Temporomandibular Joint (TMJ Pain)

Treatment of TMJ pain is NOT necessarily surgical. The American Society of Maxillofacial Surgeons recommends a conservative/ none surgical approach first. Only 20% of patients need to proceed to surgery.

see also Have you got a headache with jaw pain?

What is TMJ?

The TMJ is the joint that connects the lower jaw to the base of the skull. The reason for the name temporomandibular joint is used because it refers to the  joint between the mandible (jaw) and the temporal bone (part of the skull). As you will know it is highly mobile and a well used joint for eating (the greatest strain on it), talking, yawning and even grinding of teeth during sleep!
tmj1 Temporomandibular Joint (TMJ Pain)
The photograph below shows the bony landmarks for the temporomandibular joint. Remember these are only the bony areas and the cartilaginous disc and supporting capsule are missing as is the muscle movers.

tmj4 Temporomandibular Joint (TMJ Pain)

 

A normal TMJ joint.

This video shows a normal joint working in schematic form

The following video shows normal movement and all the soft tissues associated with this joint.

TMD are a family of problems related to the jaw joint. It can develop for many reasons.

TMJ pain

You might grind or clench you teeth at night or you may have received an injury. Whatever the cause, the symptoms are some or all of the following:

  • Pain and other symptoms affecting the head, jaw and face.
  • Headache, tenderness of the jaw muscles
  • pain surrounding the ear area
  • dull aching facial pain with severe exacerbation in or around the ear

The above are all common symptoms of TMD.You may also have

  • Difficulty in opening the mouth “locking” of the jaw
  • clicking noises as the mouth is opened or closed
  •  pain associated with opening the mouth very wide e.g. yawning or by chewing if persistent.

Anterior Disk Displacement with Reduction

Anterior Disk Displacement without Reduction

Causes of TMJ pain

There are a number of causes but principally it is felt that this pain and other symptoms are related to spasm of the muscles that are involved in chewing/mastication.

This may be as a result of

  • grinding or clenching the teeth due to stress, emotional tension or habit.
  • mal-alignment of the internal structures of the joint which may cause  the muscles and ligaments which support this joint to not work together properly.
  • Damage to the meniscus, its attachments or other internal joint problems may also affect the muscles and supporting joint structures and lead to symptoms.
  • Incorrect alignment of the teeth and\or jaws  which may place additional stress on the muscles and may be considered a factor.
  • TMJ problems may also be caused by displacement of the joint components as a result of jaw, head, and neck injuries.
  • Osteoarthritis and other forms of arthritis are a rare cause of TMJ problems, but can occur and their management is not isolated to this joint but forms part of the overall care of that form of arthritis.

Treatment of TMJ disorders ( now known as TMD)

Treatment is NOT necessarily surgical. The American Society of Maxillofacial Surgeons recommends a conservative/ none surgical approach first. Only 20% of patients need to proceed to surgery.

( PLEASE NOTE The only registered specialists that treat this problem are Oral & Maxillofacial Surgeons. There is NO specialist category of TMJ specialists and any one purporting to be one is Not legitimate. )

There is no one specific treatment at present; treatment is either physiotherapy type, and is aimed at eliminating the muscle spasm and relieving the pain. The use of occusal appliances ( like mouth guards ) should really only be regarded as “oromandibular crutches”.

“They cannot unload the TMJ; they cannot retrain the muscles: they cannot relieve headache conditions that are neurovascular in origin: they CANNOT recapture discs or produce a ideal occlusion ” ( Klasser & Green Professors from College of Dentistry, University of Illinois.USA.

Do it yourself help for TMJ Pain

  • Resting your jaw, this relaxes muscles and takes the pressure of the joint. The key to rest is keeping your teeth apart, eating soft foods and reducing stress.
  • Using ice and heat in the combination of ice / cold for 20 minutes and then warmth / heat for 10 minutes. The use of ‘wheat bags’ or a ‘hottie’ both hot and cold are good ways to achieve this.
  • Exercises of gentle opening and closing the mouth can be practiced on waking, before meals and at bedtime. Increase the movements gradually, eventually opening as widely as possible but not to the extent of causing any pain. To do this, hold your chin between your forefinger and thumb, and apply mild pressure backwards, slowly opening your mouth keeping the lower jaw pressed back as far as possible. After holding your mouth open for 2 to 5 seconds, slowly close it. Pause and then slowly repeat this exercise. Repeat this programme six times each session, two to four times daily.

Professional help for TMD

  • First see and be correctly diagnosed by a registered specialist ,ensure that the professional you are seeing is appropriately speciality registered.
  • ( Check using the Dental council or Medical council web sites ) As there are a considerable number of people currently claiming to be TMJ specialists and certainly appear to be legitimate and very plausible but in reality are little more self proclaimed experts.
  • Formal physiotherapy and acupuncture. The use of muscle relaxing drugs, and/or non-steroidal anti-inflammatory medication.
  • A bite raising appliance is often a very good method of reducing symptoms. This fits over the teeth and prevents grinding and or clenching, often at night. Because of the anatomy of the joint this type of appliance alters the functional relationship of the joint elements and hence helps in symptomatic relief. Its precise of action is not well understood.
  • Surgical intervention such as arthroscopy with or without joint surgery and arthrocentesis may be indicated either for diagnosis or treatment.

TMJ5 Temporomandibular Joint (TMJ Pain)

Above Post Arthroscopic patient. Note very small and cosmetic scars

Whatever the type of treatment this will be organized to be appropriate to the individual patient and can be as simple as medication through to an artificial joint. A lateral x-ray showing a left artificial joint in place
tmj 6 Temporomandibular Joint (TMJ Pain)