Temoromandibular Joint Syndrome

The fact that humans need to speak and eat makes the jawbone one of our busiest moving parts. The twin joints that connect the lower jaw, or mandible, to the temporal bones of the skull are relatively simple hinges with small disks of cartilage to protect the bony surfaces that rub against each other. The jawbreaking term for pain or discomfort in this area is temporomandibular joint (TMJ) syndrome, or myofascial pain dysfunction.

As many as two-thirds of Americans exhibit symptoms of TMJ at some point in their lives, when something as simple as a wide yawn or eating a chewy bagel sets off facial pain or jaw popping. This temporary condition usually resolves itself without treatment or responds quickly to rest and painkillers. In some instances, though, patients feel pain that radiates through the face and around the neck and shoulders, a chronic pattern of TMJ that results from other conditions. Most temporary TMJ discomfort can be helped with inexpensive, at-home remedies; but for a few TMJ sufferers, persistent and sometimes unbearable pain is a serious problem requiring medical treatment. Unfortunately, some health insurers insist on labeling TMJ as a dental rather than a medical problem and object to paying for treatment, a fact that can sometimes discourage sufferers from seeking available help and relief.

Causes

Most cases of TMJ are due to excessive strain on the jaw muscles, a displaced disk, or degenerative joint disease - sometimes in combination. The most common cause is strain to the temporalis muscles that open and close the jaw. The strain can stem from unconsciously clenching or grinding the teeth or jutting the jaw forward, as well as from a poor bite caused by misaligned teeth or poorly fitting dentures.

Displacement of one or both of the disks in the jaw's hinges can result from a sudden blow or injury to the head, or simply from hard chewing or a wide yawn. Usually the displaced disk slips back into position without permanently harming the jaw. If such dislocation happens often, however, the jaw may start to pop or click when opened, and the joint may become inflamed, stiff, and painful. The effects of degenerative joint disease are similar: Osteoarthritis or rheumatoid arthritis inflames the joint, causing pain and stiffness. On rare occasions, malnutrition in children can lead to bone deformities that cause TMJ.

Treatment

Taking a painkiller may ease the inflammation and relieve the pain of TMJ but does not get to the underlying cause of the problem. TMJ sufferers need to assess their entire lifestyle - from potentially avoidable day-to-day stresses to eating foods that strain the jaw. In cases where tooth alignment is at fault, you need to see your dentist.

Conventional Medicine

Most doctors tell people with mild TMJ to take an over-the-counter analgesic, massage the area, and limit talking and chewing for a few days - resting the jaw by eating soft or liquid foods. More painful or chronic conditions may require treatment by a dentist, physical therapist, orthodontist, oral surgeon, or behavioral specialist.

Some people unconsciously grind their teeth while sleeping, a condition called bruxism. A dentist can diagnose that problem and fit the patient with a bite guard or splint. A doctor who suspects that TMJ is caused by excessive muscle strain may prescribe a muscle relaxant such as diazepam to relieve pain and tension. Since TMJ can be a chronic condition, however, a patient should not rely on such prescription drugs for long-term relief, because of the risk of addiction.

Physical therapy may relieve pain and restore jaw mobility in some cases of TMJ. A physical therapist may recommend massage, moist-heat compresses, ultrasound, or stimulation by interferential electric current to promote circulation and to relieve pain and stiffness. To improve the jaw's range of motion, a therapist may use stretching exercises and may recommend the spray-and-stretch technique, in which the face is sprayed with a numbing coolant and the jaw muscles are stretched. Other physical therapy options include short-wave diathermy and laser treatments. The waves from such treatment reach much deeper than moist-heat applications, and the undulating pressure works like a massage, increasing blood flow to the affected area and reducing inflammation and pain.

Doctors recommend surgery only for extreme cases. The least invasive form, arthroscopy, involves inserting a fiberoptic tube through a small incision and using it to reposition the disk. If arthroscopy fails, open TM joint surgery may be necessary; this entails completely exposing the area and may include a joint replacement. Before making a commitment to surgery, however, a patient should explore all options, potential complications, and side effects and should get a second opinion from another qualified surgeon.

Alternative Choices

Various alternative therapies can be effective in treating TMJ. A number of herbal remedies may act as sedatives or relax muscles to ease the pain. Many medical doctors acknowledge biofeedback's success rate for controlling stress-related TMJ.

Acupressure

For patients who feel squeamish about acupuncture needles, acupressure offers a gentle alternative. The acupressure therapist presses points on the stomach meridians, which pass through the area where muscle spasms, stiffness, and pain associated with TMJ are most apt to occur.

