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Read NY Times article: TMJ Do's and Don'ts
Images of TMJ anatomy from Google Images
I recommend you
view the one labeled "TMJ Pathophysiology" where you can see two short
Simulated real-life films: one of a normal functioning TMJ, and the second showing a TMJ with
typical "Disc" problem causing a click in the joint---Excellent!
When you get to the TMJ page of images using the link above, look for the
image you see below.
TMJ: Patient's right side
What is TMJ?
The letters TMJ are an acronym that stand for the words Temporal-Mandibular
Joint. This is the joint that operates the opening and closing
of your mouth.
The joint is composed of a part of the skull
called the Temporal bone, the lower jaw bone called the Mandible which is
connected to the Temporal bone. Lying between the Temporal bone and the
Mandible is a disc of cushioning material controlled by the muscles that
help to open the mouth.
You can feel the joint by putting your index
fingers just in front of your ears and opening and closing the jaw
(mandible). The right and left side together comprise the TMJ. However,
doctors often call the pain you feel around the joint when you are under
tension and stress "TMJ".
They will tell you that "you have TMJ". There are
two basic kinds of TMJ problems: The first kind is related to pain that
comes from some disorder of the parts inside the joint. This kind of
disorder is much less common than the pain that originates in the muscles
just surrounding the joint that help to open and keep the jaw closed.
A common example of this kind of pain/disorder
occurs when you are under a great deal of stress and you begin to clench and
grind (brux) your teeth , not only during the day but at night in your
sleep. This extra ordinary (para-functional) chewing puts a great deal of
stress on your TMJ. The muscles that hold the mouth closed go into a kind of
painful spasm which can be very painful. The treatment is very simple: allow
the jaw to rest, among many methods that are useful.
Orthodontists can often diagnose the problem easily
because patients report that upon waking their jaws hurt. A simple removable
device called a bite plate is usually very helpful to alleviate the pain. In
some cases just limiting the jaw from making its maximum movements gives the
TMJ and the muscles that create jaw movement a chance to rest can lessen TMJ
pain over time.
TMJ Pain: What you can do right now
1. You can take 2
Advil liqui-gel tablets every 6 hours for 2-3 days (Advil contains
200 mg. Ibuprofin (NSAID-non steroidal) and
Aspirin (beware of allergies) This will relieve pain and begin reducing
any inflammation within the joints.
2. Do not open your mouth more than 1/4": That means for the time being you
must talk "small" (lips
very near each other when you are speaking).
3. For the time being do not chew gum at all.
4. Eat mushy foods; do not eat any thing that requires you to chew.
5. Be very careful when you sneeze or when you yawn.
6. Avoid any intimacies that require you to keep your mouth open (wide) for
a prolonged period of time
7. More than likely one of the muscles that draws your mouth open is cramped
(in spasm) as a result of you clenching your teeth tightly together during
the day and or evening when you are sleeping in effect preventing your jaw
muscles from relaxing as they should normally do.
8. The object
of treatment for this common problem is to reduce stress (easy to say)
and get you to stop clenching on your back teeth.
The variety of treatment methods can make your head spin. The most commonly
use device that I know of is a simple bite plate which can be worn 6-12
weeks. The fee for a bite plate can vary between $685 and $1185.
9. Sometimes the pain is caused because the crookedness of your teeth so you
need to know if that is part of the cause.
10. What you must certainly find out is whether the cause of the pain is
from a cavity or abscess in and around your teeth back.
11. Consequently it wise to visit a dentist. Even better,although I am
biased, a consultation with an orthodontist might serve you better.
12. This type of problem is not within the expertise of a chiropractor,
13. Sometimes the problem is not caused by a spastic muscle, rather it is
caused by what dental professionals call an "internal derangement"
of the TM Joints i.e. a problem I liken to "Tennis Elbow" or a knee joint
problem wherein some part of the joint within is in disrepair.
14. When your
jaw has limited opening or cannot close "normally"
more likely your problem is more serious. Your Jaw tends to deviate
toward the side with the joint that has the problem.
15. A consultation for TMJ takes more time than other types of
consultations. I charge $125 -175 depend on how long I need to do a thorough
16. You can save a lot of time by preparing a written history of your
problem and be sure to bring any device you are currently wearing to help you with your
TM Joint discomfort.
17. You may also apply a heating pad (warm not hot) in the evening and
morning as long as time allows.
18. There a few medications specifically/commonly prescribed for the jaw
muscles to reduce spasm. One of these is
19. There are some meds that have an inherent side effect of causing the jaw
muscle to go into spasm. Consequently, ask your physician
if your meds
have that effect or just look in your browser and ask : "What are the side
effects of (name of medicine) or
go to "Drug
Ecstasy, Cocaine and
are known to cause involuntary clenching.
21. Get to a dental
professional as soon if only to determine that 1.
That the source of the pain/dysfuntion is simple (muscle spasm of the
"internal pterygoid" or other chewing muscles) or 2. more complex i.e.
part of the TM Joint, (some part "INSIDE" the right or left joint) is in a
22. And to give you advice if
it would help to have a "CAT" or "MRI" Scan (X-ray) $250 -$750 of the right
and or left TM joints to get diagnostic information.
23. Your ENT (ear, nose and
throat) physician might also be a very good source of information because
there are few conditions of the ear that can mimic TM pain.
Orthodontic Jaw Wiring: To limit excessive opening and movement of
the jaw thereby allowing it to rest.
