Helping Your Temporomandibular Joint (TMJ) Heal

The temporomandibular joint (TMJ) is a
ball-and-socket joint located where the upper and lower jaws meet. When the TMJ and
related
muscles are injured, they need time to heal. Self-care is very important. You can
take
steps to reduce pressure on the TMJ and speed healing.

Eating with care

Chewing strains the TMJ. When
symptoms are bad, you may not be able to chew at all. To get you through times when
your
symptoms are at their worst, try these tips:

• Choose soft foods. These include
  scrambled eggs, oatmeal, yogurt, quiche, tofu, soup, smoothies, pasta, fish,
  mashed potatoes, milkshakes, bananas, applesauce, gelatin, or ice cream.

• Don’t bite into hard foods. These
  include whole apples, carrots, and corn on the cob. Instead cut foods into
  bite-sized pieces.

• Grind or finely chop
  meats and other tough foods.
  Try hamburger meat instead of steak.

Using ice and heat

Your healthcare provider may
suggest using ice and heat. Ice helps reduce swelling and pain. Heat helps relax
muscles, increasing blood flow.

• Use a gel pack or cold pack
  for severe pain. Apply
  for 
  10 to 20

  minutes. Repeat as needed. To make a cold pack, put ice cubes in a plastic
  bag that seals at the top. Wrap the bag in a clean, thin towel or cloth. Never put
  ice or a cold pack directly on the skin.

• Use moist heat

  for mild to moderate muscle pain.
  Apply a moist, warm towel to the muscles for 
  10 to 20 minutes. Repeat as
  needed.

Staying away from triggers

Certain activities (called
triggers) strain the TMJ, making symptoms worse. The tips below can help you stay
away
from common triggers and limit strain:

• Don’t eat hard or chewy
  foods. 
  These include nuts, pretzels, popcorn, chips, gum, caramel, gummy
  candies, carrots, whole apples, hard breads, and even ice.

• Reschedule routine dental visits,

  like cleanings, if your jaw
  aches.
  If you have severe pain, call your healthcare provider.

• Support your jaw
  when yawning. When you feel a yawn
  coming on, put a fist under your jaw. Apply gentle pressure. This helps prevent
  wide, painful yawns.

• Don’t do any activity that
  hurts. 
  This includes nail biting, yelling, and singing.

Maintaining good posture

Work at improving your posture
during the day and when you sleep. Good posture can help your body heal. Try these
tips:

• Use a headset
  when on the phone. Don’t cradle the
  phone with your shoulder.

• Keep ergonomics in mind. This
  includes making sure your workstation fits your body. Support your lower back.
  Take breaks often to stretch and rest. If you use a computer, keep the monitor at
  eye level.

• Keep your head in a neutral position.

   Keep your ears in line with your shoulders. Don’t slouch or crane your head
  forward.

• Use an orthopedic pillow. Use this
  to support your head and neck during sleep.

Follow up with your healthcare provider

It’s important to see your healthcare provider regularly, especially
if your pain doesn’t get better. Discuss other treatment choices with your healthcare
provider. Your provider may advise the following:

• Medicines, such as pain relievers or muscle relaxants
• An intraoral appliance, such as a nightguard, to decrease
  clenching and grinding of teeth
• Physical therapy or exercises to strengthen your jaw
  muscle
• Relaxation methods or counseling to reduce stress

TMJ Symptoms | Alex Rader, DDS

Headaches / Migraines

Headaches are one of the most common symptoms of a TMJ (temporomandibular joint) problem. Tension headaches are the most common type of headache, and the TMJ headache is a tension type of headache. It is often described as a feeling of wearing a hat two sizes too small, with pain in a ring around the head, or as a migraine headache.

There are a few TMJ-related causes for tension headaches. Constant contraction of muscle fibers within a muscle, create tension, pressure or a tight feeling in the face and head, but constant tight muscle fibers prevent or reduce blood flow to that area. The body sends more blood to the areas and this can result an increase in general blood pressure to the muscles and head, sometimes referred to as vascular headaches. Clenching and grinding the teeth, which are TMJ symptoms, produce pain from the muscles in the head, which is a headache.

Unfortunately, these headaches can be so frequent or severe that they are frequently misdiagnosed and treated as migraine headaches.

