TMJ/TMD

The temporomandibular joint (TMJ) plays a significant role in promoting jaw movement. It connects the skull to the jawbone. Each side of the jaw has a temporomandibular joint. You can feel these joints by placing your fingers in front of the ears and opening the mouth. This joint lets you chew, speak, and perform various oral functions. A problem can, however, occur within the TMJ, which can cause discomfort and affect your daily life. Temporomandibular disorders, abbreviated as TMD, are common and can manifest in several ways. The Hawthorne Dentist has experienced dentists who can help you if you have a problem with the temporomandibular joints.

Understanding the Temporomandibular Joints

The temporomandibular joints (TMJ) are two joints that connect a person’s lower jaw to the skull. More specifically, these joints rotate and slide in front of each ear. They constitute the lower jaw and the side and base of the skull or temporal bone. TMJs are among the most complicated joints in the human body. Along with other muscles, these joints allow the mandible to move forward and back, side to side, and up and down.

Smooth muscle actions like swallowing, yawning, talking, and chewing only occur if the mandible and joints are well aligned. You can experience several issues if the temporal bone, jaw bone, muscles, ligaments, and disk are not aligned or synchronized in movement.

Temporomandibular Disorders (TMD)

Temporomandibular disorders (TMDs) can be more than 30 conditions that cause dysfunction and pain in the jaw muscles and joints that control the movement of the jaw. The following are the major categories of TMDs:

• Headaches linked with a TMD
• Disorders of the muscles used for chewing
• Disorders of the joints, including disc disorders

You can suffer one or more of the above conditions simultaneously. Most TMDs are short-lived and heal by themselves. In some situations, however, TMDs can be permanent or become chronic. Additionally, TMDs can arise alone or at the same period as other medical conditions like:

• Irritable bowel syndrome
• Fibromyalgia
• Sleep problems
• Back pain, and
• Headaches

Most adults experience pain in the temporomandibular joint region at some point. Women are more likely to suffer temporomandibular disorders than men, particularly women aged 35 and 44 years.

Causes of TMDs

You can suffer TMDs if your temporomandibular joint or jaw is injured. However, in most situations, the actual cause of TMDs is unknown. Most people’s symptoms begin without apparent reasons. On the other hand, some scientists claim that a combination of psychological and life stressors and genes causes TMDs. Experts also allege that how you perceive pain can play a role in the occurrence of TMD and whether it will be permanent.

The prevalence of TMDs in women has made scientists investigate if the difference in the TMJ structure and mechanics between women and men can play a role. However, there is no relationship between TMDs and bad bites or orthodontic braces.

Sometimes, the primary cause of TMD is excessive strain on the jaw joints and the muscle group that controls speech, swallowing, and chewing. The strain can result from bruxism, a habitual, involuntary grinding or clenching of teeth. However, trauma to the neck, head, and jaw can also cause TMJ. Displacement of the jaw disks and arthritis can also cause TMJ pain.

In some situations, another painful medical condition, like irritable bowel syndrome or fibromyalgia, can overlap with or worsen TMD pain. Studies by the National Institute of Dental and Craniofacial Research revealed that certain factors can put you at higher risk of developing chronic TMD. These include nervous system, genetic, sensory, clinical, and psychological factors.  

The Indicators That You Have TMD

Sounds like popping or clicking without pain in the TMJs is common. This is often normal and does not require you to undergo treatment. However, you could be suffering from TMD if you have the following signs:

• A change in the manner in which the lower and upper teeth fit together
• Dizziness, loss of hearing, and a ringing sound in the ears
• Painful popping, clicking, or grating in the jaw joint when closing or opening the mouth
• Restricted locking or movement of the jaw
• Stiffness in the jaw
• Pain that spreads to the neck, back, shoulder, eyes, and face
• Pain in the jaw joint or chewing muscles
• Persistent headaches
• Tingling sensation and numbness in the fingers
• Sensitivity of the teeth without the presence of an oral health disease

Diagnosis Of TMD

There is no ordinary, standard test to diagnose TMDs because the actual causes and symptoms are unclear. In this case, it can be hard to identify these disorders. A dentist or doctor can investigate the symptoms and develop a detailed medical history. He/she will inquire from you about your pain, including:

• Whether the pain stays in one place or spreads to other parts of the body
• What makes the pain worse or better
• The time the pain arises, and
• The place where you are feeling the pain

Your dentist or doctor will also ask if you experience other pain conditions, like back pain or headaches.

