- What is TMJ/TMD?
The temporomandibular joint (TMJ) is the joint connecting the lower jaw (mandible) to the skull (temporal bone). The lower jaw and the skull are connected by a number of muscles and ligaments, which function in harmony with each other if the lower jaw is in the correct position. The head of the jaw bone (lower jaw) is called the condyle and it fits into the concavity of the temporal bone called the glenoid fossa. The TM joint resembles a ball and socket with the round condyle being the ball and the glenoid fossa of the temporal bone being the socket. For normal joint function to occur, a piece of cartilage called an articular disc acts as a cushion or shock absorber between the two bones.
When the lower jaw opens and closes, the disc stays between the condyle and the glenoid fossa of the temporal bone at all times. When this happens, this is a normal healthy TMJ and the patient can open wide without any discomfort and without any noise. With a normal opening, the patient should be able to get three fingers between the upper and lower front teeth when the mouth is open as wide as possible. In cases where the TM joint is functioning normally with the disc in the proper position, the muscles of the head, neck and shoulders function relatively pain-free.
What is TMD?
Temporomandibular disorder (TMD) is the condition referring to a joint that is not normal.
The position of your teeth can affect the position of your jaw joints. Each jaw joint is a ball and socket joint. When functioning properly, the ball and socket do not actually touch because a thin disc of cartilage rides between them. The disc acts as a cushion and allows the joint to move smoothly. Each disc is held in place and guided by muscles and ligaments. If your bite is not right, as in cases where the following may occur: deep overbite, lower jaw too far back, narrow upper jaw or upper front teeth crooked and tipped backwards, this can cause the jaw to become dislocated. Typically the disc is pulled forward. The lower jaw then has a tendency to go back too far and the top of the lower jaw, which resembles a ball (condyle), presses on the nerves and blood vessels at the back of the socket and causes pain.
Usually, the protective disc (cartilage) is displaced forward and no longer serves as a cushion between the condyle (lower jaw) and the bony socket (skull) and eventually this can lead to the condyle rubbing against the bony socket. This can cause a problem called osteoarthritis.
Mild displacements cause a clicking or popping sounds in the jaw joint.
When the disc becomes displaced, this is what causes the various noises within the jaw joints such as clicking and popping sounds. Patients must be aware that any noises or pain that occur during the opening and closing of the jaw is an indication that the jaw joints have become dislocated. Patients are advised to seek treatment as soon as possible to avoid allowing the problem to get worse.
More severe displacement can be very painful and eventually can cause permanent damage to the joint. An unstable bite can cause both jaw joint displacement and muscle strain and pain. Many seemingly unrelated symptoms results, which are collectively known as craniomandibular dysfunction. These symptoms include headaches, neck aches, ringing in the ears, stuffiness in the ears, pain behind the eyes, ear pain, shoulder and lower back pain, dizziness and fainting, difficulty swallowing, and tingling of the fingers and hands. These symptoms include:
- Neck aches
- Ringing in the ears
- Stuffiness in the ears
- Pain behind the eyes
- Ear pain
- Shoulder and lower back pain
- Dizziness and fainting
- Difficulty swallowing
- Tingling of the fingers and hands
- Symptoms of TMD
TMJ disorders have been called the "Great Impostors" due to the fact that many of the symptoms have overlapping characteristics, which often mimic other conditions. Because these symptoms masquerade so many other conditions, many people travel from medical doctor to medical specialist in search of a cure. Most patients never think to contact a dentist since the symptoms are primarily medical in nature.
TMJ symptoms may include any of the following:
- Earaches, congestion or ringing in the ears
- Clicking, popping or grating sounds when opening and closing the mouth
- Limited jaw opening or locking
- Neck pain or stiffness
- Dizziness and fainting
- Pain when chewing
- Facial pain
- Difficulty closing the teeth together
- Tired jaws when chewing
- Numbness in hands
- Difficulty in swallowing
Signs that you may have a TMJ problem:
- Clenching and grinding of the teeth (bruxism) is a common sign of TMJ disorder. The clenching and grinding of the teeth put additional stress on already tired, overworked muscles and can result in pain being referred to the head, neck, face, shoulder or back.
- Headaches are one of the most common complaints of TMJ sufferers and these headaches are frequently so severe they can be confused with migraine headaches. TMJ headaches are most often felt in the temple area, behind the eyes and at the back of the head with pain radiating to the neck and shoulders. Migraine headaches are mainly on one side with the patient suffering from visual disturbances and being extremely sensitive to light. The treatment for migraine headaches is much different from headaches caused by dislocated joints.
If you suspect a migraine headache, then a referral should be made to a neurologist. If the TMJ (jaw joint) is the problem, a referral should be made to a dentist or dental specialist with training in the diagnosis and treatment of these disorders. An excellent reference for dentists experienced in the treatment of patients with TM joint disorders would be to consult the website of the American Academy of Craniofacial Pain.