The pain from muscle headaches can be blocked with medications, or nerves cut with brain surgery or muscles somewhat relaxed with muscle and psychological therapy, but the cause of the disease and damage from the bad bite, malocclusion, will persist. Side effects with medications, complications from brain surgery, and limited results with muscle or psychological therapy do not correct the source of the problem. Neuromuscular dentistry ensures the muscles are happy because they do not have to work hard positioning the teeth to a strained bite.

By putting the temporomandibular joint back into alignment and placing the jaw into its optimal position, neuromuscular dentistry can alleviate most headache problems related to TMJ, muscle, nerve and joint disorders.

Facial Pain /Jaw Pain

The jaw area of the face is a complex network of bones, joints, muscles, and nerves. When the jaw becomes unaligned, the surrounding bones, muscles, and nerves are also affected. This includes the muscles of the face, which experience strain or spasm because the muscles are working extra hard to compensate for the unstable bite. A neuromuscular dentistcan help facial pain problems by working with the source of the problem, the bite. Your neuromuscular dentist will stabilize and realign your bite so that the teeth, muscles, and joints all work together without stress.

Neck and Shoulder Pain

Having a “bad bite” (malocclusion) causes an imbalance in the jaw-to-skull relationship, which in turn twists the jaw into a strained position that refers pain to the muscles in the neck, shoulders, and back.

Muscles work as a team. Seldom does a single muscle work without other muscles in the team joining in. The bones in the neck, especially the atlas and axis, are intimately involved with the muscles of chewing, biting, talking, breathing, and head posture. Sore, tight, contracted muscles of the jaw will tilt the head and shoulders causing compensation from neck, shoulder and back muscles. Although theneuromuscular dentist does not claim to treat neck, back, shoulder, or arm pain, patients are pleased how frequently these problems can be relieved.

Neuromuscular dentists understand that the bones, joints, muscles, and nerves in the face and neck have a complex relationship. They work to correct the bite, relieving strain on the jaw and the surrounding muscles. Once the bite has been aligned, resulting pain in many areas of the body disappears.

Tinnitus (Ringing in the Ears)

Ringing in the ears, or tinnitus, is another symptom of TMJ that is commonly misdiagnosed and often goes untreated or is treated ineffectively. In many cases ringing in the ears is one of the results of having a strained bite in which the jaw is not aligned. The jaw area of the face is a complex network of muscles and nerves, and when the bite is misaligned muscles and nerves throughout the head, including the ears, can be affected.

If your neuromuscular dentist diagnoses the cause of your tinnitus to be an unstable or misaligned bite, he or she can work with the source of the problem by stabilizing and realigning the bite so that the entire jaw area works together without pain. Your bite will be back to its normal position, relieving theringing in your ears that was caused by the misaligned bite.

Sensitive and Sore Teeth

Sensitive or sore teeth are common symptoms of TMJ. If the teeth are the cause of TMJ then any or all of the teeth may be sore. The teeth may also become sensitive because of clenching or grinding the teeth, a common action in many people, when the disc of the TMJ is displaced.Unfortunately, when seeking relief from this tooth pain many patients are misdiagnosed and may even go as far as having the nerve from the tooth removed with root canals or even having the tooth extracted. The worst part is that these measures may not relieve the pain, and can actually make it worse!

Neuromuscular dentists relieve sensitive and sore teeth related to TMJ by going to the source of the problem-the “bad bite” and misaligned jaw. In most cases, correction of the bite can be accomplished without the use of surgery, and patients report long-lasting pain relief.

Numbness or Tingling in Hands / Arms

The nerves and muscles in the jaw area of the face are very complex, so when your bite is off, these nerves and muscles are also affected. A misaligned bite can cause the muscles throughout the jaw, face, neck and shoulders to go into spasm. When these muscles (scalenes) are in spasm they can pinch the nerves (brachial plexis) leading down the arms and into the hands, which in turn results infeelings of numbness or tingling.

Neuromuscular dentists can help you with numbness or tingling in your hands or arms by working with the source of the problem-your bite. Once your bite is aligned, the muscles affected by the jaw joint will be able to go back to their normal function, relieving the spasm and the numbness and tingling that are felt as a result.