The dentist or doctor will also evaluate your face, neck, head, and jaw for tenderness. He/she will also assess you to determine if you have jaw popping, clicking, or difficulty in joint movement. Usually, your dentist or doctor will book you for imaging exams like a computed tomography (CT) scan, magnetic resonance imaging (MRI), or X-ray. Face, jaw, or mouth pain might be linked to TMDs. Before diagnosing a TMD, your dentist or doctor can rule out other conditions.

Treatment Of TMDs

You should understand the following before undergoing treatment for TMDs:

• Scientists strongly recommend avoiding treatments that cause long-lasting changes to the bite, teeth, or jaw joints or involve surgery. They do this because there is no proof for most TMD treatments.
• TMD signs and symptoms will clear in most individuals without undergoing treatment.
• It is expected to experience sounds in the jaw without pain in the temporomandibular joints. Popping or clicking sounds occur and do not require treatment.

Non-surgical Treatments

A simple treatment can be the best for you because most jaw joint and muscle issues are temporary and do not worsen. Your dentist or doctor can recommend the following when you first experience discomfort in your jaw joints or muscles:

• Avoid behaviors like nail biting, gum chewing, or jaw clenching
• Take over-the-counter medications like ibuprofen, which is a nonsteroidal anti-inflammatory drug (NSAID)
• Application of cold or heat to your face in combination with exercises to gently strengthen and stretch your jaw muscles
• Eat soft foods

Your dentist or doctor can recommend the following treatments if the above remedies do not assist you or your doctor diagnoses a specific TMD in the process of trying them:

Complementary Treatments

A complementary treatment is a non-surgical treatment that works in combination with traditional medicine. Transcutaneous electrical nerve stimulation (TENS) and acupuncture are two complementary treatments that have been studied for TMDs. Acupuncture is a procedure that doctors use to stimulate specific points in a patient’s body by placing thin needles through the skin. Unfortunately, there is no substantial proof that it treats TMDs.

On the other hand, TENS is a device powered by a battery. It uses electrodes inserted into a patient’s skin to create electrical impulses, which can alter how pain is perceived. Some scientists claim that TENS has helped relieve pain in TMDS and improve the ability to open the mouth.

Intraoral Appliances

Intraoral appliances are instruments that are placed over a patient’s teeth. These devices alter the bite or teeth. They are also called bruxism splints, interocclusal splints, occlusal splints, stabilization appliances, or nightguards. However, there is no sufficient proof that they improve TMD pain. You should do the following if your dentist or doctor recommends that you use one:

• Stop using it and seek doctor or dentist advice if it causes pain
• Ensure that it is not meant to alter your bite permanently

Medications

Your dentist or doctor can suggest the following medications to treat your symptoms:

• Prescription medications like opioids, anti-seizure medications, antidepressants, and antianxiety medications
• Over-the-counter medications like nonsteroidal anti-inflammatory drugs (NSAIDs) used to relieve pain

Some of the above medications can cause addiction or have other detrimental effects. Your dentist or doctor should guide you on how to take and for how long if he/she prescribes any of the above medications.

Self-Management And Behavioral Health Approaches

Self-management is the activities a person can do on their own at home. They include:

• Continuously engaging in activities that are meaningful to them
• Setting specific goals associated with managing their condition
• Learning relaxation or meditation techniques
• Learning all he/she can about the particular types of TMD

Some behavioral health methods, especially those provided by psychologists, have been proven to assist in managing TMDs. These include biofeedback and cognitive behavioral therapy. Biofeedback involves sensors monitoring temperature, muscle contraction, heart rate, and breathing. For example, placing a sensor on the patient’s jaw can help detect when he/she tightens their jaw muscles. Cognitive behavioral therapy identifies thought patterns or negative thoughts, changes them, and offers coping skills. A therapist can assist you in learning to identify unwanted behavior and relax.

