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Dr. Arthur Kezian |
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Dr. Narine Tashjian |
What is TMJ (Temporomandibular Joint Syndrom) ?
It is estimated
that 10 million Americans suffer from TMJ syndrome, a condition in which the
temporomandibular joint does not function properly. This is the joint that
connects the temporal bone (the bone that forms the sides of the scull) with
the mandible (the jaw bone). We use this joint more frequently than most of
the other joints in our bodies. Every time we talk, chew, bite down, or swallow
we put the TMJ to work. This condition produces pain in the muscles and joints
of the jaw that can radiate to the face, neck, and head and even the shoulders.
There also may be difficulty opening the mouth all the way, or clicking and
popping noises when chewing, yawning, kissing or moving the joint.
TMJ can
be caused by trauma, disease, wear due to aging, or habits:
- Trauma:
Trauma is divided to microtrauma and macrotrauma.
- Microtrauma is
internal, such as bruxism (grinding the teeth) and clenching (jaw tightening).
This continual hammering on the temporomandibular joint can change the alignment
of the teeth. Muscle involvement causes inflammation of the membranes surrounding
the joint. Teeth grinding (bruxism) and clenching are habits that may be diagnosed
in people who complain of pain in the temporomandibular joint or have facial
pain that includes the muscles involved in chewing (myofascial pain).
- Macrotrauma,
such as a punch to the jaw or impact in an accident, can break the jawbone
or damage the disc.
- Bruxism:
Teeth grinding as a habit can result in muscle spasm and inflammatory
reactions, thus causing the initial pain.
- Changes in
the normal stimuli or height of the teeth, misalignment of the teeth,
and changes in the chewing muscles may cause temporomandibular joint changes.
Generally, someone who has a habit of grinding his or her teeth will do
so mostly during sleep.
- In some cases,
the grinding may be so loud that it disturbs others.
- Clenching:
Someone who clenches continually bites on things while awake.
This might be chewing gum, a pen or pencil, or fingernails. The constant
pounding on the joint causes the pain. Stress is often blamed for tension
in the jaw, leading to a clenched jaw.
- Osteoarthritis:
Like other joints in the body, the jaw joint is prone to have arthritic changes.
These changes are sometimes caused by breakdown of the joint (degeneration)
or normal aging. Degenerative joint disease causes a slow progressive loss
of cartilage and formation of new bone at the surface of the joint. Cartilage
destruction is a result of several mechanical and biological factors rather
than a single entity. Its prevalence increases with repetitive microtrauma
or macrotrauma, as well as with normal aging. Immunologic and inflammatory
diseases contribute to the progress of the disease.
- Rheumatoid
Arthritis: Rheumatoid arthritis causes inflammation. As it progresses,
the disease can cause destruction of cartilage and erode bone, deforming joints.
It is an autoimmune disease involving the antibody factor against immunoglobulin
G (IgG). Chronic rheumatoid arthritis is a multisystem inflammatory disorder
with a persistent symmetric joint involvement. Certain infectious diseases
may be the cause of rheumatoid arthritis.
Help For TMJ Syndrome:
Luckily, there are a few things you can do to alleviate the pain and possibly
take care of it altogether without seeing a doctor. The American Academy of
Otolaryngology-Head and Neck Surgery recommends trying some simple remedies.
To reduce the amount of wear and injury to the joint, chew evenly (left vs.
right); stop chewing gum; avoid hard chewy foods, and stop clenching, or grinding
your teeth. To aid the healing processes, apply a heating pad (or some form
of heat) for 20 minutes at least twice a day. Two aspirin or ibuprofen tablets
can help reduce inflammation. Don't use them everyday; if the pain is that
bad, see your dentist. If pain persists after a few weeks, or if it is already
unbearable, your should see your dentist who can check the alignment of your
teeth. Most cases of TMJ dysfunction can be taken care of by either readjusting
a patient's bite or by fitting him or her with a mouth-piece. A special mouth-piece
is made to be worn at night to prevent clenching and compression of the joint.
This also may help correct the bite. Your dentist should be qualified to do
both of these procedures.Orthodontists, physical therapists, and dentists
all offer treatments for TMJ. However, it is estimated that 90% of all TMJ
cases respond to simple, inexpensive treatments, like giving up chewing gum
for a few weeks or more to see if that helps, avoid sleeping on the side of
your face where your jaw is more sore. More severe cases of TMJ dysfunction
are referred to an oral surgeon who can coordinate a treatment plan that may
or may not include surgery. Reconstructive surgery of the jaw is rarely required.
In fact, studies have shown that the results are often worse than before surgery.
Be cautious about any non-reversible treatment method that permanently alters
your bite. However, if a mouth guard doesn't work, your dentist may recommend
orthodontics to help re-align your teeth.
Muscle relaxant medications may help. Nonsteroidal anti-inflammatory medications
(NSAIDS) help reduce inflammation in the jaw stemming from arthritis or other
causes of inflammation.
Outlook (Prognosis)
Most cases can be successfully treated, although initially it may be difficult
to diagnose the problem and find an effective solution. Some cases of pain
go away on their own without treatment. TMJ-related pain tends to be cyclical
and may return again in the future. If the cause is nighttime clenching, treatment
can be particularly tricky because it is a sleeping behavior that is hard
to control.
Mouth splints are a common treatment approach for teeth grinding. While some
splints may silence the grinding by providing a flat, even surface, their
effectiveness at reducing pain or stopping clenching is more controversial.
Splints may be effective in the short-term but could become less effective
over time. Splints can also cause changes in your bite.
Possible Complications
- Chronic headaches
- Chronic facial
pain
When to Contact a Medical Professional:
See your health care provider immediately if you are having trouble eating
or opening your mouth. Keep in mind that a wide variety of possible conditions
can cause TMJ symptoms, from arthritis to whiplash injuries. Experts who are
specially trained in facial pain can help diagnose and treat TMJ.
TMJ problems do not fall clearly into one medical discipline. There are a
wide variety of treatment approaches. If you are interested in a massage-based
approach, look for a massage or physical therapist trained in trigger point
therapy, neuromuscular therapy (NMT), clinical massage, or pain relief, particularly
as it applies to TMJ pain.
Dentists who specialize in evaluating and treating TMJ disorders will typically
perform x-ray exams and may use a kinesiograph or EMG (electromyography).
They may give the patient a mouth guard. Surgery is now considered a last
resort by most TMJ experts.
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Office Hours:
Monday - Friday: 8:00am - 6:00pm
Saturday: 8:00am - 2:00pm
Tuesday & Thursday: Evening Appointments
*Any
emergency request will be given priority.
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