TMJ Disorder and Jaw Pain: What You Need to Know

TMJ Disorder and Jaw Pain: What You Need to Know

 

The temporomandibular joint (TMJ) or otherwise commonly known as jaw-joint is a type of joint that connects the lower jaw of our face to the upper skull bone which are located just in front of both the ears. These joints are used while opening and closing of mouth that help us for chewing food, speaking, deglutition and performing various facial expressions.

This joint, which is the most used joints or body parts in the human body, is used up to 2000 times a day on an average. Any disorder or dysfunction appears to be a problematic with the TMJ, commonly known as temporomandibular joint disorder (TMD) in which the muscles, ligaments, intraarticular disc and/or fluid and nerves in and around the joints are affected.

According to the research studies, more than 10 million adults in the United States and more than 25 percent of the total population in our neighboring country India have suffered from some type of TMJ disorder at least once in their lifetime. Very few researches conducted in Nepal including small populations have shown that a significant percentage of the population has already developed some signs and symptoms of TMDs. However, a detailed study has yet to be done nationwide to evaluate accurate prevalence of the disorder among entire population based on various variables.

 

What are the various forms of TMJ disorders?

It can be mainly classified into the following categories:

• Problems within the joint (Intra-articular)
• Muscles involved in and around the joint (Myofascial)
• Infection related (Osteoarthritis)
• Breathing and posture related (Sleep apnea)
• Nerves around associated (Neuropathic & Orofacial Pain)

 

What are the symptoms of TMJ disorder?

The TMD symptoms may vary person to person and are typically seen in and around the joints on one and/or both sides of the face.

• Pain in the joint in front of the ear
• Pain in the jaw or facial bones
• Pain in the face which can radiate to head, neck up-to the arms of the involved side
• Clicking/popping sound in front of ear while opening and closing the mouth
• Difficulty chewing
• Limited mouth opening (locked jaw)
• Wider opening of the jaw than usual (Jaw dislocation)
• Headache, pain in and around the ear and facial muscles
• Ringing sounds in the ears (Tinnitus)
• Pain in the muscles around the joints, ears, teeth and jaw while chewing food, crackling/crepitus sounds and feeling uncomfortable while swallowing food
• Grinding of the teeth while sleeping at night and a feeling of stiffness in the jaw when waking up in the morning (Sleep bruxism)
• Sudden changes in the bite of the lower and upper teeth

Causes of TMJ Disorders:

• Trauma/injury to facial bones/muscles/joints
• Grinding of teeth while sleeping at night
• Improper bite/occlusion of own natural or artificial teeth (prosthesis)
• Hereditary
• Mental stress
• Joint or bone infection (Osteoarthritis)
• Disc displacement within the joint (Internal derangement)
• Condylar hyperplasia and/or joint tumor
• Dental treatment performed with mouth open a long period of time
• Orthodontic/braces treatment following improper protocols

Factors aggravating TMJ disorders:

• Using your teeth as tools (opening bottle caps, biting cloth threads, etc.)
• Habit of chewing pen/pencil, nail & lip biting, chewing gum, etc
• Consuming betel nut, chhurpi, paan, gutkha etc for a long period of time
• Bad/incorrect body posture (it exerts extra or unwanted pressure on neck, arm and facial and jaw muscles)
• Wide opening of mouth while eating (eg; burger, pani-puri etc)
• Unwanted habit of teeth grinding and clenching (bruxism)
• Incorrect sleep position (sleeping usually on prone position)

Treatment:

For the correct identification and diagnosis of this disorder, it is necessary to consult a doctor who has specialized in TMJ and orofacial pain. Various clinical examination and supportive radiological tests are required to understand the jaw joint and surrounding structures.

• X-ray of the face teeth and temporomandibular joints
• CT-scan (to evaluate the bony morphology)
• TMJ-MRI (to evaluate the soft tissue detail in and around the joint)
• Certain blood tests are also required for further evaluation of blood related parameters

The correct treatment of TMJ disorders depend on several factors, including the underlying cause and the severity of the disease. The clinical consequences of TMJ disorder consists of joint pain, joint sounds (TMJ clicking), limited mouth opening, closed-lock and might progress to osteoarthritic changes at late stage of the disease. Majority of affected patients get benefitted with conservative (non-surgical) methods of treatment while a considerable proportion of patients with non-responsive condition after a certain period of time, minimal invasive or open surgical procedures are being advocated.

The hierarchy of treatment protocols dispensed in the following order:

1. Counselling and consultation:

• Ask the patient to avoid wide opening of mouth as much as possible (preferably eating with a spoon or chopstick is recommendable)
• Avoid chewing hard food objects (consuming soft food would exert lesser load into TMJ)
• While yawning, try holding the lower chin against wider mouth opening
• Avoid self-palpating TMJ area and performing jaw movements by opening, closing and side to side sliding.

2. Oral Orthotics: Occlusal devices such as oral splints or occlusal splints help keep the joint in a more comfortable position which reduces the load on the teeth and eventually to the TMJ joints.
3. Physical Therapy: This includes isometric and resistance exercises. It works in myofascial pain conditions to strengthen the muscles and ligaments around the jaw joint.
4. Trigger point and joint injection: Local anesthesia, steroid and botulinum toxin injections are injected as required.
5. Physiotherapy: It includes TENS therapy (to relax facial muscles) and ultrasound therapy (with the help of sound waves, heat is generated in the depth of the joints and muscles to increase blood flow).
6. Behavioral modification: This includes changes and corrections in the patient’s daily physical posture and mental stress, including behavioral modification.
7. Surgery: It can be categorized into two forms; minimal invasive and open surgery.
8. Minimal Invasive surgery:

• Arthrocentesis: In this method, the joint is washed and cleaned from the inside. Medicines are then put inside the joint with the help of a needle as needed.
• Prolotherapy: In this case, the patient’s blood, platelet rich plasma (PRP), dextrose and other form of medicines are placed inside the joint.
• Arthroscopy: This form of surgical procedure is performed inside the joint with the help of arthroscope. It includes a general examination of the joint and surgery of the soft tissues inside the joint. This surgery is done with the help of a camera without making a big incision in and around the joint.

9. Open joint surgery: When the problem of the joint becomes complicated and if none of the methods mentioned above works, opening the joint with incisions made as per need remains only option to deal with the disease. If the joint is completely damaged, the entire joint needs to be replaced with an artificial joint prosthesis.