TMJ Disorders and Treatments

The temporomandibular joint connects the mandible (lower jawbone) to the temporal bone of the skull in front of the ear (Fig.). Within the joint formed by these two bones, there is a tiny disc of cartilage. The masseter and temporal muscles provide power to the joint, making it one of the most used joints in the body. The temporomandibular joint is responsible for all the movements of the jaw, including chewing, swallowing, breathing, and talking.

Disorders
The causes of temporomandibular joint syndrome (TMJ) are the same as for any other joint in the body. Arthritis, cartilage damage, dislocation, and injury are all possible sources of pain and dysfunction. The muscles that move the joint are also subject to fatigue, injury, and disease. Minor to severe and incapacitating pain can arise from the joint, the muscles, or both. Symptoms range from clicking or popping of the jaw, to headaches, facial pain, neck pain and stiffness, or a "locked" jaw. Some patients experience symptoms for many years and have no apparent loss of function, however, others slowly get worse and require treatment.

The causes of TMJ disorders are varied and can be difficult to determine. For patients who experience TMJ disorders due to an injury and trauma, it is clear that an injury has occurred, however, the injury does not always directly involve the joint. For example, a car accident that causes a whiplash injury to the head and neck can injure the temporomandibular joint. Aging can also affect the joint. One-third of the population over the age of 50 has signs of osteoarthritis in their joints, including the temporomandibular joint. Oral habits, however, are often the culprit for patients younger than 50. These patients usually discover the cause of their problem by examining their oral habits. Tongue thrusting, wide yawning, nail biting, gum chewing, or teeth grinding and clenching, are a few of the activities that place the jaw in an abnormal position and cause unnecessary wear and tear on the structures of the temporomandibular joint. The habitual action of the temporomandibular joint causes the same wear and tear injuries that are often seen in many active people, especially competitive athletes who damage joints with repetitive movements. TMJ syndrome can also be associated with bite problems, jaw alignment, tooth problems, and stress.

Treatment
The treatment options for patients with TMJ syndrome are varied and sometimes controversial. The first area of controversy is whether the condition is medical or dental in nature. This issue is even a topic of discussion with insurance companies. Dentists and oral surgeons provide patients with a good course of treatment, but ear, nose and throat physicians (otolaryngologists) also offer excellent TMJ treatment plans.

Treatment for TMJ syndrome is most successful when the symptoms are recognized early and treatment is sought quickly. The longer you wait to seek treatment, the longer it will take to resolve the problem. This is especially true if your jaw becomes disabled due to the dysfunction of the joint. Often, a health care provider can recommend a conservative treatment plan that may include resting the muscles of the jaw by eating soft foods and avoiding foods that require the jaw to open wide, such as corn on the cob, large sandwiches, or apples. You may be told to stop chewing gum, nail biting, and clenching or tensing the jaw. Treatments may also include applying moist heat to relax the muscles of the jaw for 30 minutes, twice a day or applying ice for 20 minutes, twice a day to reduce inflammation and soreness in the muscles of the jaw.

Your physician or dentist may try a variety of treatment options, including medication or prescribing an occlusal splint that allows the TMJ to improve while preventing additional wear and tear on the joint. Surgery to improve the alignment of the upper and lower teeth is an option, but it is usually reserved for advanced cases and when no other treatment plan has worked. Disorders of the TMJ are treatable and often can be resolved with heat and ice applications, a soft diet, anti-inflammatory medications, and changing a few habits.

Bruce Getz, ATC
Columbus, Georgia