Temporomandibular Disorders (TMD)

Overview

Temporomandibular disorders (TMD) is a common ailment. It is estimated that more than 10 million Americans experience TMD symptoms at one time or another. A majority of these people are women between the ages of 20 and 40 years old. Temporomandibular DisordersThe good news is that for most TMD sufferers, symptoms usually do not mean they have a serious, long-term problem. In fact, with or without treatment, most people do get better.

TMD is not just one specific problem. It is a group of conditions that affect the jaw joint, also known as the temporomandibular joint or TMJ, and/or the muscles that control chewing and moving the jaw. The TMJ is like a ball and socket. When you open your mouth, the ball, or condyle, moves out of the joint socket. When you close your mouth, the ball slides smoothly back in place. A soft cushion, or disc, lies between the ball and socket to prevent them from rubbing and to absorb shocks from movements like chewing. Holding all this together are muscles that stretch from the top of the skull to the lower jaw. Usually the muscles that help close the jaw are the ones affected by TMD.

The TMJ allows us to open and close our mouths and move our jaws from side to side and backward and forward. As a result, we can talk, yawn, chew and swallow. You can feel your jaw joint or TMJ by placing fingers on each side of your face in front of your ears. Now open and close your mouth. You should feel the condyle moving in and out of the socket.

Symptoms

TMD can cause many different types of symptoms. The most common symptom of TMD is pain or discomfort in the jaw joint or chewing muscles. Other symptoms may include:

  1. Popping, clicking or grating noises when the jaw opens and closes
  2. The inability to open the mouth very wide
  3. Lockjaw
  4. Pain in the face, neck and shoulders
  5. A tired feeling in the face
  6. Sudden uncomfortable bite, as if the upper and lower teeth aren’t fitting together right
  7. Swelling on the side of the face

Some people also experience earaches, toothaches, headaches, ringing in the ears, dizziness and hearing problems.

Possible Causes

Experts are unsure about what causes TMD. However, many think it can be the result of:

  1. Injury to the jaw, chin or TMJ as a result of a car accident, fight or fall. It is also possible to injure the jaw by opening the mouth too wide, like when trying to bite into a huge sandwich.
  2. Grinding or clenching the teeth, which puts a lot of pressure on the TMJ.
  3. Stress, which causes a person to tighten facial and jaw muscles or clench his or her teeth.
  4. Dislocation of the soft cushion or disc between the ball and socket.
  5. Arthritis, such as osteoarthritis or rheumatoid arthritis, which can result from injury.

Treatment

Most TMD problems are temporary and do not get worse; simple treatment may be all that is needed to relieve discomfort. Simple self-care practices are often effective in easing TMD symptoms. Acute pain following trauma can be treated and cured. Chronic pain, where tissue damage occurred long ago, can be managed.

Simple Self-care Techniques include:

  1. Diet
  • Eating SOFT FOODS like soups, milkshakes, eggs, etc. This is to relieve the load on the joint and to cause less muscle activity.
  • AVOID hard and chewy foods (ie French bread, bagels, steak, candy, jerky, etc). Cut fruits into small pieces and steam vegetables.
  • Chew with our back teeth rather than biting with your front teeth. DON’T TAKE BIG BITES or open your mouth any wider than 1-2 inches. Don’t eat any foods that require prolonged chewing.
  • If you chew only on one side of your mouth you concentrate all the pressure on one side rather than equally on both sides of your mouth so you need to learn to chew evenly, left vs. right.
  1. Habit Control
  • Keep yawning and chewing to a minimum and avoid extreme jaw movements like yelling or singing. When you need to yawn, place a fist under your chin and press up to keep your mouth from opening too wide.
  • Avoid oral habits that put strain on the jaw muscles and joints. These include clenching, grinding, biting cheeks, jaw tensing, biting objects, popping your jaw joint, leaning on the palm of your hands while reading or watching TV or other habits.
  • Do not thrust your lower jaw forward, such as biting off a piece of thread, smoking, applying lipstick or while under stress.
  • Avoid sleeping on stomach or leaning on the jaw since this puts adverse forces on the jaw/neck muscles.
  • DO NOT CHEW GUM! Chewing gum much of the day increases the wear and tear on the joint giving little opportunity for your jaw to recover between meals.
  1. Learning how to rest the tongue, teeth and lips
  • Closely monitor your jaw position during the day in order to maintain a relaxed and comfortable position. This involves placing the tongue lightly on the top of your upper front teeth, allowing the teeth to come apart and relax the jaw muscles.
  • Lips together teeth apart is a technique to keep the jaw in neutral relaxed position. The teeth should never be touching (Except occasionally during swallowing).
  • Saying the letter “N” throughout the day can remind you to unclench or discontinue grinding your teeth.
  • Practice this technique during the day and before falling asleep.

Home Physical Therapy

Physical therapy you can do at home, which focuses on gentle muscle stretching and relaxing exercises, is helpful. Many people find that a routine of ice, exercise and applying moist heat helps TMD symptoms.

Ice, Exercise, and Heat:

  • Start by applying an ice pack to the side of your face and temple. For cold compresses you can use ice wrapped in a washcloth for 3-10 minutes 2 to 4 times daily. Ice should only be applied to the painful area until numbness is experienced. This relaxes tight muscles that may be causing spasms. Heat or ice can reduce joint or muscle pain and relax the muscles. For acute injuries cold is recommended.
  • Use massage to reduce pain and heal sore muscles. Use your fingers to massage the tender muscles in a circular motion for 5-10 seconds.
  • Stop the message and gently stretch the mouth open to the point where it is comfortable and not painful and hold open for 5 seconds. Do not massage while stretching. This helps to stretch the chewing muscles to their full length.
  • Do this alternating massage and stretching technique for 5-10 repetitions and than return to hot or cold packs. Repeat this regimen frequently throughout the day.
  • Apply heat for 5-10 minutes 2 to 4 times daily. Microwave a wet towel for about 1 minute or until towel is warm.       You can also wrap the moist hot towel around a hot water bottle to keep it warm longer. This will increase circulation and relax involved muscles.

NSAIDS

Nonsteroidal anti-inflammatory agents (Ibuprofen, Naprosyn, Tylenol, Alleve) even aspirin are very effective for reducing inflammation in joints and are recommended before bed and upon waking. Most can be bought over-the-counter at pharmacies and drug stores. NSAIDs are indicated for mild to moderate acute inflammatory conditions. They may be used for 2 weeks. Long term NSAID use is not recommended.

Splint Therapy

The dentist can fabricate an oral appliance called a splint or bite plate.   This is a plastic guard that fits over the upper teeth. The splint can help reduce clenching or grinding, which eases muscle tension. Sometimes over the counter mouth guards are also helpful in preventing clenching and grinding.

Surgical treatment

Surgical treatments are often irreversible and should be avoided where possible. A conservative approach for the treatment for TMD is usually effective. If this condition is not effectively treated with self care techniques and the use of a bite splint you may require care by a specialist.

Remember:

  • In most people, discomfort from TMD/TMJ will eventually go away whether treated or not.
  • Simple self-care practices are often effective in easing TMD/TMJ symptoms.
  • If more treatment is needed, it should be conservative and reversible.
  • Avoid, if at all possible, treatments that cause permanent changes in the bite or jaw.
  • If irreversible treatments are recommended, be sure to get a reliable second opinion.