TMJ disease

The temporomandibular (tem-puh-roe-man-DIB-u-lur) joint (TMJ) behaves Like a sliding hinge, linking your jawbone to your skull. You’ve got one joint on both sides of your jaw. TMJ disorders — a kind of temporomandibular disorder or TMD — may lead to pain in your jaw joint and in the muscles that control jaw motion.

The exact cause of a person’s TMJ disease is often difficult to determine. Your pain could be caused by a combination of factors, like genetics, arthritis or jaw injury. Some men and women who have jaw pain tend to clench or grind their teeth (bruxism), although lots of individuals habitually clench or grind their teeth rather than develop TMJ disorders.

Generally, the discomfort and pain associated with TMJ disorders Is temporary and can be alleviated with self-managed care or nonsurgical treatments. Surgery is typically a last resort after conservative measures have failed, but some people with TMJ disorders may benefit from surgical therapies.

What’s Temporomandibular Joint (TMJ) Syndrome?

Temporomandibular joint (TMJ) syndrome is a pain in the jaw joint That may be caused by many different medical issues. The TMJ joins the lower jaw (mandible) to the skull (temporal bone) in the front of the ear. Certain facial muscles that control chewing can also be attached to the lower jaw. Problems in this area can lead to head and neck pain, facial pain, ear pain, headaches, a jaw that’s locked in position or hard to open, issues with biting, and jaw snapping or popping noises when you bite. The temporomandibular joint syndrome is also called the temporomandibular joint disease. In general, more women than men have TMJ syndrome.

The TMJ consists of muscles, blood vessels, nerves, and bones. You’ve got two TMJs, one on either side of your jaw.

Muscles involved in chewing (mastication) also open and close the mouth. The jawbone itself, controlled by the TMJ, has two motions: spinning or hinge action, which is opening and closing of the mouth, and gliding action, a motion which allows the mouth to open wider. The coordination of the action also lets you speak, chew, and yawn.

If you Put your fingers just in front of your ears and open your mouth, you can feel the joint and its motion. When you open your mouth, the curved ends of the lower jaw (condyles) glide along the joint socket of the temporal bone. The condyles slide back to their original position when you shut your mouth. To keep this motion smooth, a soft disc of cartilage lies between the condyle and the temporal bone. This disc absorbs shock into the temporomandibular joint from chewing and other movements. Chewing generates a strong force. This disc distributes the forces of chewing through the joint area.

What Causes TMJ Syndrome?

TMJ syndrome can be due to injury , disease, wear and tear due to aging, or oral habits.

  • Trauma: Trauma is broken into microtrauma and microtrauma. Microtrauma is internal, like grinding the teeth (bruxism) and clenching (jaw tightening). This continual hammering on the temporomandibular joint may alter the alignment of the teeth. Muscle involvement causes inflammation of the membranes surrounding the joint. Teeth grinding and clenching are customs which might be diagnosed in people who complain of pain in the temporomandibular joint or have facial pain that comprises the muscles involved with chewing (myofascial pain). Microtrauma, like a punch to the jaw or cause an accident, may break the jawbone, cause dislocation of the TMJ, or damage the cartilage disk of the joint. Pain from the TMJ can be caused by dental work whereby the joint is stretched open for long intervals. Massage and heat program after the dental procedure can be helpful.
  • Bruxism: Bruxism, or teeth grinding, is a habit which can lead to muscle strain and an inflammatory response that could result in the initial pain. Changes in the normal stimuli or elevation of the teeth, misalignment of teeth, and repetitive use of chewing muscles can cause temporomandibular joint changes. Generally, someone that has a habit of grinding their teeth will do so largely through sleep. Sometimes, the grinding may be so loud that it disturbs others.
  • Clenching: Someone who clenches continually or snacks on things while awake. This may be chewing gum, a pen or pencil, or fingernails. The constant pounding on the joint causes the pain. Anxiety is often blamed for tension in the jaw, resulting in a clenched jaw.
  • Osteoarthritis: Like other joints in the body, the jaw joint is prone to arthritic changes. These changes are sometimes brought on by the breakdown of the joint (degeneration) or the regular wear and tear of regular aging. The degenerative joint disease causes a slowly progressive loss of cartilage and formation of new bone in the surface of the joint. Cartilage destruction is due to numerous mechanical and biological factors instead of a single entity. Its incidence increases with repetitive microtrauma or microtrauma, in addition to with normal aging. Immunologic and inflammatory diseases result in the progression of this disease.
  • Rheumatoid arthritis: Rheumatoid arthritis causes inflammation in joints and may impact the TMJ. As it progresses, the disease can cause the destruction of cartilage, erode bone, and finally cause joint deformity. Rheumatoid arthritis is an autoimmune disorder. It causes disease in many different organs with characteristics of persistent joint inflammation. It sometimes affects the TMJ, particularly in young children.
  • Other causes of TMJ syndrome include infection of the joint, cancer, and bone deformity that occurs at birth.

