Health
November 20, 2017
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TMD - Facial jaw joint pain

By: George Malkemus
November 10, 2017

Temporomandibular Disorder (TMD) is a condition that causes pain in the jaw joint, known as the temporomandibular joint [TMJ] and the muscles that control jaw movement and chewing. TMD affects an estimated 10 million Americans per year. TMD symptoms can closely resemble the symptoms that cause ear and sinus infections and some headaches and facial nerve pain. TMD pain can range from slight achy discomfort to severe dysfunction with inability to open the mouth. 

The TMJ is the most complicated joint in the body, working as three joints in one. It works as a hinge during opening and closing. It also slides forward and back as well as sliding from side to side. The joint is able to do these involved movements by having the condyle, the rounded end of the lower jaw bone (mandible) move under a disc that acts as a shock absorber between the socket of the temporal bone and the condyle. Ligaments surround the disc, like numerous rubber bands that hold the joint together but allow movement. When the disc becomes out of alignment, or worn out or the ligaments become damaged, TMD can develop. Sometimes the damage can lead to bone on bone relationship and an arthritic joint. 

Symptoms of TMD

The symptoms of TMD will usually involve more than one of the numerous TMJ components: muscles, nerves, tendons, ligaments, bones, connective tissue and the teeth. Referred pain from TMD is common, particularly headaches and earaches. Due to the proximity of the ear to the TMJ, TMD pain can often be confused with ear pain. 

Upon opening and closing, joint sounds and deviations of the jaw are common with TMD. The sounds produced with TMD are usually described as a “click” or a “pop” when a single sound is heard and as “crepitus” when there are multiple, rough, grinding sounds. Pain is the most significant symptom of TMD.

Symptoms associated with TMJ disorders may be:

    * Biting or chewing difficulty or discomfort

    * Clicking, popping, or grating sound when opening or closing the mouth

    * Dull, aching pain in the face

    * Earache (particularly in the morning)

    * Headache (particularly in the morning)

    * Hearing loss

    * Migraine (particularly in the morning)

    * Jaw pain or tenderness of the jaw

    * Reduced ability to open or close the mouth

    * Tinnitus

    * Neck and shoulder pain

Causes of TMD

There are various causes of TMD including:

• Degenerative joint disease, including arthritis, an inflammation of the joints that can affect the jaw joint.

• Bruxism: grinding or clenching of the teeth putting strain on the chewing muscles and the jaw joint. 

• Trauma: injury to the face from sports falls or auto accidents causing a displaced disc, dislocated jaw or fractured jaw.

• Habits that wear or over stretch the TMJ, such as, excessive gum chewing, nail biting or overly large bites of food.

• Genetically abnormal TMJ or jaw structure.

• Constant habit of holding the jaw in an unnatural position, during growth at a young age, particularly holding the jaw in forward position called jaw thrusting.

• Misaligned bite causing strain on the TMJ, often due to dental neglect with decay or missing teeth.

• Orthodontic tooth alignment that misaligns the TMJ.  This was a problem prior to 25 years ago when TMD was unknown.  Now joint position is always considered when moving teeth for bite correction.

Treatment for TMD 

Symptoms of TMD seem to have peaks and valleys like riding a roller coaster. Many times the symptoms resolve themselves and go away within a short period of time, a few days, weeks or months with initial treatment. Initial treatment for acute pain includes: 

1)  High doses of Ibuprofen [2400mg per day] and acetaminophen [3000mg] with lots of water for pain relief and anti-inflammation. Stronger pain relievers can be prescribed if needed.

2)  Alternate use of hot and cold packs on the face every 15 minutes. 

3)  Referral to a physical therapist to use ultrasound, biofeedback and stretching exercises to relax the jaw muscles.

4)  Eating soft foods.

5)  Fabrication of a bite guard or TMJ repositioning stint, similar to a night guard, use for teeth clenching and grinding. A bite guard keeps that natural relaxed space between the teeth and takes the strain off the muscles.  

6) Stress reduction in life style. Keeping a relaxed life style goes a long way in preventing TMD.

Some patients suffer long-term chronic pain. Treatment for chronic pain includes use of long-term pain, anti-inflammatory, or muscle relaxant medications along with physical therapy, wearing a TMJ repositioning stint and stress reduction. Surgical intervention is a last resort treatment; results can be unpredictable.

The most common cause of TMD is muscle pain from bruxism at night, causing facial muscle pain. Treatment with a bite guard used at night is usually successful in about 80 percent of TMD cases. It is important to know that when the jaw muscles are in their relaxed state, there should be space between the teeth. The only time teeth should touch is when chewing. The jaw muscles contract with strong force when closing. Incredible strain can be put on the muscles with grinding and clenching, causing muscle pain and cramping. A mouth guard keeps space between the teeth, so the muscle stays in their relaxed un-contracted position.

 Amazing TMD Cure

Many years ago, I treated a 34-year-old woman who complained of a severe ache in her left jaw joint that radiated pain throughout her entire face when eating. Upon examination, I could see and feel her left TMJ jet out a quarter inch when she closed down with a loud popping sound. All of her teeth fit together well and she had never worn braces. I took a mold of her teeth in her ideal TMJ position, which was vastly different from her existing bite. Our biting position is based on a constant memory of our teeth touching. Without a constant touching of the teeth, the biting position changes to the hinge of the joint. When the teeth biting position is different from the ideal joint position, unnatural forces are put on the joint resulting in pain. Looking closely at her ideal joint position, her teeth were totally misaligned.  Her left row of teeth did not touch at all, having more than a quarter inch gap. I made her a TMJ stint to wear to change her to the ideal jaw position.  

After four days, all her symptoms went away wearing the stint. She wore the stint for two years until it wore out. Due to finances, she did not have braces to move the teeth or purchase a new stint. But she trained her muscles to stay in that position, only chewing on her right side, for her left side was still unable to touch.  Amazingly after two more years in that position, all her teeth moved into a healthy bite. Teeth continue to grow out of the gums (erupt) until they are stopped and balanced by the opposing teeth. Uppers go down and lowers go up until meeting, and the teeth on the left side of her mouth actually erupted until they met, that is, they began to move out of the gums even at 35 years of age!

I surmise that she had a habit she developed very young where she held her jaw to the side and her teeth erupted to fit that position. She is now in her 60s and has never had another problem.

I wish this story was true for everyone, but some people have chronic pain that is never cured.  Luckily treatment is effective for most people. 

      ENJOY LIFE AND KEEP SMILING!

George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ malkemusdds.com.  Visit Dr. Malkemus’ Web site at http://www.malkemusdds.com