Sometimes caused by injury but more often appearing without warning or obvious cause, TMJ is one of those physical annoyances that can crop up in the human body. However, the condition is not a sign of serious illness, and most symptoms will go away without needing major treatment in most cases.
The lack of a need for any treatment is actually a good thing because scientists still don’t know what to do about the condition. There is currently no scientific research that shows what treatments work and which don’t. In most cases, even persistent ones, the current recommendation is watchful waiting and hope that the symptoms and pain go away on their own, with pain medication and recommendations on stress reduction the most commonly prescribed methods of dealing with the condition.
That’s not to say that TMJ isn’t annoying. The symptoms can include pain, ringing in the ears and migraine headaches. It is estimated that three-fourths of Americans have one or more of these symptoms at one time or another, and about 5 to 10 percent of those need a doctor’s attention, if only to abate the pain. Because there is no sure-fire treatment, many patients who seek relief sometimes are convinced to undertake comprehensive and costly treatments that do little to help them find relief.
How the Jaw Works
The TMJ has a hinge and a sliding mechanism. When you open your mouth, the rounded ends (called condyles) of the lower jaw slide along the sockets of the temporal bone. The muscles connecting the jaw and this temporal bone allow chewing and other jaw movements, with a soft disc in between absorbing shock to the jaw caused by chewing and other movements.
When first studied, scientists believed that TMJ was caused by dental malocclusion, the fancy name for misaligned upper and lower teeth that affected jaw movement. That led to treatments that called for replacing missing teeth and using braces to change how the jaw moved.
Further studies revealed that malocclusion was not the cause of facial pain and other TMJ symptoms. Today, although there’s still no definitive research, it is widely believed that TMJ results from a host of symptoms that work in some mysterious conflict. These causes include behavioral, environmental, emotional, cognitive and social factors, all combining to create temporomandibular disorders. The one thing most research scientists agree on is there is no single cause of TMJ.
The mechanics of TMJ are traced to developmental or congenital abnormalities of the jaw, the movement of the shock-absorbing disc in the jaw bone, arthritis or other inflammation that affects the jaw, any major injury to the jaw area, infections, tumors, and a slack jaw or excessive tightness. You can even blame opening your mouth too wide for causing the symptoms, researchers say.
TMJ Complaints
The most common complaint generated by TMJ sufferers is myofascial pain disorder, which afflicts the chewing muscles. This is described as a dull pain that originates around the ear and sometimes travels to the side or back of the head, or may be experienced further down the neck. Patients with this variation of TMJ complain of difficulty opening or closing their mouth, have achy jaw muscles, and claim to hear clicking or popping sounds in their jaw. When they chew or yawn, the pain becomes worse.
While modern medicine offers no real cure, physicians dealing with the complaint will likely prescribe some mild pain medication and inquire about patient habits that may cause TMJ symptoms. These can include teeth grinding at night, biting fingernails or lips, jaw clenching, gum chewing, or chomping on a pencil or other hard and unforgiving object. If none of these are blamed, then such psychological factors as depression, anxiety or stress are examined.
Strangely, most TMJ complaints come from women, who represent about 90 percent of cases. Most of the women are middle-aged adults.
TMJ Treatments
Doctors will often request an MRI or CT scan with a cone-beam image to obtain an inside view of the joint. Depending on the problem's severity, doctors may refer patients to a clinic specializing in TMJ issues, many of them at leading research hospitals and dental schools.
Based on patient feedback, doctors will tell patients to stop bad habits that may exacerbate TMJ problems. These include keeping the mouth open at a reasonable degree (holding a fist under the chin may help) and avoiding laughter or hard chewing that may cause a wider opening. In extreme cases, a soft-foods-only diet may be recommended for a time, along with warm compresses and anti-inflammatory medication.
Doctors may recommend not sleeping on the jaw, avoiding playing musical instruments that may aggravate the jaw’s condition, and physical therapy to realign the spine, jaw, head and potentially tongue. Diathermy or ultrasound treatments may also help.
Some patients use a low-dose antidepressant or anti-anxiety medication. Used in combination with stress-relief therapies like meditation, yoga, cognitive therapy, biofeedback and counseling, the goal is to relax patients and help them deal with stress. Patients may be required to wear a night mouth guard to prevent teeth grinding.
The final option for treatment may be surgery, but that’s usually performed when some congenital malformation in the jaw is discovered or if arthritis has caused bone fragmentation that requires jaw reshaping.
No single treatment is right for sufferers of TMJ, and scientists strongly advise against exotic or costly treatments that likely won’t ameliorate relieve symptoms. Many patients who have tried orthodontics, crown and bridge work, or repositioning splits to change the bite, find that nothing has changed. Before undergoing any procedure that may alter the jaw area permanently, get several opinions from doctors. That’s the prudent way to go on a condition that likely is temporary.