Temporomandibular Joint Dysfunction (TMJ) has become an increasingly common complaint in general, otherwise healthy, populations. Symptoms of TMJ dysfunction can appear with no obvious underlying cause, or they can occur because of clear trauma such as a car accident or injury.
Symptoms may include:
- Pain in the face, ears and jaw
- Ears that feel muffled or clogged
- Pain when chewing/moving jaw
- Dental pain/worn or chipped teeth
- Neck, back, shoulder, and/or chest pain
- Jaw clicking (popping/snapping) when chewing or yawning
- Jaw locking / change in bite
The number, type and severity of symptoms range from person to person and can change over time.
The temporomandibular joint connects the lower jaw, called mandible, to the temporal bone at each side of the head. Because these joints are flexible, they allow motion in all three planes when working properly. The jaw can move smoothly up and down, side to side and foreword to backward. This free motion allows us to talk, chew, and yawn without pain. Muscles of the jaw and face attach to and surround the jaw joint (TMJ) control its position and movement. If there are conditions in this musculature that affects the balance between the muscles, the symptoms of TMJ dysfunction will result. Other factors that may cause TMJ dysfunction include:
- Severe injury to the jaw or TMJ
- Arthritis in the TMJ
- Malocclusion (offset of the bite)
- Orthodontic treatments ( braces)
- Increased stress especially the kind that leads to clenching/grinding one’s teeth at night
Diagnosis is best made by a practitioner familiar with the condition with training in this area. Dentists often are the first to hear of the symptom from their patients and initiate care. If trauma was the cause of TMJ dysfunction, x-rays of the TMJ mandible of facial bones may be required. A history of the previously mentioned symptoms and then a hands-on physical exam is usually enough to make the correct diagnosis.
As most TMJ problems are not involved with severe degenerative changes in the TMJ itself, but are involved with the musculature and soft-tissue structures around the joint, conservative strategies that are focused on these structures are best.
Self-care practices such as- choosing soft food, no gum-chewing, avoiding extreme jaw movements (such as wide yawning, loud singing) and applying local heat or cool packs -can be quite helpful in diminishing TMJ symptoms. Also learning special relaxation techniques and reducing stress may help those with TMJ pain. Medications including muscle relaxants, anti-inflammatories, and mild sedatives may help.
If initial conservative care strategies are not effective, the next step may be the use of a bite splint. This may be helpful as it reduces night-time clenching and grinding, allowing the jaw musculature to relax and heal. Other modalities of care include injections of medication into painful muscle sites, often called “trigger point”. This therapy is not for everyone but can be very effective. Another reliable option that has been very effective is Intramuscular Stimulation (IMS). This well established modality of treatment can help relax and reset the jaw musculature that few modalities can compare. It also has the ability to decrease local inflammation, improving blood flow. The concept of energy balancing in its flow through the body is also involved as an added benefit. Most of our patients respond to the first treatment and usually require 6 to 8 regular visits with maintenance visits on an as needed basis thereafter.
Prolotherapy treatment can also be quite effective especially if the TMJ joint is arthritic or has imaging evidence of degenerative changes.