The OJW position of physiologic
Is a parted resting position of the mandible at which the
muscles of mastication are in a minimally contracted position
thereby allowing the lower jaw to be suspended from the
Interocclusal wiring allows the mandible to move 2.0mm- 4.0mm
laterally, vertically and antero-posteriorly thereby minimally
impeding speech and minimizing the possibility of temporo-mandibular joint
(TMJ) stiffening. This position is often congruent with an
observable interocclusal space of 2.0mm to 4.0mm and closely
approximates the position we know as the "physiologic jaw
resting" position, the initial position from which all jaw
(It is this condition of jaw "weightlessness" that precludes
the possibility that the upper/lower teeth are extruded during
the time the OJW device is in place.).
Here is an overview of the problem as published in an American Dental
What are the limitations
for normal movement of your jaw?
you should have no difficulty doing as this photo demonstrates:
More than fifteen percent of American
adults suffer from chronic facial pain.
Some common symptoms include pain in
or around the ear, tenderness of the
jaw, clicking or popping noises when
opening the mouth, or even headaches
and neck aches.
Two joints and several jaw muscles make it possible to open and close the mouth. They work together when you chew, speak, and swallow. These structures include muscles and ligaments, as well as the jaw bone, the mandible (lower jaw) with two joints, the TMJ’s.
The TM joint is one of the most complex joints in the body. Located on each side of the head, these joints work together and can make many different movements, including a combination of rotating and translocational (gliding) action, used when chewing and speaking.
Several muscles help open and close the mouth. They control the lower jaw (mandible) as it moves forward, backward, and side-to-side. Both TM joints are involved in these movements. Each TM joint has a disc between the ball and socket (see diagram). The disc cushions the load while enabling the jaw to open widely and perform rotating and translocational movements. Any problem that prevents this complex system of muscles, ligaments, discs and bones from working together properly may result in a painful TMJ disorder.
Diagnosis & Treatment
A dentist can help identify the source
of the pain with a thorough exam and
appropriate x-rays. Often, it's a sinus,
toothache or an early stage of periodontal
disease. But for some pain, the cause
is not so easily diagnosed. The pain
could be related to the facial muscles,
the jaw or temporomandibular joint, located
in the front of the ear. Treatments for
this pain may include stress reducing
exercises, muscle relaxants, or wearing
a mouth protector to prevent teeth grinding.
They've been successful for many and
your dentist can recommend which is best
Several conditions may be related to TMD, but they can be quite varied, and they are often difficult to pinpoint. TM disorders can result when the jaw muscles or jaw joints are affected.
The joint, ligaments, and muscles used for chewing and grinding food may all be involved. In some cases, it is not possible to clearly determine the causes. In some complex cases, where more than one doctor is involved, it may be difficult to get a consensus on treatment.
Some TM problems result from arthritis, dislocation, and injury. All of these conditions can cause pain and dysfunction. Muscles that move the joints are also subject to injury and disease. Injuries to the jaw, head or neck, and diseases such as arthritis, might result in some TM problems. Other factors that relate to the way the teeth fit together—the bite—may cause some types of TMD. Stress is thought to be a factor. TMD affects women of childbearing age more than men, or older men and women.
Diagnosing TMJDs can be difficult and confusing. Presently, there is
no widely accepted, standard test to correctly identify all TMJ
conditions. In most cases a complete evaluation, including a
detailed medical history, the patientís description of symptoms, and
physical examination of the head, neck, face and jaw provide
information useful for making a diagnosis.
Most current tests are
intended to rule out other possible medical conditions. A diagnosis
of TMJDs may be made only after every other possibility has been
considered and eliminated. (For example, facial pain can be a
symptom of many conditions: sinus/ear infections, various types of
headaches, facial neuralgias (nerve-related facial pain), tooth
decay, and even tumors.)
Many TMJ patients see multiple healthcare providers in their
search for answers.
This list includes: primary care physicians, dentists, sleep
specialists, ear, nose and throat specialists, neurologists,
endocrinologists, rheumatologists, pain specialists and
NOTE: Before undergoing costly diagnostic tests, get an
independent opinion from another healthcare provider not associated
with your current provider.
There are several ways the TMJ disorders may be treated. Your dentist will recommend what type of treatment is needed for your particular problem or recommend that you be referred to a specialist. Treatment may involve a series of steps. The step-by-step plan is in your best interest because only minor, relatively non-invasive treatment may be needed.
Diagnosis is an important step before treatment. Part of your clinical examination includes checking the joints and muscles for tenderness, clicking, popping or difficulty moving. Your complete medical history may be reviewed, so it is important to keep your dental office record up-to-date. Your dentist may take x-rays and may make a “cast” of your teeth to see how your bite fits together. Your dentist may also request specialized x-rays for the TM joints. Depending on your case, the dentist may refer you to a physician or another dentist.
Additional symptoms of TMJ:
- pain in the neck and shoulders
- migraine and/or chronic headache
- jaw muscle stiffness
- limited movement or locking of the jaw
- painful clicking, popping or grating in the jaw joint when
opening or closing the mouth
- a change in the way the upper and lower teeth fit together
or a bite that feels "off'
- ringing in the ears
- ear pain
- decreased hearing
- dizziness and vision problems
Here's some specifics that might help you:
Many medical and dental insurance plans do not pay for treatment
of jaw joint and muscle disorders, or only pay for some procedures.
Until the causes of the various TMJ diseases and disorders have been
discovered, and quality science demonstrates that treatments are
effective without causing harm, insurance companies will not
recognize treatments that have questionable outcomes. Contact your
insurance company to see which treatments are covered.
There are no standardized costs for TMJ treatments.