TMJ Problem?

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The TMJ or Temporal-Mandibular Joint (the jaw joint) is a very complicated area and much has been written about it, both on the internet and in print. TMJ therapy and treatment is a very controversial area and you can only believe a small portion of what you hear or read.Because this area is so controversial and complex I will try to simplify it. Some 'authorities' might disagree with me over my simplification, but it will help you understand the jaw joint better. There are two broad categories of jaw pain: that caused by muscles and that caused by bone or cartilage problems. In general, muscle pain is the more common and more easily treated of the two categories.

Most jaw pain of muscular origin is caused from overuse of the jaw and the muscles. Just as the muscles in your arm or back get tired and sore if you over work them, the muscles of your jaw joint will do the same. However the difference between TMJ pain and other muscle pain is that TMJ pain is often referred. That is, your brain doesn't know how to tell you that the muscles inside you skull hurt and so it refers that pain to other areas of your face and neck. People with this kind of pain often say that their whole face hurts or their ear hurts. Some people say that it feels like a band around their head. Another common complaint is that people will have trouble opening their jaw or their jaw will lock closed. People with this kind of pain will often admit to a period of high stress or to habits like gum chewing or clenching their teeth. Frequently there will be evidence of tooth grinding, (some people don't grind, they just clench (clenching won't wear the teeth and won't produce the telltale noise as is often described by the patient's spouse: "I can hear him grinding his teeth at night").

Treatment for TMJ pain of muscle origin is often accomplished with a bite guard or night splint. Sometimes ice packs and /or anti-inflammatory medications are also used. Although the style for the bite guard varies from dentist to dentist, it is generally a horseshoe shaped wafer of plastic that is worn over the upper or lower teeth.

Generally the plastic is a hard plastic, not soft like a football mouth guard, although even this is controversial. I was taught that hard plastic was best, and that people tend to "bounce" on a soft splint, which will exacerbate their muscle problem. Some dentists do use a soft splint, however. The theory behind the bite splint is two fold. First it distributes the stress of the clenching over a wider area of teeth. You can't just grind on one spot or find a particular tooth to clench on. Secondly, and I think more importantly, is that the splint opens the muscle beyond its working length. We all know that when we are picking something up, we are stronger when our arm is partially bent then if the arm is completely extended. That is because muscles have a "working length" at which they are most efficient. Just as your arm muscles have an optimum working length, so do your jaw muscles. If you open them up beyond that working length, then they can't exert as much force. So by wearing the bite splint you allow the muscles to rest or at least, not to work as hard.

For most people, the bite splint is best worn at night. It's hard to speak with it in and it is visible in a patient's mouth, so most people don't want to wear it during the day. However, for patients with severe muscle spasms or for people whose daily activities allow it, the splint can be worn during the day. Some persons grind their teeth while they work at their computers. Some who travel a lot grind and clench while they drive or fly to their meetings. Some people clench while they study. For these people, it may be helpful to wear the splint during these occasions.

Be sure not to try and bypass your dentist and go out and by a football mouth guard to wear to bed. It probably won't work and it could severely damage your jaw joint. It is very important that the bite is balanced on the splint. A soft mouth guard from the store can't be adjusted to match your bite. Your back teeth will probably hit first and that could allow you to set up a lever in your mouth, with the back teeth as a fulcrum, and cause you to "lever" your jaw joint out of position.

Sometimes people who have this pain develop a pattern of discomfort that could be described as "chronic pain syndrome". These people have major, debilitating pain that doesn't respond well to normal conservative therapy. They should receive treatment at a chronic pain clinic, especially one associated with a major university. Often the treatment is multi-disciplinary, involving physicians, dentists and psychiatrists. The treatment might take many months or years and can involve treatment with stronger pain medications or anti-inflammatory medicines, muscle relaxants and antidepressants. (The relationship between antidepressant medications and chronic pain is just being investigated and is not well understood, it is not necessarily related to clinical depression, but perhaps linked to levels of certain neurotransmitters in the brain.)

The other category of jaw pain is caused by bone or cartilage problems. Sometimes arthritis can make the joint stiff and sore just as other joints in your body can be affected by arthritis. Bone spurs in the joint can cause locking and pain. But most of the problems related to bones and cartilage is related to the cartilage disc that is present between the bones of the joint. If the bones put pressure on the disc or if the disc is forced or slips out of position, then the jaw can't function correctly.

Many people have clicks or popping noises in their jaw. I was taught that most people tolerate these noises well and if it is just noise and not pain or restriction of motion, then it is probably best not to treat the noise. Other people disagree with this statement and think that any noise should not be tolerated. Just be sure that if you have treatment for jaw noise, you have a reasonable assurance that the treatment will be safe and effective.

This treatment of a misplaced disc is the most controversial area of all. Some people claim to be able to treat it effectively, some people say it can't be cured, it can only be treated, some people say that it can't even be treated very effectively. If you have this kind of a problem, be sure that you receive treatment form someone who really knows what they are doing. I think one of the best avenues for treatment is through a major university. Be sure that unless you have exhausted all other means of treatment, you don't allow any non-reversible treatments to be done on you.

Some people will treat these problems through full mouth rehabilitation. This means that most, if not all, of the teeth are crowned or capped. This can work if the diagnosis is correct and if the person doing it is skilled and meticulous about the dentistry. But it must only be done after careful diagnosis of the problem. It frequently is done in such a manner that until the dentist knows it is going to work it is reversible. For instance, the dentist might place temporaries or a temporary splint in place first in order to see if full mouth reconstruction is going to solve the problem or make it worse.

Let me restate a few points: this area is a complicated and controversial one. If the pain is severe or long lasting, think about a referral to a university setting or a pain clinic. Get a second opinion if you are confused or unsure of the diagnosis. And most of all, try to use treatments that are non-invasive and reversible (like bite splint therapy).