Temporomandibular Joint (TMJ) Disorders

Temporomandibular joint (TMJ) disorders are an umbrella of problems, mainly inflammation characterized by pain, related to the TMJ of the manbible. The TMJ is no different to any other joint in the body, being susceptible to types of musculoskeletal problems such as arthritis, ankylosis, and dislocations. Typically, the underlying etiology is dysfunction of the muscles of masticastion (chewing), thus causing various forms of displacement of the disc of the TMJ joint.

 The most common symptoms of TMJ dysfunction include:

  • Ear pain
  • Headache (typically in the AM)
  • Pain with chewing
  • Popping with jaw opening
  • Reduced opening of the mouth
  • Facial Pain
  • Pain along mandible and facial-neck muscles
  • Hearing loss
  • Tinnitus

The typical causes of TMJ problems are:

  • Bruxism – unconcious and repetitive clinching of teeth, often at night during sleep

  • Bite collapse – loss of hieght of mandible, typically due to dental extractions and aging

  • Degenerative joint disease – arthritis

  • Parafunctional habits – gum chewing commonly irritates the joint

  • Myofascial pain syndrome – Tension headaches

  • Dental mal-alignment and poorly fitting dentures

  • Head and neck trauma

Once the diagnosis is made, there are 2 main treatment strategies. The first is to treat the acute exacerbation with warm massage 3 times daily, NSAIDs (often Ibuprofen 400-800mg with breakfast and dinner for 1-2 weeks) for pain control, avoid gum chewing and eating a softer diet for 1-2 weeks. The second realm of therapy is aimed at preventing further problems, and this often requires a formal dental evaluation. Using a nighttime bite guard, which can be made by a dentist or orthodontist, is very helpful for patients who experience bruxism. Although uncommonly needed, a small group of patients will need orthodontics (braces) or oral and reconstructive surgery by an oral surgeon.

Robert Wilson, MD

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