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TMJ Disorder and Treatments

Jessica Majewski DMD > News > Uncategorized > TMJ Disorder and Treatments

TMJ or TMJ Disorder is a very common problem amongst our patients. A typical sign of TMJ Disorder is a patient will complain of jaw and muscle tenderness. Some describe headaches that radiate up to the head. Others even feel generalized discomfort in their teeth as the pain radiates. It can be difficult to diagnose and treat, and most treatment is palliative.

What is TMJ?

TMJ actually stands for temporomandibular joint and we have two of them on either side of the head. It is the joints and muscles that connect your lower jaw to your head. The TMJ allows the mouth to open and close. It allows for proper chewing and speaking as it brings your teeth together.

Each TMJ has a disc between the ball and socket. The disc cushions the load while allowing the jaw to open wide, rotate, and glide. Any problem that prevents this complex system of muscles, ligaments, discs and bones from working properly may result in a painful TMJ disorder.

What causes TMJ Disorders?

There are many contributing factors that could cause TMJ disorders/pain. A few include:

  • arthritis
  • dislocation
  • injury
  • tooth and jaw alignment
  • stress and teeth grinding

The most common one we see day to day is due to stress and teeth grinding. This can happen at night when we are unaware of it occurring or during the day. Also called bruxism, the grinding and clenching of our teeth causes more loading and more forces on our TMJs, the jaw joints. This can then manifest as headaches, joint and muscle tenderness in the face, head and neck, and, if there are excessive forces, damage to the teeth and bones that support the teeth.

Signs and Symptoms of Teeth Grinding We Look For

When a patient comes in and complains of jaw and muscle tenderness or headaches we first do a thorough exam of the head, neck, mouth and teeth. We are checking for actual sore muscle spots or knots like you can get in the muscles of your back and neck.

We also check for wear marks on your teeth. This is a very common and noticeable sign that teeth grinding is occurring. The wear marks have a characteristic look and the teeth are indented. If the wear marks are very deep we can sometimes see the underlying dentin of the tooth which can be very sensitive. If grinding is very severe sometimes the actual nerve of the tooth is exposed which will usually result in very sensitive teeth to cold and hot.

Excessive grinding can cause teeth to fracture or break. If a tooth has fillings or a crown these can also break. We look for any fracture lines in teeth that are very worn or sensitive. We also check the health of the gums and bone around the teeth. Excessive forces from grinding can cause bone to be damaged. Teeth can become loose if the force is great enough.

Another sign is a tongue with many grooves on the sides of the tongue. Clenching will cause the tongue to squeeze between the spaces of the teeth and a pattern will result on the tongue.

How to Treat TMJ Disorders From Teeth Grinding

If we determine the cause of the joint and  muscle tenderness is from excessive grinding we usually recommend a night guard be worn. We take customized impressions and fabricate a plastic night guard that is worn over the teeth. This helps 1) protect the teeth from further damage and 2) acts as a cushion so the joint is not receiving too much force when we grind.

If there are underlying problems like arthritis or the joint disc fuses we recommend many disciplines getting involved and treat the TMJ disorders. Arthritis or fusion of the joints will need many doctors involved such as primary care physicians, rheumatologists, oral surgeons, ENT, etc.

Acute TMJ Pain

Many time we have patients wake up one morning after a stressful day and are in excruciating pain due to stress teeth grinding and clenching. While there is no definitive treatment we can render there are some palliative treatments or pain relief mechanisms we recommend.

What can I do to ease the pain?

There are many things you can do to help your pain get better. When you have pain:

  • Eat soft foods and stay away from chewy foods (for example, taffy)
  • Try to use both sides of your mouth to chew
  • Don’t chew gum
  • Don’t open your mouth wide (for example, during yawning or singing)
  • Don’t bite your cheeks or fingernails
  • Lower your amount of stress and worry
  • Applying a warm, damp washcloth to the joint may help.
  • Over-the-counter pain medicines such as ibuprofen (one brand: Advil) or acetaminophen (one brand: Tylenol) might also help. Do not use these medicines if you are allergic to them or if your doctor told you not to use them.

TMJ Exercises to help relieve pain:

  1.    Resisted mouth opening: Place your fist under your chin and open your mouth slowly, while pushing up gently on your chin with your thumb. You want to apply resistance with your fist. Hold for three to six seconds and then close your mouth slowly.
  2.    Resisted mouth closing: Place your thumbs under your chin and your two index fingers on the ridge between your mouth and the bottom of your chin. Push down gently on your chin as you close your mouth.
  3.    Tongue up: Slowly open and close your mouth while touching the roof of your mouth with your tongue.
  4.    Side-to-side jaw movement: Place an object about .25” thick (for example, two tongue depressors) between your front teeth. Slowly move your jaw from side to side. Increase the thickness of the object as the exercise becomes easier.
  5.    Forward jaw movement: Place an object about .25” thick between your front teeth and move your bottom jaw forward so that the bottom teeth are in front of the top teeth. Increase the thickness of the object as the exercise becomes easier.

The TMJs are very intricate joints in our head, and they can be difficult to treat once aggravated or damaged. You should always see your dentist if you think you suffer from any of the signs and symptoms discussed. If the problem is determined early, there are many dental and physical issues that can be prevented.