Clicking or Popping in Jaw Joints

Clicking, popping, or snapping in the jaw joint is the most common symptom of TMJ. There may or may not be pain in the jaw when the clicking or popping sound is heard. The clicking sound may even be so loud that others can hear it when you chew or speak.

Usually the cause of the popping jaw is a displaced disc in the jaw. The jaw joints are ball and socket joints, just like the shoulder joint. When ball and socket joints are functioning properly, the ball and socket do not touch because of a thin disc of cartilage located between the ball and socket. This disc of cartilage is held in place and guided by a muscle.

If your bite is not right or trauma tears the tissues the jaw joint is pulled out of alignment, and the disc is typically pulled forward or torn. Now that the cartilage disc is not serving as a cushion between the ball and socket these bones are rubbing against each other and pressing on nerves, causing pain in the jaw and clicking or popping sounds in the jaw joint. The muscles holding the disc in place are now strained as well, causing additional pain in the jaw and face as well as in the head, neck, back and shoulders.

Limited Jaw Movement or Locking Jaw

Limited jaw movement or locking jaw may feel like the lower jaw is catching when the jaw is opened. In some cases a person with a locked jaw must move the jaw to one side or the other in order to open the mouth wide. A person might also have to open the mouth until a popping sound is heard and felt, at which point the jaw unlocks.

Limited jaw movement or locking jaw is often a result of a “bad bite”. When the bite is not aligned correctly it causes problems in the jaw joint, the TMJ.

Depression

While not a physical symptom, the majority of people suffering from TMJalso suffer from depression, usually as a result of their condition being so commonly misdiagnosed or dismissed as having no physical cause. There is also scientific evidence that shows that patients with chronic pain, a condition that nearly all TMJ patients can claim, have chemical changes in the brain as a result of the pain. These chemicals can cause depression.

Because TMJ is a multifaceted disorder, many patients need to work with more that one specialist to return to optimal health. Some patients work with a neuromuscular dentist as well as a psychological counselor and sometimes a chiropractor or physician. However, other patients experience complete pain relief from the treatment their neuromuscular dentist provides and the peace of mind that comes from having their condition diagnosed and treated. Speak with yourneuromuscular dentist about your personal needs

Treatment of TMJ (joint dysfunction)

Publication date:

March 13, 2019.

Date when information on the page was updated:

May 19, 2023.

TMJ dysfunction is a fairly common pathology today, since it is largely caused by stress factors. Here it can be difficult to understand what is primary, what is secondary, because people with joint dysfunction come, as a rule, with bite pathology, pathology of the musculoskeletal system (curvature of the spine, neck). Therefore, joint treatment is a complex story. It happens that the primary pathology is the pathology of the joint, it happens that the musculoskeletal system.

Causes of TMJ dysfunction

The orthodontist should find out what was primary – bite, misalignment of the teeth or the absence of some teeth, possibly not very successful orthodontic treatment in history, early treatment when they were children or adolescents and subsequent treatment could have been the cause. It is important to correctly diagnose.

Comprehensive TMJ treatment

When the doctor has determined the cause of the joint pathology, or causes, he determines the patient’s readiness for a comprehensive treatment plan. In addition to the orthodontist, an osteopath or a chiropractor, or even an orthopedist, can be involved if a more complex correction of the musculoskeletal system is needed.

The patient must be aware that it is possible to align the jaw with a splint or splint, but it will not solve the problem of malocclusion. Orthodontic treatment is required to correct the bite. If you have already had orthodontic treatment before, then it is more difficult to decide on a second treatment.

Therefore, the problem with the joint is first solved by means of a splint or joint splint, then the bite is corrected, and, if necessary, prosthetics. In parallel, work is underway with an osteopath to restore the muscular corset of the back and neck.

It happens that a patient refuses treatment with braces after resolving a problem with a joint. In this case, we warn him about the need to wear an articular splint constantly in order to avoid the appearance of old problems with the TMJ. After all, a relapse can happen against a background of stress quite quickly.

What are the symptoms of TMJ dysfunction?

• Soreness or pain in one or both TMJs at rest or when opening the mouth.
• Crackling, clicking, crepitus and other noises in the area of ​​one or both TMJs when opening the mouth.
• History of TMJ injuries (previously), incl. dislocation, subluxation, chronic subluxation.
• Restrictions in the mobility of the TMJ, restriction in opening the mouth.
• Excessive masticatory muscle tone, bruxism (“grinding” of teeth during sleep, at rest).
• Asymmetry of the chin, lips, frenulum of the lips, asymmetry of the opening of the mouth, S-shaped opening.
• Suspicion of the forced position of the lower jaw.

