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Temporomandibular Joint Disease
Also known as TMJ disease
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TMJ disease is also called temporomandibular joint disease and involves pain and or degeneration of the temporomandibular joint in the face. It is the joint that allows for the opening and closing of the jaw during chewing and talking. It sits directly in front of each ear and connects the maxilla and the mandible, or lower jaw. The joint is a ball and socket type of joint that slides along the socket when you need to chew something or talk or open your mouth wide. It slides very far when a person is yawning, which is also the most common time that a person can dislocate the joint. Many muscles and tendons are combined to keep the joint in the right place and moving smoothly.
The TMJ can be identified by putting a finger on the bone just in front of the ear. When the joint is moved in the movement of the face, there is movement of the TMJ joint. If there is pain on palpation of the joint or a grinding sensation on the palpation of the joint, this can indicate TMJ disease.
There are several different TMJ disorders related to dysfunction of either the joint, the muscles or the ligaments around the joint. There are many different causes of TMJ dysfunction that have to be looked into when a person has pain or degeneration of the TMJ joint. Teeth grinding or clenching can increase the wear and tear on the TMJ. If you grind your teeth or suffer from teeth clenching, you may not realize the effect of teeth grinding on the TMJ. If you habitually chew gum or bite your fingernails, you can have TMJ dysfunction.
Misaligned teeth can contribute to TMJ disease. Dental problems that affect the way you chew can put undue pressure on the temporomandibular joint. If you only chew on one side of your face, you can develop TMJ disease. Trauma to the jaw can contribute to damage to the TMJ. This can include old fractures of the face. Stress can really make the TMJ tighten and become damaged. Certain occupational hazards, like holding the phone cockeyed on the face and neck can cause TMJ disorders.
Common TMJ dysfunction symptoms include having spasm of the facial muscles, a headache that may be on one side or on both sides of the head. It is estimated that eighty percent of all those with TMJ disease will complain of a headache. Pain in the ear is also common. Half of all TMJ sufferers have ear pain unassociated with any common ear findings. This is because the TMJ is located so close to the ear. The patient can also hear grinding or popping sounds in the ear because of damage to the TMJ. The medical term for this is called crepitus. Forty percent of all sufferers report a vague dizziness but not a spinning sensation. A third of all patients report the sensation of fullness in the ears or clogged ears. It is usually caused by Eustachian tube dysfunction, which regulates the amount of fluid in the ear. Spasms around the TMJ seem to be precipitating this problem. Another third of patients experience ringing in the ears that has no known relationship to TMJ but goes away when the TMJ is resolved.
In order to diagnose TMJ, doctors or dentists need to do a complete evaluation of those things related to the temporomandibular joint. If there is popping or grinding of the TMJ, this is a sign of TMJ disorders. The teeth may be worn and all the ridges on the teeth can be worn away. Dental x-rays, CT scans and MRI exams can be done to find damage on the TMJ or spasm of the muscles.
The treatment of TMJ diseases includes resting the jaw. It means having the patient chew soft foods, and not chew gum or eat hard or chewy foods. They shouldn't open their mouth widely to eat big foods like hamburgers. This can help the jaw rest and can relieve some of the spasm. Heat alternating with ice to the TMJ also seems to help resolve the symptoms. Heat reduces the spasm and cold seems to help the pain and swelling. Anti-inflammatory medications help a lot to decrease inflammation of the temporomandibular joint. In some cases, local injections of corticosteroids can help reduce the degree of inflammation in the joint. Physical therapy can be used, including massage and electrical stimulation and some people take muscle relaxants like Valium to correct the spasm of the muscles.
Occlusal therapy with an acrylic appliance can be fitted over the teeth at night to balance out the bite and correct teeth grinding. Stress management can work for some people as can dental correction of anomalies of the bite. Surgery to replace the joint or correct damage to the joint are a last resort but are used when nothing else seems to help.