop it, minimize it, or protect the teeth as the person grinds, says Dr. Claros. It’s not so much treating the grinding, but protecting the teeth from the damages caused by grinding. This appliance is particularly helpful for individuals who grind their teeth while sleeping and therefore cannot consciously control the habit.
In rare occasions, your dentist may recommend minor adjustments to the biting surfaces of the teeth, using crowns, bridges, or braces to adjust one’s bite. Even more rarely is surgery suggested to adjust or replace the joint. However, the National Institute of Dental and Craniofacial Research of the NIH advises against it, citing that There have been no long-term studies to test the safety and effectiveness of these procedures.
Injury plays a role in some TMJ problems, but for many people, symptoms seem to start without obvious reason. The good news is that for most people, pain in this area is not a signal of a serious problem. Generally, discomfort is occasional and temporary and will go away with little or no treatment. Even if symptoms persist, most patients still do not need aggressive types of treatment.
Still, it helps to know if you’ve bitten off more than you could chew.