Which Are TMJ Syndrome Signs and Symptoms ?

  • Pain in the facial muscles and jaw joints can radiate into the shoulders or neck. Joints may be overstretched and muscle spasms can occur. The pain may occur with speaking, chewing, or yawning. Pain usually appears in the joint itself, before the ear, or it might move elsewhere on face, scalp or chin and result in headaches, dizziness, and symptoms of migraines.
  • TMJ syndrome can lead to ear pain, ringing in the ears (tinnitus), and hearing loss. Sometimes people mistake TMJ pain for an ear problem, like an ear disease , once the ear isn’t the problem in any respect.
  • Once the joints move, they may create noises, such as clicking, grating, and/or popping. Others may also have the ability to hear the popping and clicking sounds. This means the disc might be in an unnatural position. Sometimes no treatment is required if the sounds don’t cause pain.
  • The mouth and face may swell on the affected side.
  • The jaw may lock in a wide open position (suggesting it is dislocated), or it may not open completely whatsoever. Additionally, upon opening, the lower jaw may deviate to one side. Some people can experience favoring one debilitating side or another by opening the jaw . These modifications could be sudden. The teeth may not fit nicely together, and the bite may feel odd.
  • Muscle spasms associated with TMJ syndrome can lead to difficulty swallowing.
  • TMJ syndrome may also result in headache and nausea, potentially resulting in nausea and/or nausea .
  • Some people with TMJ syndrome can have a history of poor dentition or psychological distress.

What Are Risk Factors for TMJ Syndrome?

Ongoing studies conducted by the National Institute of Dental and Craniofacial Research (NIDCR), part of the U.S. National Institutes of Health, are focused on assessing risk factors for TMJ syndrome in healthy people. First results have identified a group of physiological, psychological, sensory, and genetic and nervous system factors that might increase the chance of developing TMJ syndrome. New findings will allow us to better understand the onset and development of TMJ syndrome. Additional novel strategies to diagnose and treat the condition can be developed. Below are some risk factors that have been identified:

Gender: Women are at greater risk of developing TMJ Syndrome when compared with men. Additionally, there can be differences in how men and women respond to pain and to pain drugs .

Age: Studies of people between the ages of 18-44 reveal that the risk to develop TMJ conditions increases for girls. This has been noted particularly for women during their childbearing years. For men ages 18-44, there was no increased risk.

Pain tolerance: Studies Suggest that individuals who are more sensitive to moderately painful stimuli have a higher chance of developing TMJ syndrome.

Genetics: There’s some indication that genes associated with stress reaction, psychological wellbeing, and inflammation may increase the risk for TMJ syndrome.

Persistent pain: People who suffer with chronic pain conditions like lower back pain and headaches might be at greater risk for TMJ syndrome.

How Long Do TMJ Symptoms and Signs Last?

  • Intense TMJ symptoms and signs may last anywhere from a few days to a couple of weeks and then disappear after the injury or cause of discomfort has resolved.
  • For a chronic TMJ condition, the signs can be continuing with episodes of dull or sharp pain that occur over a protracted time period (months to years).

