TMJ Syndrome Overview

TMJ Disorders or TMD

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 joint 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 problems generally fall into three categories:

• Myofascial pain, the most common type of TMD, which is discomfort in the jaw, neck or shoulder muscles.
• 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).
• Degenerative joint disease, such as osteoarthritis or rheumatoid arthritis in the TMJ or jaw joint.

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
TMJ problems can be caused by a blow to the face or arthritis of the jaw joint.  Most commonly, however, it appears to be related to stress level.  TMD tends to cluster in high stress professions (physicians, lawyers, commodity and equity traders, etc.) and is more likely to occur when the individual is experiencing a high level of stress.  In a very small percentage of cases (estimated at less than 5%), TMD 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
TMD pain is much 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 dentist (like Dr. Mitchell) with advanced postgraduate training in TMD.  The TMD dentist will examine the teeth, mouth, gums, and tongue, palpate the muscles to determine level of tenderness, measure lower jaw range of motion, conduct JVA (joint vibration analysis), perform diagnostic imaging (MRI or cone-beam x-rays), etc.

Treatment of Low Level, Episodic TMJ Problems
TMD 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: gentle stretching and massaging of the jaw joint, heat or ice packs, avoiding chewing gum, and not opening the mouth excessively wide.

TMD Treatment
Individuals experiencing symptoms of prolonged pain or sensitivity may require treatment for their TMD.  In a 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 dentist that has received advanced postgraduate training in TMJ problems (currently thought to be less than 1 in a 100 dentists).