Structure of the TMJ

The presence of one or more of the above signs may indicate dysfunction of the TMJ.

Conventional orthodontic treatment does not address TMJ dysfunction. In the process of orthodontic treatment, the severity of dysfunction may not change, decrease or increase. At the moment, in the world scientific orthodontic literature there is no convincing data on the relationship between orthodontic treatment and the state of the TMJ. Deterioration of the joint after treatment may not be related to this treatment.

Please note! Even in the absence of visible clinical manifestations of joint dysfunction, there may be hidden disorders that require special diagnostics to identify them.

If there is a forced incorrect position of the lower jaw, its position may change during treatment with a change and complication of the treatment plan (the need to extract individual teeth, an increase in the duration of treatment). A reliably forced position cannot be diagnosed by traditional orthodontic methods; to check its presence, as a rule, a special analysis is required (manual functional analysis, determination of the central ratio of the jaws), the use of a special articular splint for a period of several months, which, however, does not give 100 % guarantees.

For detailed joint diagnostics, clarification of the specifics of your case, further production of the joint splint, you can make an appointment with a dentist-orthodontist who deals with the issue of TMJ dysfunction.

TMJ dysfunction is a chronic condition that can be managed but not cured (i.e. it is possible to eliminate the symptoms, however, the pathological changes in the joints, if they have already occurred, are likely to persist).

What happens if TMJ dysfunction is not treated?

If the dysfunction is not treated, the compensatory capabilities of the body may be exhausted sooner or later, the symptoms will worsen, the pathology will begin to progress, causing more discomfort (sometimes for several years), thereby affecting the deterioration of the function of the dentoalveolar system.

In order to try to prevent this and treat the individual temporomandibular joint structure and function, patients are usually offered the following approach.

TMJ dysfunction treatment method

1. Diagnosis of TMJ dysfunction.

• During the diagnosis of the joint in the clinic, a number of measurements and tests are carried out, all sensations in the joints are recorded (discomfort, clicks, pain, jaw deviation when opening and closing), the difference in sensations in the right and left joints.
• The orthodontist also takes casts of the jaws and takes photographs of the face and intraoral photographs, as well as a three-dimensional computed tomography of the face (3D CT), if necessary, the doctor can give a referral for an additional study – magnetic resonance imaging of the TMJ (MRI).
• Often, an orthodontist, in addition to manual functional analysis, conducts a visual assessment: posture, symmetry of the shoulder girdle, shoulder blades, hip bone structures, etc., performs the necessary tests, photographs. According to the results, it is possible to appoint an appointment for a consultation with an osteopath or a chiropractor for joint management of the patient. Allied specialists (orthopedist, surgeon, periodontist) can also be involved in the preparation of the treatment plan.

What exercises are prescribed to patients to normalize the work and relax the masticatory muscles?

Exercise No. 1

Draw a vertical line on the mirror with a marker, stand opposite, so that the line divides the face into right and left halves, put your fingers on the area of ​​the articular heads, lift your tongue up and back, open and close your mouth along the line (it may not turn out immediately), 2-3 times / day for 30 repetitions. You do not need to open your mouth wide (comfortable width), the main thing is symmetrically (so that the jaw does not “move out” in any direction). If there is a click, open until it clicks.

Exercise No. 2 (cycle)

Do it whenever possible, for example, in front of the TV, at the computer, in a traffic jam while driving. Open – close your mouth without closing your teeth for 30 seconds, then reach your tongue alternately to the right, then to the left cheeks for 30 seconds. Open again – close your mouth, then for 30 seconds move your tongue in a circle inside the vestibule (behind the lips), first in one direction, then in the other direction (clockwise – counterclockwise), open again – close your mouth, etc .. For this a half-hour cycle, the teeth should not touch, the lips are closed. If you want to close your mouth or take a sip, put your tongue between your teeth. Repeat the cycle for 20-30 minutes 2-3 times/day

2. Occlusal therapy for TMJ dysfunction

After the diagnosis, the patient is booked to the orthodontist for an appointment to determine the central ratio of the jaws (“true” position of the lower jaw, the position in which your joint and masticatory muscles will be most comfortable).