Physical Therapy

The primary purpose of physical therapy is to bring back, improve, or maintain movement and physical function. Various types of physical therapy are available for you. For example, you can use manual therapy, where your therapist uses their hands to stretch the muscles and soft tissues around the joint. Manual therapy has successfully assisted in improving jaw function and relieving pain.

Surgery and Other Medical and Dental Procedures

The treatments in this section are more complicated. These treatments involve piercing the temporomandibular joints or chewing muscles with a needle or other instrument. It can also include changing a person’s bite or teeth. However, some, like occlusal treatments, might not work and can worsen the problem. You should do the following before undergoing these procedures:

• Seek a second opinion from qualified dental or medical specialists
• Inquire about the risks
• Inquire about the procedure and understand how it will assist you in improving your specific TMD.
• Ask the dentist or doctor to give the details of the procedure in a way you can understand
• Inquire about simple treatments and try them first

Your surgeon will access the temporomandibular joint through open surgery by making an incision next to the ear. Surgery always makes long-lasting changes to the patient’s joint. There is no significant research on the safety of open surgery for TMDs or how it relieves the symptoms. A surgeon can book you for surgery because of the following reasons:

• If you have severe symptoms like pain and difficulty opening your mouth even after you try other treatments
• If your joint is severely damaged and cannot be fixed using other procedures

You should inquire the following from your surgeon if he/she recommends that you undergo surgery:

• Whether there are risks associated with the surgery
• Whether the surgery will be of any help to you
• Whether there are other alternatives apart from surgery
• The reasons behind their recommendation for the surgery

TMJ Implants

Implants are artificial instruments that can be used to replace part of the jaw joint or the whole joint. Currently, the FDA has approved three TMJ implants. Your doctor or dentist can book you for implants because of the following reasons:

• If your doctor or dentist has tried all more straightforward treatments and has failed
• If there is ongoing pain
• If your jaw joint is severely damaged
• If you are suffering from ankylosis because of infection or injury
• If you were born with a condition that needs to be repaired, like a congenital condition
• If you have suffered an injury in the jaw joint

Some dentists claim that TMJ implants can improve function and quality of life if used in specific cases. Implants used long ago were not helpful to the patients because they left many patients with severe complications like permanent damage to the jaw joints. As a result, scientists have embarked on long-term research to investigate the efficacy and safety of the newer TMJ implants. You should seek several doctors’ opinions to understand the risks before surgery, including implant surgery. If possible, you should consult a surgeon who specializes in treating TMDs.

Arthroscopy

During this procedure, a surgeon will insert a device with a tiny video camera into the jaw joint. The tiny video camera will enable the surgeon to see the joint, which can assist in diagnosis. The surgeon can also reposition the joint’s disc or remove adhesions. Arthroscopy works moderately well in reducing pain and improving TMJ joint function.

Arthrocentesis

During arthrocentesis, a surgeon will use a needle to push liquid into the TMJ. The pressure from the liquid eliminates scar-like tissue, also known as adhesions. Additionally, once the liquid is removed from the joint, substances that cause inflammation are eliminated.

This procedure has proved to be best in relieving pain and improving mouth opening in patients whose temporomandibular discs are out of place. Fortunately, these effects do not last long.

Prolotherapy

During prolotherapy, your surgeon will inject a solution into the TMJ area. The solution will cause irritation, and its main purpose is to trigger your body to respond by repairing the joint. Prolotherapy has proven its efficacy for the treatment of TMDs in which the joint has suffered a dislocation. This procedure is also efficient in cases where the joint goes beyond its normal range of movement, also known as hypermobility. However, there is little evidence of this treatment for TMDs.

Botulinum Toxin

Botulinum toxin type A’s main purpose is to enhance muscle relaxation. The FDA has approved it for some medical conditions, like migraines, but not for TMDs. Some scientists claim that injecting botulinum toxin type A into the chewing muscles can reduce pain and stop muscle spasms. Unfortunately, the allegations do not substantiate whether this treatment can relieve TMD symptoms.

