DANIEL J. JOHANEK, D.D.S.
TMJ disorder describes a variety of conditions affecting the Temporomandibular Joint.
This is the point where the lower jaw connects to the skull, right in front of the ears. About ten million Americans who suffer from such seemingly unrelated symptoms as headaches, earaches, tenderness of the jaw muscles, or dull, aching facial pain often share a common problem. They all suffer from what has come to be known as temporomandibular joint (TMJ) disorders. These conditions and associated problems are now more readily diagnosed and treated, than in the past.
What causes TMJ?
Oral habits and problems with the bite often work together to cause TMJ disorders.
As researchers learn more about facial pain and headaches, they are discovering that a number of things can trigger the pain, including certain foods, stress, clenching and grinding teeth, a condition called "bruxism", even poor posture.
TMJ disorders often result when the chewing muscles and the temporomandibular joint do not work together correctly. When this occurs, the muscles often cramp. This spasm can then become part of a cycle that results in tissue damage, pain and muscle tenderness.
Most people don't associate headaches with dental problems.
Although accidents such as injuries to the jaw, head or neck, or diseases such as arthritis, may result in some TMJ problems, factors relating to the teeth and bite are believed to be more common causes of TMJ disorders.
Among these factors are the following:
Oral habits such as clenching the teeth or grinding the teeth.
These habits can tire the muscles and cause them to go into spasm. The spasm causes pain, which in turn causes more spasm. The end result of this spasm-pain-spasm cycle may eventually be a TMJ disorder. Many people unconsciously "clench" their teeth during the day, often in response to unperceived environmental stress.
Problems in the bite or the way the teeth fit together.
Improperly aligned teeth can sometimes place the chewing muscles under stress and cause them to go into spasm, thus setting off the harmful cycle described above.
What are the symptoms of TMJ?
Some of the most common signs and symptoms of TMJ disorders include the following:
- Pain in or around the ear. This pain often spreads to the face.
- Tenderness of the jaw muscles.
- Clicking or popping noise when one opens or closes mouth.
- Difficulty in opening one's mouth.
- Jaws that "get stuck," "lock," or "go out."
- Pain brought on by yawning, chewing, or opening the mouth widely.
- Certain types of headaches or neck aches.
Dr. Johanek can determine the cause of your symptoms by conducting a series of diagnostic tests.
These may include a complete medical history, a clinical examination, X-rays, and casts of your teeth. Dr. Johanek may refer you to a physician or a specialist. This procedure may seem time-consuming, but proper diagnosis is an important step before treatment. It can save time and money by ensuring that you receive the treatment appropriate for your particular problem.
How can these symptoms be treated?
Treatments vary since the teeth, chewing muscles and temporomandibular joints all can be involved in a TMJ disorder.
Dr. Johanek will decide what type of treatment is needed for your particular problem. Often, treatment will involve a series of phases. This step-by-step plan is in your best interest because only minor corrective treatment may be needed. If pain and other symptoms persist, a more involved treatment, such as changing the way your teeth fit together, or even surgery, may be needed. However, surgery is recommended only when a precise cause of the disorder has been pinpointed and usually should not be undertaken until more conservative treatments of the disorder have been tried first.
Some common methods of treating TMJ disorders are listed below:
Elimination of Spasms and Pain
This can be done by applying moist heat to the face, using prescribed muscle relaxants or other medications, massaging the muscles, and eating soft, non-chewy foods. These are especially helpful for acutely painful flare ups. Bite plates or occlusal (bite) splints can also be made. This treatment helps to eliminate the harmful effects of clenching or grinding the teeth. Bite guards/splints are more helpful over time to prevent acute flares.
Correcting the Way the Teeth Fit Together
If your bite is incorrect or uneven, it can be adjusted by selective grinding of the teeth. Orthodontic appliances (braces) and other dental procedures may also be used to reduce problems caused by improperly aligned teeth. Crowns may also be made to correct the bite
Physical therapy or Biofeedback/Relaxation Training
If emotional stress is one of the factors that causes clenching or grinding of the teeth, reduction or elimination of that stress is important. Biofeedback, and relaxation training teaches people to control stressful tension throughout various parts of their body. This will also be helpful in reducing muscle tension in the jaw.
If muscle spasms have occurred for long periods, the TMJ itself may become injured or arthritic. In addition the bones and soft tissues of the TMJ may slip out of normal position because of trauma such as a blow to the head, or some other cause. Occasionally, in cases such as these, surgery may be needed to correct the TMJ problem.
Who is more likely to get TMJ?
According to the National Institutes of Health, over ten million Americans suffer from TMJ disorders.
Both males and females can get TMJ disorders. However, 90% of those seeking treatment for TMJ are women, most between puberty and menopause. A study conducted by Dr. Linda LeResche, University of Washington in Seattle , demonstrated that women on hormone replacement therapy were 77% more likely to seek treatment for jaw pain than those not undergoing such treatment. Also, women on oral contraceptive therapy were 19% more likely to seek treatment.
Approximately one-third of people over the age of fifty have signs of osteoarthritis in their jaw joints. It is believed that since osteoarthritis is a normal part of the aging process and affects most joints in the body, it may also have affects on temporomandibular joints.
In order to properly diagnose TMJ, the first step is a through dental exam.
Secondly, the treatment may vary from reshaping the teeth, to wearing an appliance (night guard), to orthodontics, or full mouth reconstruction, depending on the cause of the symptoms. Dr. Johanek has been trained and taken numerous courses given by some of the most knowledgeable and renowned doctors regarding TMJ, neuromuscular dentistry and symptoms of the head, neck and facial pain.