TMJ/TMD Treatment and Jaw pain Treatment

Temporomandibular Joint Disorder

Temporomandibular joint disorder (TMD) refers to a group of related disorders that result from problems with the jaw or jaw joint, or the facial muscles involved in jaw movement. The temporomandibular joint (TMJ) is the small joint located in front of the ear where the skull and lower jaw meet; it enables the jaw to move and function normally, and is one of the body's most frequently used joints. Talking, yawning, chewing and swallowing all involve the TMJ. For the TMJ to function properly, the muscles, ligaments and bones involved in its movement must be working properly; any conditions that prevent them from doing so may cause TMD.

Types of Temporomandibular Joint Disorder

TMDs are usually categorized in one of three ways.

Muscle Disorders

Muscle disorders cause pain and discomfort (myofacial pain) in the muscles surrounding the jaw joint, and in the muscles of the shoulder and neck. This is the most common type of TMD.

Joint-Derangement Disorders

Joint-derangement disorders are structural, as opposed to muscular, conditions. They can be caused by injury to the lower jaw; wear on the joint, such as from bruxism; severe malocclusion; repeated excessive jaw movements; or the dislocation or displacement of the articular disc, which is a component of the TMJ.

Degenerative/Inflammatory Joint Disorders

The overuse or aging of the joint can cause degeneration and/or inflammation. This may be a result of osteoarthritis, rheumatoid arthritis or a perforated TMJ disc.

A patient may experience one or more of these disorders at the same time.

Causes of Temporomandibular Joint Disorder

What causes TMD is not clear, but symptoms are believed to develop from problems with the jaw muscles or with the joint itself. TMD may be the result of many factors, including the following:

  • Trauma to the head or neck
  • Clenching or grinding of the teeth
  • Bad "bite" or missing teeth
  • Arthritis
  • Malalignment of the upper and lower jaws

Stress may also play a role in developing TMD because it can lead to tightening of jaw muscles and clenching of teeth.

Symptoms of Temporomandibular Joint Disorder

TMDs can cause discomfort and pain that is constant or intermittent, with symptoms that can include:

  • Chronic pain in the face, jaw, neck and shoulders
  • Chronic pain in or around the ear
  • Limited ability to open the mouth wide
  • Difficulty chewing
  • Uncomfortable "bite"
  • Swelling on one or both sides of the face
  • Clicking or popping noises when opening the mouth
  • Headaches and neck aches

Symptoms vary from being barely noticeable to causing seriously debilitating pain. It is also possible that the above symptoms have causes other than TMD.

Diagnosis of Temporomandibular Joint Disorder

In order to diagnose TMD, a physical examination, as well as the following tests, may be performed:

  • Clench test
  • X-rays
  • CT scan or MRI scan
  • Computer bite analysis
  • Joint-vibration analysis

Many tests for diagnosing TMD are designed to rule out other conditions that may be causing the same symptoms.

Treatment for Temporomandibular Joint Disorder

Treatment for TMD depends on the severity of the condition, and may include:

  • Stress-reduction exercises
  • Muscle relaxants
  • Low-level-laser therapy
  • Mouth protectors to prevent teeth-grinding
  • Changing diet to soft foods
  • Heat or ice packs
  • Avoidance of extreme jaw movements

More extensive corrective treatments include injections for pain relief. If nonsurgical treatment is unsuccessful or if there is joint damage, surgery may be needed. Types of surgery performed for TMD include:

  • Arthrocentesis
  • Arthroscopy
  • Open joint surgery

Although TMD can be a chronic condition, it can be effectively managed with proper treatment.

Sleep Disorders

Sleep disorders are common conditions that involve difficulties falling asleep, staying asleep, or waking up. Sleep disorders may develop as a result of changes in the brain regions and neurotransmitters, stress, anxiety, depression, poor sleep habits or many other possible causes. By not getting sufficient sleep at night, many people are affected during the day and may have difficulty completing their everyday activities.

Sleep Apnea

There are three different kinds of sleep apnea: obstructive, central and mixed; of these, the most common form is obstructive.

When you breathe normally, air passes through the nose and past the flexible structures, such as the soft palate, uvula and tongue, in the back of your throat. When you are awake, your muscles hold this airway open. When you are asleep, these muscles relax and the airway usually stays open. Yet, in the case of obstructive sleep apnea the tongue is sucked against the back of the throat blocking both the upper airway and airflow. This causes the oxygen levels in the both in the brain and the blood to lower. Obstructive sleep apnea (OSA) is often seen in people with cardiovascular problems and excessive daytime sleepiness. Untreated, sleep apnea can cause high blood pressure, memory problems, weight gain, impotency and headaches. If left untreated, it may be responsible for motor vehicle crashes and job impairment. Fortunately, sleep apnea can be diagnosed and effectively treated. There are several treatment options now available and research into other treatment methods continues.

Sleep Apnea Treatment Options

There are several ways to treat sleep apnea. The most common method is with a continuous positive air pressure (CPAP) machine. Using a tube and a mask that covers the nose, the pressure generated by the CPAP splints the structures in the back of the throat holding the airway open during sleep.

Another option is surgery. By repositioning the anatomic structure of your mouth and facial bones, surgeons are able to eliminate the tissue that collapses during sleep.

Depending on the severity of your sleep apnea, dentists with training in oral appliance therapy can determine which appliance is best suited for your specific dental and medical condition. Working in coordination with your physician, your dentist will participate in your diagnosis, treatment and on-going care. Follow-up care with your dentist, in order to evaluate the response of your teeth and jaws, will ensure a successful treatment.

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