When Should Someone Seek Medical Care for TMJ?

Irregular pain in the jaw joint or chewing muscles is common and can not be a cause for concern. See a doctor if your pain is severe or if it doesn’t go away. You also need to see your health-care professional when it hurts to open and close the jaw or in case you have difficulty swallowing food. Treatment for TMJ syndrome should begin when it’s in the first stages. If the problem is identified early, the physician can explain the performance of the joints and the best way to prevent any activity or habit (for example, chewing gum) that might aggravate the joint or facial pain.

If your jaw is locked closed or open, go to a hospital’s emergency department.

  • The open locked jaw is treated with sedating one to a comfortable level. Then the mandible (upper jaw) is held with the thumbs while the lower jaw is pushed down, forward, and backward. This move is usually done by the Emergency Department physician or an ear, nose, and throat (ENT) specialist.
  • The closed locked jaw can be treated by sedating you till you’re completely relaxed. Subsequently the mandible is gently manipulated until the mouth opens.

How Do Health Care Professionals Diagnose TMJ Syndrome?

Medical history

In diagnosing your jaw problem, the physician will ask these questions:

  • What sort of pain do you have?
  • Is it an ache, a throbbing pain, or a sharp stabbing pain?
  • Is your pain constant or intermittent?
  • Can you summarize the field of pain on your face with your finger?
  • What helps to relieve the pain? What aggravates the pain?
  • Do you grind or clench your teeth? Do you bite your nails or chew on some other items, like pens or pencils?
  • Can you hold the phone with your shoulder from the ear for quite a long time?
  • Can you chew gum frequently? For how long?
  • Have you got some oral habits that you haven’t mentioned?

Physical examination

 

During the physical exam, the physician will examine your head, neck, face, and temporomandibular joints, noting some of the following:

  • tenderness (pain) and its place;
  • sounds, such as clicking, popping, grating;
  • the mandible (lower jaw) range of motion, while it’s easy to open and close if it can move from side to side and forward-backward with no annoyance;
  • your evaluation of pain on a scale from 0 (no pain) to 10 while the jaw has been manipulated;
  • wear and tear on the buccal cusps of the mandibular teeth, particularly the canine teeth;
  • rigidity and/or tenderness of the chewing muscles; and
  • the way your teeth align together: are the teeth ordinary, is there an open bite, crossbite, or overbite; have you had dental restorations; also is there a facial bone deformity.

Based on the what Physician suspects as the cause, he/she may order blood tests that have a white cell count and other tests to rule out lupus, rheumatoid arthritis, or gout for a reason for the TMJ syndrome.

  • Imaging: X-rays may be taken of the mouth and jaw.
  • Ultrasound may also be ordered to evaluate the role of the TMJ. It’s a useful tool to assess the Interior of the TMJ.

If the diagnosis of TMJ syndrome isn’t clear or another disease is suspected, CT or MRI scans may also be obtained The MRI scan can help evaluate the soft tissues as well as the interior of the joint. A CT scan Can help evaluate the bony structures and muscles. Experts believe that in doubtful cases, MRI is the study of choice since it’s helpful in assessing TMJ disease.

In rare instances, if all of the above tests fail To make a diagnosis of TMJ syndrome and pain still persists, the surgeon can use a needle to clean and irrigate the joint (arthrocentesis).

 

Are There TMJ Home Remedies?

In the vast majority of instances, TMJ syndrome is self-limiting. The Majority of the Symptoms disappear in a couple of weeks when the jaw is rested There are an assortment of choices for treating TMJ syndrome in the home.

  • Anti-inflammatory and pain medicines like aspirin or acetaminophen (Tylenol) or aspirin (Motrin, Advil) may provide relief.
  • Eat a diet of soft foods.
  • Avoid chewing gum and eating hard candies or chewy foods. Don’t open your mouth wide. Your physician may show you how you can perform gentle muscle stretching and relaxation exercises.
  • Stress-reduction techniques might help you handle stress and relax your jaw together with the rest of the body.
  • Apply warm compresses on the region of pain. Home treatment includes mandible (lower jaw) moves, like opening and closing the jaw from side to side. Try this after a hot compress is used for 20 minutes. The lower jaw motions should be repeated three to five times per day, five minutes constantly every time, for approximately two to four weeks. A gentle massage of the area may also be beneficial.