In order to more precisely establish and fix this position, an occlusal splint (splint) will be individually made for the patient from a special plastic that is erased as it is worn. The tire must be worn constantly (sleep, talk, eat in it if possible) – this is the meaning of occlusive therapy, which will help the joint and masticatory muscles to reorganize into the most comfortable functional state.

Cleaning and caring for the tire is very simple – after eating (as well as while brushing your teeth) clean with a soft brush with toothpaste or soap.

3. Installation of a bracket system for a patient with TMJ dysfunction

Installation of a bracket system on the upper jaw is carried out after an average of 3 months of occlusive therapy. The splint is adjusted once every 1-2 weeks, or at the discretion of the doctor, until the main complaints from the TMJ are eliminated (in parallel with the alignment of the teeth in the upper jaw), then the bracket system is installed on the lower jaw with a partial reduction (grinding) of the interfering parts of the occlusal tires, or complete removal. Here the patient needs to be patient – the process can take several months.

At the same time, the new position of the lower jaw is monitored: repeated manual functional analysis, photometry, bite registration is possible, computed tomography of the face during treatment, continuation of orthodontic treatment on a bracket system.

Upon completion of orthodontic treatment, the final control of the position of the lower jaw follows (manual functional analysis, photometry, bite registration, 3D CT of the face upon completion (after) treatment).

Splint

Joint splint with braces

4. TMJ dysfunction treatment result

Treatment results in a satisfactory aesthetic result, achievement of full occlusion with multiple even fissure-tubercular contacts and elimination or reduction of TMJ dysfunction. Mandatory, if indicated, is a full-fledged rational prosthetics or functional and aesthetic restoration of teeth, as the final stage of treatment – at this stage, a detailed consultation of an orthopedic dentist is necessary.

Treatment and diagnosis of TMJ dysfunction at the Confidentiality Clinic

Orthodontists with education in the field of maxillofacial surgery work at the Confidentiality Clinic. They are proficient in modern diagnostic methods, such as Aqualizer splint therapy, and the clinic is equipped with modern diagnostic equipment. The treatment uses an integrated approach, including the recommendation of exercises, wearing an articular splint, and installing braces. For the full restoration of the health of the joint and oral cavity, depending on the case, implantologists, orthopedists, and periodontists are involved.

To get detailed consultations from specialists and the most detailed comprehensive treatment plan, you can use the Dental Check-up service (includes examination of all specialists, diagnostics, treatment plan and recommendations).

You may also be interested:

• Ankylosis of the TMJ
• TMJ hypermobility
• TMJ disc displacement
• TMJ dislocation

The author of the article: Petrova Elena Aleksandrovna

Orthodontist

TMJ dysfunction

with the temporomandibular joint. Therefore, if you notice noise and ringing in your ears, restrictions on opening your mouth, incomprehensible pains in your head, neck and temples, then make an appointment with a gnatologist or a neuromuscular dentist. It could be TMJ dysfunction (temporomandibular joint dysfunction).

Headaches, snapping jaw…. Gnatologist to help you!

TMJ dysfunction is a functional pathology of the temporomandibular joint caused by muscular, spatial and occlusal disorders. Almost always, TMJ dysfunction is accompanied by pain syndrome: headache, temporal and neck pain, clicks in the joint, the amplitude of mouth opening is limited, there is noise and ringing in the ears, bruxism and snoring.

Evaluation of patients with suspected TMJ dysfunction begins with examination of complaints and analysis of plaster models of the jaws. Then orthopantomography, X-ray and tomography of the TMJ, electromyography, rheoarthrography, phonoarthrography, etc. are performed. Treatment of TMJ dysfunction is carried out based on the causes and may include grinding of supercontacts of the teeth, correct prosthetics, bite correction, wearing a cap or articular splint, and surgical treatment.

What is TMJ dysfunction?

Gnathologists call TMJ dysfunction a violation of the coordinated activity of the temporomandibular joint after changes in occlusion, the relative position of the TMJ elements and muscle function. Statistics include almost 75% of patients who have signs of dysfunction.

