TMJ Disorders | Fairfield Sleep TMJ

TMJ Disorders (TMD) and Treatment Options

Patients suffering from TMJ disorder have varying degrees of the condition and will experience unique combinations of symptoms. Common complaints include:

• TMJ headaches
• neck pain
• teeth grinding
• ringing in ears (tinnitus)
• facial pain
• vision problems
• ear aches
• vertigo

Patients with TMD often grind their teeth (bruxism) to find a comfortable bite.

If you experience any one or more of these symptoms of TMJ disorder, call us TODAY for a consultation!

TMJ Disorder Symptoms and Causes

When a patient’s jaw joints or jaw muscles are irritated, there can be deviation of the lower jaw to one side on opening. This is called mandibular opening deviation. For various reasons, the human face does not always grow symmetrically. Facial asymmetry can cause TMJ problems. Continual jaw muscle spasm can cause muscle shortening with limited opening and severe jaw pain.

TMJ Headaches

Headaches are commonly seen in TMD sufferers. The most common TMJ headache is located on the side of the head over the area of the temple. This is called a temporal headache and is often misdiagnosed as migraine.

Ear Problems

The temporomandibular joints are located just in front of the ears. Tenderness and deep pain in the TM joints and surrounding areas can also cause ear ache and decreased hearing. With time ringing in the ears (tinnitus) can occur. Eventually, the middle ear can be affected causing vertigo or dizziness. These problems along with combinations of other TMD symptoms can cause difficulty sleeping (insomnia). TMD sufferers often have pain in one or both of the jaw joints and TMJ pain is common. The jaw joints may have clicking and popping noises.

Teeth Grinding

Because of uncomfortable jaw joints, many patients clench and grind their teeth. Patients who grind their teeth may experience dental hot and cold sensitivity. The clenching and grinding can cause over development of the supporting jaw bone. Bone bumps that grow horizontally out into the cheeks, in the middle of the palate, and on the inside of the lower jaw are called torii. These patients often have multiple root canals as a result of their teeth dying from the constant teeth grinding pressure.

Other TMD Symptoms

The imbalance of a TMD patient’s facial, chewing and neck muscles can cause difficulty swallowing. This is called dysphagia. Because of the instability of the jaw, head and neck, cervical problems are common. This can lead to occipital headaches located at the back of the head.

Bell’s Palsy and Trigeminal Neuralgia can also be TMJ disorder symptoms.

The Temporomandibular Joint (TMJ)

The joint connects the mandible (the moving part of our head) to the skull (the non moving part). It’s a ball and socket joint that has a piece of cartilage in between for smooth opening movements. When this cartilage gets damaged or worn, problems start to appear. There may be no symptoms, or a clicking sound in front of the ear, when the jaw is opened. For some, however, this can become very painful. TMD pain seems to affect more women than men, although both are affected. Symptoms include headache, muscle spasms, non specific jaw pain that usually radiates, inability to open wide, tiredness of the face and unexplained tooth wear and filling breakage.

Causes of TMJ Problems

Tension. One of the major causes for TMJ disorder is teeth grinding and clenching. Stress produces excess energy, which needs an outlet. This excess energy usually is dissipated via grinding, at night, or clenching during the day. Each produces extreme pressure on the muscles and the temporomandibular joint, ultimately resulting in the damage of the joint. Besides this wear facets, or worn areas on teeth caused by tooth on tooth contact, may start to appear, causing sensitivity in those teeth, especially during chewing. Tooth or filling breakage is common. The key is palliative treatment. Stress reduction is important, jaw exercises and biofeedback programs can be very effective. To protect the teeth a bruxism appliance may be recommended. This appliance can be worn at night or during the day when clenching occurs. It prevents tooth on tooth contact and prevents the force of the muscles to perform its isometric exercise during this time.

Parafunctional habits (biting habits). Parafunctional habits include fingernail biting, pencil chewing, ice crushing, etc. These activities put pressure on the TM joint, and also place the joint into unusual positions when force is applied. This can produce a myriad of symptoms, which can only be diminished via the removal of that habit.

Ill-fitting/worn dentures with loss of vertical support for the chewing muscles may result in muscle spasm causing facial pain, headaches, neck pain, etc. due to improper jaw function

Surgery. Accidents and arthritic changes can also cause TMJ problems. Surgery may sometimes be required to eliminate and alleviate the functional problems ,as well as the accompanying painful symptoms. Accidents can cause the TMJ capsule either to completely be pulled out of the ball and socket area or have adhesions form between the head and the capsular area, making it very difficult to move the mandible.

Eating and Swallowing – The TMJ Association

Eating and drinking are enjoyable activities that positively impact an individual’s quality of life and are also necessary for maintaining good nutrition.