Which Are TMJ Treatment Choices?

For chronic TMJ syndrome, a team approach is usually required. This May have a dentist, ENT surgeon, pain specialist, physiotherapist, and a primary care doctor. Modalities used to alleviate pain and restore the function of the TMJ may include the use of splints, physical therapy, emotional counseling, acupuncture, hypnotherapy, and arthrocentesis.

Medications that may be used to relieve pain may include tricyclic antidepressants, muscle relaxants, and prescription-strength painkillers. Botulinum toxin (Botox) may be used alone or in conjunction with other treatments to relieve the muscle spasm and pain.

There Are several kinds of appliances to treat bruxism. These splints are custom made and help redistribute the force of their teeth while biting. The health care provider may fit you with a splint or bite plate. This is a plastic guard that fits over your upper or lower teeth, like a mouth guard in athletics. The splint can help reduce clenching and teeth grinding, particularly if worn at night. This will ease muscle strain. The splint shouldn’t cause or increase your pain. If it does, don’t use it.

Surgery

Surgery Is not the first choice of treatment for TMJ syndrome. Arthrocentesis entails using a needle to clean and irrigate the joint. Throughout the procedure, the surgeon may inject a local anesthetic or a steroid to the joint. Arthroscopy operation is done if there is suspicion of an internal problem with the TMJ. It does require anesthesia and has a higher success rate in resolving pain.

Physical treatment

Anyone with recurrent or Chronic TMJ syndrome is known for physical therapy. The therapist can help restore joint mobility, improve muscle strength, and relieve pain.

Other remedies

A variety of other treatments are Also available for chronic TMJ syndrome and contain friction massage, transcutaneous electric nerve stimulation (TENS), and cognitive behaviour therapy.

  • The National Institute of Dental and Craniofacial Research (NIDCR) advises that if surgery is recommended, you seek out other individual opinions before proceeding. Usually, experts recommend the most conservative and reversible treatment potential according to a reasonable diagnosis.
  • NIDCR advises that other irreversible treatments have never been proven effective and might potentially worsen the problem. These include orthodontia to modify the sting, restorative dentistry, and modification of the sting by grinding down teeth to bring the sting into equilibrium.

Follow-up for TMJ

Follow your doctor’s specific instructions for taking any medicine prescribed and for home care with compresses or gentle jaw exercise.

  • You might be instructed to follow up with a professional such as an oral and maxillofacial surgeon, a general dentist, or a pain-specialist doctor. Maxillofacial surgery might be necessary when there is poor alignment of the jawbone (mandible) with the skull bone.
  • Dentists are often the first to diagnose TMJ syndrome. They are knowledgeable about conservative treatments. Specially trained facial pain specialists can be useful in diagnosing and treating TMJ syndrome.

Is There a Way to Avoid TMJ Syndrome?

  • If you tend to have occasional bouts of jaw pain, avoid chewing biting or chewing objects, like pens or fingernails. Avoid eating hard or chewy food. When you yawn, support your lower jaw with your hand.
  • Avoid large snacks while eating.
  • Regularly massage your jaw, cheeks and temple muscles.
  • If you feel dizzy, employ moist heat.
  • Maintain decent sleep posture with neck support.
  • Avoid cradling the phone between your neck and shoulder.
  • See your dentist if you grind your teeth at night or find yourself clenching your jaw. The dentist may make a splint for you.

What’s the Prognosis of TMJ Syndrome?

Many people do well with conservative treatment, like resting the Jaw or with a mouth splint. The success of treatment is dependent upon how severe the symptoms are and how well you comply with therapy.

Only about 1 percent of people who have TMJ syndrome require joint replacement surgery.

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