You have likely heard a friend, colleague or family member say that he or she has TMJ. The person experiencing the pain associated with TMJ may cup his/her hand to the side of the face as symptoms are described to the listener. If you've not had the agonizing experience of feeling stabbing pain or difficulty opening and closing your jaw, count yourself lucky. This is a condition with a prevalence of 5-12% of the population which is unusually high for chronic pain disorders. It is most common in women between 20 to 40 years of age.
What is TMJ?
Let's first clarify....what is TMJ?? We are born with two temporomandibular joints, often abbreviated TMJ. This is the joint on both sides of your face located just in front of your year. Your TMJ allows your mandible (aka your lower jaw) to function with the temporal portion of your skull. Without the ligaments, fibrocartilage disc and muscles of this bilateral joint, your lower jaw would have no ability to guide the critical movements of swallowing, eating and speaking.
When someone makes a comment that they have TMJ, what he or she is referring to is a condition more commonly known as TMJ dysfunction. In the world of dentistry, we would casually refer to this as TMD. Think of it like having knee, hip, elbow or shoulder pain. There is one huge difference between your jaw joints and the others previously mentioned....the jaw joint is a bilaterally functioning joint and it is the only one in the body to work this way. That means both sides work together and when one is hurting it is difficult to compensate by relying on the other. For example, if you hurt your knee, you can limp along putting more weight on the good knee. This is impossible with the jaw and can lead to a very frustratingly long recovery period. Plus unlike other joints that can be forced to rest when injured, the jaw rarely gets a break because we still need to eat, speak and swallow.
Temporomandibular Disorder
Temporomandibular Disorder can present in a multitude of ways sometimes making it difficult to isolate the actual problem. I most commonly see patients with this condition as their second or third visit to a healthcare provider. Often people will experience pain in and around the ear making them think they have an ear infection. Headaches, painful chewing, muscle soreness, toothache and tinnitus are other symptoms that can be noticed. Due to the broad range of painful territory, patients are sometimes lead down a path unrelated to the actual problem.
Once a patient has exhausted a medical contribution to their pain, they eventually may seek guidance from the dental provider. In a world of give me a quick fix, dentistry has mainly focused on something called splint therapy and pharmaceutical drugs like muscle relaxers and/or BOTOX to initially address a patient in pain. These tend to work quite well as a primary treatment consideration but don't always bring long term relief. When we identify a patient with TMD, our first step is to fabricate an appliance that is worn either on the upper or lower arch and indicated for use during sleeping hours. Some extreme cases may be encouraged to wear their splint 24 hours per day only to be removed when eating. These splints are kind of like crutches for the jaw. It forces the jaw into a neutral position and reduces the amount of force applied to the jaw when clenching.
Bruxism
A distinction must be made between TMD and a very common condition known as bruxism. A fairly broad portion of the population (around 30% of adults and my personal experience with patients would suggest that number is likely a bit higher) has the habit of clenching or grinding their teeth either during sleep or while awake that produces no jaw pain. These patients are commonly treated with the same splint therapy as used with TMD. The splint is indicated as an intervention to reduce tooth erosion and wear. In some cases, the splint is recommended prophylactically to avoid the more serious condition of TMD.
Treatment
Unfortunately, like most things, there is not a one size fits all fix to this very complex problem known as TMD. An oral splint is just a Band-Aid for a larger problem: joint dysfunction, sleep apnea, poor oral or bodily posture, stress and muscle fatigue are just a few underlying conditions that can impact the TMJ with pain and soreness. In an effort to make a positive long term impact, patients who suffer from TMD may consider acupuncture, massage therapy, postural physical therapy, chiropractic care, myofunctional therapy and/or orthodontic treatment.
Individuals having an acute experience with TMD may benefit from some conservative home remedies. I generally recommend that patients use an NSAID like Advil taken as directed to initially address the inflammation. I encourage patients to apply heat and/or ice to the area. When your body is struggling with TMJ pain, some individuals feel relief from heat and others to ice….listen to your body. Try to manage a soft diet and limit wide opening (ie yawning). Self massage with applied pressure to the tender area performed a couple of times/day. Yoga and breathing exercises might also help release muscle tension and bring focus to the body.
Posture, posture, posture!
Your head and neck posture may be the key to prevention! We are living in a world of forward head posture and slouchy shoulders. Poor posture places unwanted pressures on our joints and can be a key player on the development of TMD, back and neck pains.
When you are sitting at your desk, driving in the car or scrolling on your phone:
try to pull your shoulders back by moving your shoulder blades toward your spine.
align your head so that your ears are directly over your shoulders.
relax your jaw muscles, place your tongue in the roof of the mouth
be sure your teeth are slightly apart with your lips gently touching
Now that you have established proper head posture, breathe in through your nose. When you breathe in, breathe in deeply to expand the diaphragm. If you are breathing properly, your shoulders and chest should not move. You should feel the expansion in the area below your ribs. Proper breathing helps to engage the parasympathetic nervous system (think rest and digest). When we breathe through our mouth or breathe shallowly, we engage our sympathetic nervous system (think fight or flight).
I recommend that patients attempt to bring awareness to their posture on an hourly basis. It can be helpful to set a timer on your phone or watch to gently remind you to examine how you are holding your body. After some time of practicing this, it will become more natural to hold yourself in alignment.
Complex Systems
If this is something you have experienced or are currently enduring, getting to the root cause of your condition allows the body to heal naturally and rely less on interventional therapy like pharmaceuticals and appliances.
Hopefully your provider has established working relationships with clinicians outside the world of dentistry. The more I read and learn, the more convinced I am that we may not be able to rely solely on our individual training. The body is a complex system and most conditions are best treated with a holistic approach to care.
Thanks Jessica! I wish you could be my dentist
Very informative... thank you.