The pain and jaw dysfunction associated with TMJ disorders can make chewing and swallowing food challenging. TMJ patients who also have eating disorders face even more challenges. How and what you are able to eat can influence your nutritional and health status – an aspect that is often overlooked by both patients and health care providers.

The TMJ Association asked patients their opinion on this topic. Here are a few comments:

“…Eating fruits, veggies, and health foods tend to be very hard on my jaw; I can get a headache just from eating an apple or a few carrots. I would much rather eat mashed potatoes and not hurt…”

“…There are days I am so hungry, but I know the price I will pay if I ‘chew’ the wrong foods…”

“…My daily food choices are very limited, due to the possibility of my jaw locking up while chewing crunchy or chewy foods…”

TMJ Nutritional Guide

The TMJ Association developed a nutritional guide, TMD Nutrition and You, specifically for people with compromised oral function to help them maintain a healthy diet in spite of their oral disability. Click here to download a free copy of our booklet!

Ongoing Research

Despite the pain and functional limitations commonly seen in Temporomandibular disorders (TMJ) affecting a person’s ability to chew and swallow, there is very little research on the relationship between TMJ, diet and nutrition.  

“While nutritional modifications are often a consequence of the “soft diet” component of most TMJ self-management programs, little evidence has addressed the benefits and adverse effects of addressing nutritional needs” (National Academy of Medicine Report on Temporomandibular Disorders).

To address these questions, a study, Persistent Temporomandibular Disorders and Dietary Changes: A Cross-sectional Survey, was begun in 2019 by a team of researchers at Newcastle University in the United Kingdom in collaboration with The TMJ Association. We thank the TMJ patients who participated and are pleased to share some preliminary results.

The aim of the study was to understand the impact of TMJ on diet and nutrition, which can lead to evidence-based guidelines for making healthy dietary choices. In total, 93 individuals drawn from 11 different countries completed the nutrition study’s patient questionnaire, with 70% from the U.S. Approximately half of those who completed the questionnaire went on to complete daily diet diaries; but only half of these completed diaries over the three consecutive days requested. The mean age of participants was 50.7 years old, most of whom were women. Over 95% had been diagnosed with a TMJ disorder by a healthcare professional.

Among the findings:

• 40% of all participants had undergone surgery
• The majority of cases had multiple surgeries
• Of all surgical interventions, closed surgery (such as arthrocentesis) was most common
• Most had surgery on both the right and left TM joints
• Over 75% of participants reported that they modify their food preparation because of jaw joint pain
• 72% cut their food into small pieces
• 4% and 40% boiled or mashed their food, respectively
• The majority of respondents had received professional treatment for their jaw pain
• Simple symptomatic advice (e.g. hot or cold compresses) was most common, followed by splint therapy and physiotherapy
• 65% of participants received medications for their jaw pain
• Less frequent was dietary advice
• Least reported was a referral to a nutritionist

The results of this study have been published, May 25, 2021 in the Journal of Oral Rehabilitation: Temporomandibular Disorders and Dietary Changes: A Cross‐sectional Survey.

Dysphagia. Causes of difficulty swallowing

Author

Zaika Lyubov Sergeevna

Leading physician

Gastroenterologist

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Dysphagia is a term used in the medical literature to describe difficulty swallowing. The word “dysphagia” is a two-part word derived from ancient Greek, where “dis” indicates denial or impossibility and “phage” means eating.

Some people may only have difficulty swallowing food, while others may have difficulty drinking liquids; and some people can’t swallow at all.

Symptoms associated with dysphagia include coughing or choking while eating or drinking, a feeling of food stuck in the throat or chest, and a tendency to spit up food.

With dysphagia, eating is difficult, which means that the sick person has difficulty getting the required amount of calories and nutrients. Ultimately, dysphagia can lead to weight loss, recurrent chest infections, and other serious complications.

Causes

Although anyone can have dysphagia, it is most common in infants, the elderly, and those with nervous system disorders. This pathological condition usually occurs due to a problem in the throat, and then speak of oropharyngeal dysphagia, or localized in the esophagus, and then it is defined as esophageal dysphagia.

In the case of oropharyngeal dysphagia, the contents of the oropharynx do not enter the esophagus in the correct way. Patients complain of difficulty swallowing, nasal regurgitation (food entering the nasal passages), and inhalation of food leading to coughing. This form of dysphagia usually occurs in people with a nervous system disorder or skeletal muscle disorder.

Causes of esophageal dysphagia

Esophageal dysphagia is characterized by difficulty moving food through the esophagus, usually due to some type of obstruction or dysmotility.