Occlusal Treatments

Occlusion means the fitting together of the teeth. Most people believe that TMDs cause misaligned teeth. There is, however, no proof to support this belief. Occlusal treatments can change the teeth and bite. Examples are:

• Using orthodontic treatment to modify the position of all or some teeth
• Grinding down the teeth
• Putting crowns on the teeth

Home Treatments Of TMD

You can relieve TMD symptoms by doing certain things on your own. Your dentist or doctor can recommend the following remedies for you:

Avoid Extreme Jaw Movements

TMD can be treated by minimizing regular yawning and chewing, mainly by consuming less gum or other food items that require prolonged chewing. You should also avoid singing, yelling, or doing anything that makes you open your mouth wide.

Avoid Using Your Teeth As Tools

You should avoid using your teeth to open soda bottle tops and ripping tags off of clothing.

Changing Your Behaviors

You need to change your posture. TMJ can get worse if you sleep on your stomach regularly, and a poor sitting posture at work can also worsen TMJ pain.

Avoid Chewing Certain Items

You should avoid chewing gum, ice, pencils, or pens.

Learn Relaxation Techniques

Learning relaxation techniques will help you loosen your jaw. Consult your doctor or dentist about whether you require massage or physical therapy. You can also consider biofeedback and stress reduction therapy.

Keeping Your Teeth Slightly Apart

You should try to keep your teeth slightly apart regularly because this helps to relieve pressure on the jaw. By putting your tongue between the teeth during the day, you can avoid clenching or grinding your teeth.

Avoid Resting Your Chin On Your Hand

Avoid holding your phone between your ear and shoulder. Practice good posture to reduce facial and neck pain.

Eat Soft Foods

You should include the following on your menu:

• Grains
• Beans
• Cooked fruits and vegetables
• Fish
• Scrambled eggs
• Soup
• Cottage cheese
• Mashed potatoes, and
• Yogurt

Cut foods into tiny pieces for easier chewing. Avoid the following foods:

• Hard and crunchy foods like pretzels and raw carrots
• Chewy foods like taffy and caramels
• Thick or large bites that require a person to open their mouth widely

Use Moist Heat or Cold Packs

Place an ice pack on the side of your face and temple region for a period that does not exceed ten minutes. If your physical therapist or dentist allows you to, you can also engage in simple jaw stretches. Hold a washcloth or a warm towel to the side of your face for at least five minutes after the simple stretches. Continue doing this several times each day.

Take Over-The-Counter Medications

You can relieve muscle pain and swelling by using nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen or ibuprofen.

Visible Changes In A Person’s Life After TMJ Treatment

Some of the key ways TMJ treatment can enhance your quality of life include the following:

Enhanced Facial Appearance

In some situations, TMJ disorder can cause facial asymmetry or a misaligned jaw line. TMJ treatment can correct these problems, creating a more pleasing look. The positive change in a person’s facial structure can enhance their self-esteem and confidence.

Reduced Inflammation And Pain Relief

One of the most noticeable benefits of TMJ treatment is reducing inflammation around a patient’s jaw joint. Reduced swelling can significantly reduce discomfort and pain, making activities like smiling, talking, and chewing easier.

Increased Energy Levels

Disrupted sleep and chronic pain can leave you feeling sluggish and drained. You will experience an increased energy level with TMJ treatment because you can manage your symptoms effectively.

Find a Competent Dentist Near Me

Suffering a temporomandibular disorder can be an agonizing experience due to the pain or discomfort that accompanies it. If you or your loved one suffers from TMJ/TMD, you should seek immediate medical attention from an experienced dentist. At The Hawthorne Dentist, we have competent dentists experienced in handling TMD/TMJ disorders. We take pride in being the go-to dentists for various dental conditions, including TMD. Despite offering quality dental services, we do not overcharge our clients. Contact us today at 310-775-2557 to speak to one of our dentists.