For the first time, the connection between dysfunction of the TMJ and pain in the ears was noticed in the 30s of the last century by the American otolaryngologist James Costen, for this reason, dysfunction of the TMJ is sometimes called Costen’s syndrome. Even in the medical literature, you can find the terms “musculo-articular dysfunction”, “pain dysfunction”, “TMJ myoarthropathy”, “mandibular dysfunction”, “clicking” jaw, etc.

TMJ dysfunction is considered to be a multidisciplinary pathology, therefore its treatment, as a rule, requires the joint efforts of dentists, neurologists, and psychologists.

Causes of TMJ dysfunction

There are a huge number of causes of TMJ dysfunction. But, according to most researchers, the basis for the occurrence of TMJ dysfunction consists of three factors:

• Impaired occlusion,
• Violation of the spatial relationships of the elements of the temporomandibular joint,
• Change in masticatory muscle tone.

In addition, the predisposition to the occurrence of TMJ dysfunction lies in the anatomical prerequisites for the structure of the joint, most often when the shape and size of the articular head and articular fossa do not match.

Symptoms of TMJ dysfunction

Proposed by J. Kosten Classic complex of symptoms of temporomandibular joint dysfunction:

• clicking in the joint during meals;
• dizziness and headaches;
• pain in the cervical spine, occiput and ears;
• tinnitus and hearing loss;
• Burning in nose and throat.

Modern medicine, based on the diagnostic criteria for TMJ dysfunction, identifies the following symptoms of the disease:

Diagnosis of TMJ dysfunction

Clinical manifestations of TMJ dysfunction are so diverse that they cause difficulties in diagnosis. Patients with suspected TMD have to be examined by a neurologist, internist, otolaryngologist, rheumatologist and many other specialists when they need the help of a neuromuscular dentist and gnathologist in the first place.

During the initial examination, the patient’s complaints, anamnesis of life and disease are clarified, the specialist performs palpation and auscultation of the joint area, assesses the degree of mouth opening and lower jaw mobility. Impressions are always taken for further production of diagnostic models of the jaws, occludedograms are performed.

To assess the condition of the temporomandibular joint, orthopantomography, ultrasound, X-ray of the TMJ, and computed tomography of the TMJ are performed. As a rule, an MRI of the TMJ is performed to detect damage to the periarticular soft tissues. By dopplerography or rheoarthrography, indicators of arterial hemodynamics are determined. Electromyography, phonoarthrography, gnatodynamometry as functional studies are of the greatest importance in TMJ dysfunction.

, for the correct treatment of VMO dysfunction, it should be distinguished from subluxation and dislocations of the lower jaw, arthritis and arthrosis of the TMC, fracture of the articular process, etc.

Treatment of VMO dysfunction

The main treatment of VMS dysfunction requires a decrease in the load on the integral-nominal joint (intake food, reduced speech load). Based on the causes and associated disorders, the treatment of TMJ dysfunction involves the participation of several specialists: dentists (therapists, orthopedists, orthodontists), chiropractors, vertebrologists, osteopaths, neurologists, psychologists.

In order to eliminate the pain syndrome that accompanies TMJ dysfunction, pharmacotherapy is used (antidepressants, sedatives, blockades, intra-articular injections of glucocorticosteroids), myogymnastics, massage, physiotherapy (laser therapy, inductothermy, electrophoresis, ultrasound, etc. ) . It is extremely important in complex therapy to conduct psychotherapy and biofeedback therapy, which allow you to achieve the necessary relaxation of the masticatory muscles.

Dental treatment of TMJ dysfunction, depending on the indications, includes measures necessary to restore the correct closure of teeth (selective grinding of teeth, removal of oversized fillings, correct prosthetics or reprosthetics, etc.). Correction of malocclusion is carried out with the help of braces. Often, before orthopedic and orthodontic treatment of TMJ dysfunction with fixed devices, orthopedic splints or caps are prescribed.

In the absence of the effect of conservative therapy for TMJ dysfunction, surgical treatment may be required: myotomy of the lateral pterygoid muscle, condylotomy of the head of the mandible, arthroplasty, etc.

Prognosis and prevention of TMJ dysfunction

Treatment of TMJ dysfunction is a must and the sooner the better. If this problem is neglected, it can be fraught with various complications, for example, arthrosis (development of dystrophic changes), and in some cases ankylosis (immobilization of the temporomandibular joint).