Temporomandibular Joint Dysfunction

Temporomandibular joint dysfunction (TMJ) is a very complex problem that has many different symptoms.  Your temporomandibular joints connect your jaw bone to your skull.  TMJ occurs when these joints become worn or displaced. This may occur because of an abnormal bite (misaligned upper and lower teeth), bruxism (teeth grinding), arthritis, poor posture, prior injury to the jaw, or chronic jaw muscle tension.  People who suffer from TMJ typically experience clicking or popping sensations in their jaw, jaw pain, or an inability to fully open their mouth.

The most difficult part of identifying and managing TMJ is that TMJ may present as one or more painful syndromes which may be confused with other medical disorders.  TMJ dysfunction can cause headaches, pain behind your eyes mimicking sinus disease, dizziness, earaches, ringing in your ears, neck pain, shoulder pain, back pain, and even tingling sensations in your hands and fingers.  As you could imagine, TMJ is often not recognized and then not treated because it can imitate so many other medical problems.  It is not uncommon to search for years, being evaluated by many physicians before TMJ is identified as the cause of your problems. 

Once identified, however, physicians and dentists have many available treatment options. One must realize that TMJ is a complex disease and no single treatment is effective.  TMJ  is best treated by a team of health professionals who work together in providing specific treatment related to their special areas of expertise.  In addition, expect treatment for TMJ to take time to be maximally effective.  The goals of  therapy for TMJ  will include realigning your upper and lower jaws, reducing bruxism if it exists, and most importantly, teaching you how to rest and relax your jaw muscles.  Below are some examples of how to relieve the symptoms of TMJ:

1.  Learn to relax.  This is the cornerstone of TMJ therapy.  You need to relax your facial muscles in order to reduce the tension in your jaw joints.

2.  Rest your jaw.  This is carried out by keeping your upper and lower teeth apart.  By keeping your teeth separated,  you will prevent clenching and grinding of your teeth.  Opening your mouth will also help you to be aware of relaxing your jaw muscles.  Allow yourself only to close your mouth for speaking and eating.  In addition, eat soft foods which do not require alot of chewing.  This is a temporary measure during painful and treatment periods.

3.  Learn to wind down a few hours before sleep.  Stress and worry prevent you from becoming relaxed before you fall asleep, typically worsening facial muscle tension and bruxism if it exists.  Concentrate on relaxing, pleasant thoughts or of peaceful imagery.  Bedtime rituals such as reading an enjoyable book, taking a warm bath or listening to soft music can be helpful.
 
4.  Do not plan your next day when attempting to fall asleep.  Set aside time during the day to deal with worrisome thoughts.

5.  Avoid worrying about daily problems.  Set time aside during your day to review your activities and stresses for that day.  If possible, talk about some of your stresses and problems with another person as a means to work through these problems and help relieve your tensions.

6.  Develop a good posture.  This includes both sitting with your head and back straight, and standing erect with your shoulders squared and head upright (not slouched).  You may consider putting a rolled towel or back support behind your lower back when sitting.

7.  Apply ice and heat therapies.  Application of moist warm towels directly to your jaw joints (5-15 minutes), followed by cold or ice applications (a few minutes), and then repeating this combination 2-5 times per day can help reduce jaw pain and tension.

8.  Perform jaw exercises.  Once the pain of TMJ improves you may perform joint exercises by gently opening and closing your jaw, making sure your teeth come together smoothly.

9.  Discuss any symptoms you may have with your dentist or physician.  As previously noted, TMJ is often misdiagnosed and needs to be identified for effective treatment.  Your physician or dentist may recommend one or more of the following therapies:

  • Splint therapy - fitted oral device which can reduce jaw clenching and teeth grinding, and also can help align your upper and lower jaws.
  • Orthodontic (braces) device - Adjusts teeth to align your upper and lower jaws.
  • Restorative dental work - Shape teeth for proper jaw closure, may involve making a  bridge, reducing teeth sizes or increasing teeth sizes by making crowns.
  • Physical therapy - Jaw exercise and postural training.
  • Pain therapies - Electrical stimulation or ultrasound therapy.
  • Relaxation therapy or biofeedback - This therapy will assist you in face and jaw muscle relaxation.
  • Surgery - Used for the more severe cases in which other measures would not be effective.