Temporomandibular Joint Disorders

The temporomandibular joint (TMJ) is the area on either side of the head located directly in front of the ears where the upper and lower jaws meet. This joint is a sliding "ball and socket" which has a disc sandwiched between it. The TMJ is used many hundreds of times a day in moving the jaw, biting and chewing, talking and yawning. It is one of the most frequently used joints in the body.

For people with TMJ dysfunction (also known as myofacial pain dysfunction and Costen's syndrome), problems with the joint and muscles around it may cause:
•  Pain that travels through the face, jaw or neck
•  Stiff jaw muscles
•  Limited movement or locking of the jaw
•  Painful clicking or popping in the jaw
•  A change in the way the upper and lower teeth fit together

Causes

Many TMJ-related symptoms are caused by the effects of physical and emotional stress on the structures around the joint. These structures include:
•  Cartilage disk at the joint
•  Muscles of the jaw, face, and neck
•  Nearby ligaments, blood vessels, and nerves
•  Teeth

Following are some behaviors or conditions that can lead to TMJ disorders:
•  Teeth grinding or teeth clenching (bruxism)
•  Habitual gum chewing or fingernail biting
•  Dental problems and misalignment of the teeth (malocclusion)
•  Previous history of trauma to the jaws (arthritis, dislocations, broken jaw, fractured facial bones. or structural problems present since birth)
•  Stress, poor diet, or lack of sleep can result in "trigger points" -- contracted muscles and pinched nerves in your jaw, head, and neck. Trigger points can refer pain to other areas, causing a headache, earache, or toothache
•  Occupational tasks such as holding the telephone between the head and shoulder or holding the head forward while looking at a computer all day strains the muscles of the face and neck
•  Poor diet
•  Lack of sleep

Symptoms

The following are common symptoms associated with TMJ disorder
•  Biting or chewing difficulty or discomfort
•  Clicking sound while chewing or opening the mouth
•  Dull, aching pain in the face
•  Earache
•  Grating sensation while chewing
•  Grinding, crunching, or popping sounds, medically termed as crepitus
•  Headache
•  Jaw pain or tenderness of the jaw
•  Reduced ability to open or close the mouth
•  Dizziness
•  Fullness of the ear (muffled, clogged, or full ears)
•  Ringing in the ear (Tinnitus)

Diagnosis

TMJ pain and symptoms may need to be checked by more than one medical specialist, such as your primary care provider, a dentist, or an ear, nose, and throat (ENT) doctor, depending on your symptoms. Some dentists specialize in TMJ diagnosis and treatment.

A thorough examination may involve:
•  A dental examination to show if you have poor bite alignment
•  An MRI of the jaw area
•  Feeling the joint and connecting muscles for tenderness
•  Pressing around the head for areas that are sensitive or painful
•  Sliding the teeth from side to side
•  Watching, feeling, and listening to the jaw open and shut
•  X-rays to show abnormalities
In some cases, the results of the physical exam may appear normal.

Treatment

Jaw pain may go away with little or no treatment. Treatment may include simple things you can do yourself, such as eating soft foods or applying ice packs. It may also include pain medicines or devices to insert in your mouth. In rare cases, you might need surgery.

Some of the treatment methods are:

Jaw rest: Completely avoiding teeth grinding. Avoiding chewing gum or eating hard, chewy, or crunchy foods such as raw vegetables, candy, or nuts. Eating soft foods that don't require you to chew hard or eating foods that don't require you to open your mouth widely.
Heat and ice therapy: Reduces muscle tension and spasm, and helps relieve pain.
Medications: Muscle relaxant medications may help. Nonsteroidal anti-inflammatory medications (NSAIDs) help reduce swelling (inflammation) in the jaw stemming from arthritis or other causes.
Physical therapy: Mouth exercises like opening and closing the jaw, massage and electrical stimulation can help reduce pain and strengthen the joint.
Stress management: Seeking help with stress management groups, psychological counselling together with medications can also help in reducing muscle tension.
Occlusal therapy: Custom-made devices to insert in your mouth like mouth guards act to balance the bite and reduce or eliminate teeth grinding or clenching.
Correction of bite abnormalities: Your dentist may recommend orthodontics to help re-align your teeth. Dental treatments such as dental restorations, bridges, crowns, etc. may help correct abnormal bites and ensure proper alignment of the teeth.
Surgery: Surgery is recommended as a last resort only when medical therapy has failed. TMJ arthroscopy, ligament tightening, joint restructuring, reconstructive surgery of the jaw (total temporomandibular joint reconstruction), and joint replacement are considered in the most severe cases of joint damage or deterioration.

Cost of treatment

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