Below is a list of conditions that can interfere with the muscles and nerves that keep food moving through the throat and esophagus.

• Stroke
• Injury to the brain or spine
• Disorders of the nervous system
• Multiple sclerosis
• Post-polio syndrome
• Parkinson’s disease
• Muscular dystrophy
• Inflammatory diseases
• Polymyositis
• Dermatomyositis
• Scleroderma causing thickening and narrowing of the esophageal tissue.
• Spasm of the esophagus, which is a sudden contraction of the muscles of the esophagus, preventing the passage of food into the stomach.

Examples of conditions that can cause esophageal obstruction

• Gastroesophageal reflux disease (GERD), in which stomach acid moves up into the esophagus, causing ulcers and eventually scar tissue that narrows the lumen of the esophagus.
• Esophagitis is an inflammation localized in the esophagus that can be caused by infection, allergic reactions, or GERD.
• Tumors of the esophagus, which may be benign or malignant.
• Diverticula, which are small sacs that form in the wall of the throat or esophagus.
• Formations outside the esophagus that press on and narrow the esophagus.

Diagnostics

Dysphagia is diagnosed based on the patient’s complaints and physical examination. The doctor can also test the patient’s muscle strength, speech, and reflexes. The patient may then be referred to another specialist, which may be:

• an otolaryngologist who deals with problems in the ear, nose and throat;
• a neurologist specializing in problems with the brain, spine and nervous system;
• gastroenterologist – specialist in the digestive system;
• speech therapist

To establish the exact cause of dysphagia, the following may be prescribed:

• X-ray of the neck or chest;
• endoscopy, which uses a thin tube called an endoscope that is inserted down the throat to look at the esophagus, stomach, and duodenum. During this procedure, a biopsy, which is a sample of tissue, is sometimes also taken for analysis;
• laryngoscopy, in which a speculum or endoscope is used to look at the back of the throat;
• pH monitoring, which is used to find out how regularly stomach acid enters the esophagus, as well as how long it stays there.
• manometry, in which an endoscope connected to a computer is placed in the esophagus to measure pressure during swallowing.

Treatment

The approach to treating dysphagia depends on the underlying cause of dysphagia and its type. Various aspects of treatment may include speech exercises and language exercises, placement of a feeding tube, surgical interventions aimed at eliminating the narrowing (bougienage of the esophagus, plastic surgery of the esophagus, removal of neoplasms), adjusting the consistency of food so that it can be swallowed more safely and easily, and doing exercises that help train the muscles involved in swallowing to work properly.

People can also learn to position their body in a way that makes swallowing easier. With treatment, many cases of dysphagia improve, although a cure is not always achieved.

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Swallowing and dysphagia | Centro Coromina

SWALLOWING COORDINATES DIFFERENT STRUCTURES AND MUSCLES

Swallowing disorders: how to correct them?

SWALLOWING AND DYSPHAGIA

What is swallowing and dysphagia?

Swallowing is the passage of food from the mouth to the throat and from there to the esophagus. The process of swallowing food involves rapid coordination of the muscles and organs involved, as one by one a set of voluntary and involuntary motor processes in the body, regulated by the nervous system, is performed.

Dysphagia (impaired swallowing or difficulty in swallowing) occurs when any of the elements involved in this process, does not perform its functions correctly .

The disorder is manifested by difficulty or inability to swallow food or liquid and is accompanied by a sensation of food stuck in the mouth or throat.

In many cases, the onset and progression of dysphagia is so slow that some patients do not pay enough attention to the disorder, which worsens over time. Therefore, it is strongly recommended to carry out early diagnosis and start treatment as early as possible.

Types of dysphagia

Types of dysphagia differ depending on the location of the violation in the process of swallowing. The following types are distinguished:

• Oropharyngeal dysphagia: violations are in the region of the pharynx . With this type of dysphagia, difficulties appear at the beginning of the act of swallowing . Aspiration of food into the trachea may occur, causing coughing, vomiting, pain, a feeling of constriction or choking, heartburn, and belching.
• Esophageal dysphagia : Difficulty swallowing occurs in the region of the esophagus .

What are the causes of dysphagia?

Swallowing disorders can occur due to various diseases:

• Diseases of the pharynx and oral cavity (acute tonsillitis, pharyngitis and fungal infections such as aphthae).
• Diseases of the esophagus (esophageal diverticulum, achalasia).
• Neurodegenerative diseases (multiple sclerosis, Parkinson’s disease).
• Diaphragmatic hernia.
• Foreign body aspiration.
• Dementia .
• Other causes include neoplasms of the esophagus, cancer of the esophagus, neurological disease, and stroke.

How is dysphagia diagnosed?

First of all, it is necessary to carry out a complete examination of patient .