Complete Health Dentistry

Sellwood-Moreland and Portland OR

TMJ and Whole Health Dentistry

Temporomandibular Joint and muscle disorders—frequently shortened to TMJ—refer to inflammation and tightness of the temporal-mandibular joint that connects the jaw to the skull.

Specifically it means: temporal, as in temple area of skull; mandibular as in mandible, or lower jaw; and joint as in it’s where the head and jaw meet. Aside from the two jawbones that meet at this juncture, five muscles and cartilage support the mandibular joint.

The temporomandibular joint is unique in its action. The combination of hinge and sliding motions, and tissues unique to the joint makes the entire structure and mechanism among the most complicated in the body. When you open your mouth, the rounded ends of the lower jaw—called condyles—glide along the joint socket of the temporal bone. The condyles then slide back to their original position when the mouth is closed. A soft disc lies between the condyle and the temporal bone and is designed to keep this motion smooth. It also absorbs shocks to the jaw joint from chewing and other movements.

Because of its complex movement and unique design, the jaw joint and its controlling muscles can pose a tremendous challenge to diagnoses and treatment.

TMJ can develop from injury, impact or excess strain on the mandibular joint. Some of these include teeth clenching or grinding, habitual gum chewing, and/or misalignment of the teeth or jaw. When TMJ is particularly severe it can cause significant pain in the jaw joint. It can also cause headaches, earaches, and accompanying pain in the facial neck or shoulder muscles.

Symptoms

For many people, TMJ symptoms seem to start without obvious reason. It often becomes apparent when it limits your ability to open your mouth completely, and is accompanied by a clicking, popping or snapping noise when the mouth is opened or closed. The jaw may get stuck in either position as well. But jaw clicking alone, without pain or limited jaw movement, doesn’t necessarily indicate TMJ disorder or an immediate need for treatment.

Pain, particularly in the chewing muscles and/or jaw joint, is the most common symptom.

Other likely symptoms include:

  • Radiating pain in the face, jaw, or neck,
  • Jaw muscle stiffness,
  • Limited movement or locking of the jaw,
  • Painful clicking, popping or grating in the jaw joint when opening or closing the mouth,
  • A change in the way the upper and lower teeth fit together.

Diagnosing the TMJ Disorders

Identifying TMJ can be difficult and confusing since the exact cause and symptoms are elusive. Symptoms worsen and ease over time, but what causes these changes is not known. Many people experience relatively mild forms of the disorder with symptoms that improve significantly, or disappear spontaneously, within weeks or months. For others, the condition causes long-term, persistent and debilitating pain. Sometimes, the symptoms are so similar it’s hard to diagnosis the disorder or whether it’s just a contributing disorder.

Bruxism and TMJ, for example, can produce very similar symptoms. Bruxism is a paroxysmal disorder that’s characterized by the clenching or grinding of teeth. It’s an involuntary action that primarily occurs at night, but may also occur during the day.

Most people grind or clench their teeth occasionally. But habitual teeth grinding and teeth clenching, especially that occurs at night, can be particularly damaging to oral health. Teeth clenching involves an involuntary tightening of the jaw, which consequently exerts a large force between the upper and lower teeth, while also straining the jaw muscles. The excessive pressure can lead to TMJ. Grinding, on the other hand, involves repeated forceful rubbing together of the upper and lower teeth. It can flatten out the natural grooves of the tooth, thereby weakening the tooth as a whole, and potentially causing tooth loss. Like clenching, teeth grinding may also cause headaches and stiffness and pain in the jaw.

In either case, the constant grinding and clenching of bruxism wears down the surface of teeth, and leads to the loss of teeth structure. It can also expose gum tissue, which leads to tooth sensitivity. As the problem progresses and more teeth surface is lost, the bite collapses, and the temporomandibular joint can get damaged. This leads to symptoms like pain, aching muscles, and an inability to move the mouth effectively that may easily be mistaken for TMJ. Since they’re different conditions, they’re treated differently.

Treatment

The frontline treatment for bruxism is a mouth guard. It can help minimize the tremendous amount of pressure that can be exerted on the upper and lower jaw, and helps provide a protective barrier between the upper teeth and lower teeth, thus reducing the chance of tooth damage.

Since there are no standard tests available to definitively diagnose TMJ disorders, Whole Health Dentistry takes a cautious and careful approach to treatment. Your dentist will note your symptoms, take a detailed medical and dental history, and examine problem areas, including the head, neck, face, and jaw. In severe cases, imagingstudies may be recommended.

Facial pain can be a symptom of many other conditions, including sinus or ear infections, various types of headaches, and facial neuralgias (nerve-related facial pain). Arthritis may also affect the temporomandibular joint as a secondary condition.Further complicating diagnosis, you may have one or more of these conditions at the same time.

If it’s determined that the issue extends beyond oral cavity, you may also need to consult a physician. For example, arthritis, diet and sleep disorders can also contribute to jaw strain. Ruling out or factoring in these issues can help more accurately diagnose TMJ disorders.

More research is needed into the safety and effectiveness of most treatments for jaw joint and muscle disorders, so experts strongly recommend using the most conservative, reversible treatments possible. No long-term clinical trials have been done to study the safety and effectiveness of surgical treatments for TMJ disorders.

Minimally invasive treatments are usually the first course of treatment. Even when TMJ disorders have become persistent, the best course of treatment will be minimally invasive.

It may include adjusting your bite, replacing missing teeth, or filling gaps between teeth. A mouth guard may also be advised to help prevent any clenching or grinding that’s contributing to the problem.

Mouth or bite guards may also be used for treating TMJ disorders, but function differently from those used for bruxism. TMJ guards, also called stabilization splints, are made of rigid acrylic material. They help raise the bite and reposition the jaw to a position that helps relieve symptoms and discomfort. Typically, they’re used only for a short time and won’t cause permanent changes in your bite.Your Whole Health Dentistry dentist may need to make multiple adjustments in order to achieve the most effective position.

The National Institute of Dental and Craniofacial Research (NIDCR), one of the National Institutes of Health (NIH), has started a federal research effort to better understand the pain associated with temporomandibular joint and muscle disorders. Research is alsounderway to grow human tissue in the laboratory to replace damaged cartilage in the jaw joint. Additional research is also studying ways to developing safer, more life-like materials to be used for repairing or replacing diseased temporomandibular joints, discs, and chewingmuscles.

In the meantime, keep in mind that for most people, TMJ disorders typically eventually go away on their own.