Acupuncture

Acupuncture works by relaxing the muscles, which makes it effective for TMJ symptoms that are caused by stress. Like an acupressurist, an acupuncturist will treat points on the stomach meridians for stress-related TMJ, because those meridians pass through the temporomandibular joints.

Body Work

When tension is believed to play a role in TMJ, massage therapy may provide relief. Two areas can be massaged: One runs from just above and slightly forward of the top of your ear over to your temple; the other is on your jaw about an inch in front of your earlobes. Place a finger on either of these areas, and then open and close your jaw, pressing your teeth together slightly when the jaw is closed. You will feel a muscle pop in and out as it contracts and relaxes. Place your thumb or your index and middle fingers on these areas, and massage lightly in little circles. Doing this for a minute or two at each spot can help relax muscles that cause tension around the joint. For more severe cases of TMJ, consult a professional massage therapist. Techniques that have been reported to help TMJ are deep-tissue massage, neuromuscular massage, Rolfing, and craniosacral work.

Chiropractic

Chiropractic therapy is recommended for TMJ caused by muscle overuse and strain, rather than by joint damage as in a patient who develops TMJ after whiplash injury in a car accident. A chiropractor not only treats the patient's back and body alignment, but may also use physical therapy, interferential current, ultrasound, or diathermy on the affected joint, any of which can help relax the area and allow the chiropractor to stretch the muscles and manipulate the jaw.

Hydrotherapy

A few drops of the essential oils of lavender (Lavandula officinalis) or St.-John's-Wort (Hypericum perforatum) in warm bathwater may help you to relax. To reduce inflammation of the TM joints, apply hot and cold compresses. Start with a hot towel for three minutes, then switch to a cold towel for half a minute; repeat two or three times a day for chronic conditions, or more frequently if acute.

Mind/Body Medicine

While relaxation techniques, hypnotherapy, and guided imagery can all alleviate the symptoms of TMJ, biofeedback is the most effective mind/body treatment for TMJ. Biofeedback is a drug-free, noninvasive approach to eliminating tension and controlling stress-related pain, and can be self-administered after training by a professional therapist. Using electrical readings from the muscle that moves the jaw, practitioners can train a patient to control the tension in the overall area. Studies have shown that biofeedback works especially well for chronic TMJ sufferers and may help reduce pain and minimise clicking for a longer time than other treatments.

Nutrition And Diet

It is important for TMJ sufferers to reduce strain on jaw muscles and joints. Avoid hard foods like raw carrots and apples, and chewy foods like steak and bagels. If the pain in your jaw becomes really unbearable, try fasting or putting yourself on a liquid diet for a day or two; this is especially effective if you also limit talking to when it's absolutely necessary.

From a nutritional standpoint, TMJ patients should consider taking appropriate dosages of bromelain, or the bioflavonoid pyncogenol in combination with vitamin C, to reduce inflammation; calcium/magnesium tablets for muscle spasms; or B-complex vitamins to relieve stress.

Osteopathy

Besides recommending proper dental work, physical therapy, or biofeedback, an osteopathic physician may also use hands-on techniques to help increase the range of motion in the head, neck, shoulders, and upper back. You may be able to find an osteopathic doctor who specializes in TMJ.

At-Home Remedies

No matter what causes occasional TMJ, you can take aspirin or a nonsteroidal anti-inflammatory drug (NSAID) to relieve the pain. If you have an unexplained, persistent headache that's relieved when you put an ice-cream stick between your teeth, you probably have an alignment problem in your jaw area. Stress-related TMJ usually responds well to at-home remedies. But if your pain is caused by poorly aligned teeth or damage to the joint, do not go on a steady painkiller regimen; see a doctor or dentist. Some other suggestions:

Massage the band of muscles just above and in front of your temples, as well as the larger muscles along your jaw line. Use small circular motions and repeat as needed.

Mouth guards for football and hockey players might help mild cases of TMJ due to bruxism (teeth grinding). You will find the guards in sporting-goods stores. Soften the plastic mouthpiece in warm water, then bite down straight and hard to make an imprint of your teeth. Allow the impression to set, then put the guard between your teeth at night when you sleep. If pain or grinding continues for any length of time, see a doctor.

Prevention

To prevent TMJ from unconscious muscle strain or uneven pressure on the jaw, do not sleep with your head tilted or with the entire weight of your head concentrated on your chin - a common practice among people who sleep on their stomachs. Try sleeping on your side, or on your back without a pillow.

Whenever your jaw hurts, stay away from foods that are hard to chew, and minimise talking.

If you feel tension in your jaw every morning, you may be unwittingly clenching or grinding your teeth. See a dentist or orthodontist about the advantages of being fitted with a bite guard.

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