TMJ DISORDER DIAGNOSIS AND TREATMENT

Definition of TMJ

TMJ stands for temporomandibular joint, which is your jaw joint.  Everyone has two of these: a left and right.  TMJ syndrome or TMD (temporomandibular disorder) is a medical problem related to the function of the jaw joint.  This typically manifests itself as a popping, clicking, or rustling in the jaw joint and can be accompanied by jaw joint or muscle pain, a jaw that locks in position or is difficult to open, headaches, fullness or ringing in the ears, and even numbness in the face and fingertips.

Types of TMJ Problems

TMJ disorders generally fall into three categories:

  • Myogenous TMJ problems are the most common type of TMD, accounting for over 80% of the total. Myogenous TMJ disorders involve muscle related pain and manifest as discomfort in the jaw, temple, neck or shoulder muscles-- especially upon waking. This type of TMJ problem responds well to BOTOX® treatment  and nightguards that control clenching. Nightguards that only treat grinding are typically much less effective (this is the type found in drugstores).
  • TMJ disorders can also involve jaw joint generated pain.  This results from internal derangement of the TMJ, which can involve a dislocated jaw, displaced disc within the TMJ or injury to the condyles (the rounded ends of the lower jaw that fit up into the jaw joint).
  • Another type of TMJ problem involves degenerative joint disease, such as osteoarthritis or rheumatoid arthritis.

Many TMJ problems can be treated by dentists.  However, internal derangements and degenerative joint disease may require the additional involvement of a physician.

Causes of TMD and the Link to Stress

TMJ problems in a minority of cases are caused by a blow to the face or arthritis of the jaw joint.  Most commonly, TMJ pain is related to genetic predisposition and stress level.  TMD tends to cluster in high stress professions (physicians, lawyers, consultants, traders, etc.) and is more likely to occur when the individual is experiencing a high level of stress. This stress leads to teeth grinding and clenching and the associated head, neck and shoulder pain.

In a very small percentage of cases (estimated at less than 5%), TMJ appears to have arisen due to a problem with the patient’s bite or occlusion.  This could be a result of the teeth simply growing into a suboptimal position (thereby affecting the bite) or as a result of braces or orthodontics.

TMJ Problems in Women versus Men

TMJ pain is approximately 4 times more common in women than it is in men.  Women tend to report more TMD symptoms and often have associated headache and jaw clenching problems (sometimes accompanied by grinding or bruxism).  Men report less pain and discomfort, but teeth grinding is much more likely to be in evidence (than is the case with women).

Diagnosis of TMD

TMJ problems are usually diagnosed through a detailed examination by a TMJ dentist at a specialized facility like the Mitchell Dental Spa. Dr. Margaret Mitchell, the lead TMJ dentist, has advanced postgraduate training in TMD. (Over 90% of dentists have no postgraduate training in TMJ problems.)

The TMJ dentist will look for evidence of TMD on the teeth, mouth, gums, and tongue, palpate the muscles of the head, neck and shoulders to determine level of tenderness, measure lower jaw range of motion, conduct a scan of the jaw joints using JVA (joint vibration analysis), perform diagnostic imaging (MRI or cone-beam x-rays), etc.

Treatment of Low Level, Episodic TMJ Problems

TMJ pain can sometimes be episodic and go away without any treatment.   Clinicians hypothesize that stress plays a major factor here: during times of high stress the body may react by grinding or clenching the teeth at night.  If the stress later diminishes, the clenching and grinding can decrease as well.

For individuals that infrequently experience jaw joint problems, self-care practices may be enough to control the problem.  These include: stress management (yoga, meditation, biofeedback, etc.), gentle stretching and massaging of the jaw joint muscles, application of heat or ice packs, avoiding chewing gum, and not opening the mouth excessively wide.

TMJ Treatment Relies on a Custom Fitted Nightguard

Individuals experiencing symptoms of prolonged pain or sensitivity may require treatment for their TMJ problem.  In a very small minority of cases, the bite may be so compromised that it has to be rebuilt---due to suboptimal tooth or jaw position---utilizing numerous crowns and veneers.  And in some cases, orthognathic surgery or orthodontics may be indicated.  Extreme surgical intervention, involving jaw joint disc replacement, is typically not recommended---this procedure has met with limited success.

For the vast majority of patients, however, the TMJ problem can be treated with a specially designed, plastic guard that is worn over the teeth at night.

It is very important to realize, though, that the guard be must be customized to the individual’s particular situation.  One size fits all solutions (like nightguards available in drugstores) may not solve the problem and can even make it worse.  This occurs since everyone’s TMD is different: some individuals are almost pure grinders, others clench but don’t grind, some grind sideways and clench just a little, some clench and grind both, etc.

In summary, a nightguard has to be custom-designed to treat the particular type of TMD the individual is experiencing.  This may require a visit to a TMJ dentist that has received advanced postgraduate training (currently thought to be less than 1 in a 100 dentists).

Other Types of TMJ Therapy

TMJ dentists like those at the Mitchell Dental Spa rely on nightguard therapy to control TMJ pain. Depending on the severity of an individual's TMJ problem, though, cold laser treatments, hot-cold therapy, and cranial sacral massage can also be useful. The Mitchell Dental Spa offers all of these. However, one of the most effective emerging treatments involves the use of BOTOX® 

Botox for TMJ Treatment

BOTOX® is a highly effective treatment for muscle related TMJ pain.  The Mitchell Dental Spa injects BOTOX® into overly tight, painful facial muscles to relax these areas, thereby alleviating the TMJ discomfort. BOTOX®  also appears to decrease nighttime clenching force, which also acts to decrease daytime TMJ pain. The BOTOX® treatment normally lasts 3-4 months and is repeated as necessary. Some patients only need BOTOX® once, while other highly stressed individuals may need it on and off for life.