Temporomandibular joint (TMJ) Syndrome, is one of the most common cause of facial pain. It can primarily involve muscle and soft tissue problems, or there can be problems with the joint itself, such as arthritis and degeneration. Sometimes, these two types coexist in the same patient, making diagnosis and treatment more challenging.
The muscle and soft tissue form is far more common. In this type, there are no destructive changes of the TMJ on x-ray. It is often caused by grinding of teeth and daytime jaw clenching. Stress, tension and related psychological factors may also play a role- it is noteworthy that grinding and gnashing of teeth is mentioned in the Bible, so we have been responding to stress in this fashion for at least 3500 years!!
Symptoms include pain, tenderness, and spasm of the muscles used in chewing. This will be worsened by malocclusion of the bite.
Patients with chronic eating disorders have a high prevalence of TMJ Syndrome. Also, daytime clenching is more likely to be associated with muscular pain than nighttime clenching.
- Pain around the jaw joint, which is usually associated with chewing, and may radiate to the head, but is not like a headache. The pain is often described as a variable deep ache with intermittent sharp pain with jaw movement.
- Click, pop, and snap: These sounds usually are associated with pain in TMJ Syndrome. (An isolated click is very common in the general population and is not a risk factor for development of TMJ Syndrome).
- Limited jaw opening and locking episodes.
- Headaches: The pain of TMJ is not like a usual headache. However, TMJ Dysfunction may act as a trigger in patients prone to headaches. The more painful the TMJ, the more likely it is to be associated with headache.
Conventional x-rays are the most commonly used imaging study, and in most cases is sufficient. X-rays help determine whether there is underlying joint damage where the jaw connects to the skull bones, (the Temporal- Mandibular Joint). The joint damage can be from injury or different types of arthritis. In some cases, specialized diagnostic scans are indicated.
Most patients with TMJ Syndrome respond well to Osteopathic manipulation. If significant pain is involved, or if there is arthritis of the joint, we employ acupuncture. These approaches are often complimented with self- care approaches, including exercises. Applying local therapeutic creams and over-the-counter pain relievers can provide additional relief, if needed.
To help with grinding, a TMJ splint is often useful. Many Dentists custom make these. Less satisfactory are the over-the-counter splints. I have been using a TMJ splint every night for years, as I was not kind to my teeth during medical school. That I still have teeth is a testimony to my splint and good dental care!
Occasionally, we find it necessary to provide Prolotherapy for the TMJ. This can be a highly effective treatment for TMJ Syndrome, particularly when the related neck ligaments are treated along with the TMJ ligaments. By strengthening these two sets of ligaments, Prolotherapy can eliminate not only the existing TMJ (and any neck-related) problems, but also helps to prevent recurrences as well. This approach was endorsed in the Journal of Oral and Maxillofacial Surgery in December, 2011.
If you suffer from jaw or related facial pain, there are a number of very successful treatment options- you don’t have to continue to live with the pain!