- One of the most common signs of a TMJ problem is a jaw joint making noise such as clicking, popping or grating sounds. This clicking sound occurs when the condyle (top of the lower jaw) moves forward when the patient opens the mouth and the condyle slips on and off the dislocated disc. The grating sound, called crepitus, is the sound of bone rubbing on bone and occurs later on when the dislocated discs become completely deformed. The purpose of the disc is to act like a protective cushion between the two bones of the lower jaw (condyle) and the skull (glenoid fossa). When the protective disc is permanently dislocated or distorted, the two bones contact each other and this causes loud noises, which are referred to as crepitus.
Another sign of TM joint dysfunction occurs when the jaw either locks open or closed. Our objective in the treatment of TMJ disorders is to try and correct the problem of the dislocated disc early when the jaw is clicking and not wait until the later stages when the grating sound is louder and the patient may experience an extremely painful situation if the jaw locks open or closed.
- If the patient suffers from ear pain, ringing or buzzing in the ears, fullness or a stuffy feeling without any ear infection, then this could be related to a structural problem within the TM joint. Other symptoms include a loss of hearing, dizziness and loss of balance. If the condyle is too far back and the disc dislocated forward, this can cause some of the muscles of mastication to go into spasm which can cause any of the symptoms as mentioned above. If your medical doctor or ENT (ear, nose and throat) specialist can find no apparent reason for the ear problems, these patients should be referred to a dentist with training in the diagnosis and treatment of patients with these problems.
- Sleep disturbances are common in patients suffering from dislocated jaw joints. The brain frequently does not allow the patient to reach the deep stages of sleep and they are awakened many times during the night. The patient does not awaken feeling well rested and refreshed, but rather they often feel tired and listless with an obvious lack of energy to face the new day. Often, the reason the patient cannot sleep is that they are awakened due to the pain they are suffering from severe muscle contractions, muscle spasms and trigger points caused by the dislocated jaw joints or clenching and bruxing habits.
- Depression is another common sign of patients who suffer from TM joint dysfunction for an extended period of time. These patients suffer constantly from chronic pain with no obvious solution in sight. Depression is a problem for both the medical and dental profession to try and solve. If the pain is originating from a tumor (very rare), an infection, systemic disease, nutritional deficiency, allergies or traumatic injuries, then the medical profession should be consulted. However, if the problem is a dislocated jaw or clenching or grinding habits causing TM joint pain, a properly trained member of the dental profession should be involved in the diagnosis and treatment.
If you have any of the above symptoms, you could possibly have a problem with your jaw (TMJ).
- Self-Assessment test
Here are a few questions you may want to ask yourself, to help determine if you have any symptoms:
Do you get an unusual amount of headaches? Y N Do you have a grating, clicking or popping sound in either or both jaw joints, when you chew or open and close your mouth? Y N Do you have pain or soreness in any of the following areas: jaw joints, upper jaw, lower jaw, side of neck, back of head, forehead, behind the eyes or temples? Y N Do you have sensations of stuffiness, pressure or blockage in your ears? Is there excessive wax buildup? Y N Do you ever have ringing, roaring, hissing or buzzing sounds in your ears? Y N Do you ever feel dizzy or faint? Y N Do your fingers, hands or arms sometimes tingle or go numb? Y N Are you tired all the time, fatigue easily or consider yourself chronically fatigued? Y N Are there imprints of your teeth on the sides of your tongue? Y N Does your tongue go between your teeth when you swallow? Y N Do you have difficulty in chewing your food? Y N Do you have any missing back teeth? Y N Do you clench your teeth during the day or at night? Y N Do you grind your teeth at night? (Ask your family.) Y N Do you ever awaken with a headache? Y N Have you ever had a whiplash injury? Y N Have you ever experienced a blow to the chin, face or head? Y N Have you reached the point where drugs no longer relieve your symptoms? Y N Does chewing gum worsen your symptoms? Y N Is it painful to stick your "pinky" fingers into your ears with your mouth open wide and then close your mouth while pressing forward with your "pinky" fingers? Y N Does your jaw slide to the left or right when you open wide? (Look in a mirror.) Y N Are you unable to insert your first three fingers vertically into your mouth when it is open wide? Y N Is your face crooked and not symmetrical? Y N
If you answered yes to some of these symptoms, you may have a TMJ disorder (TMD) Consult your dentist for an examination.
Here are some ways you can visually check your TM joint:
- Put your fingers inside your ears. Open and close several times. If the jaw clicks or cracks, or if you feel a grinding sensation.
- While looking in a mirror, open very slowly, notice whether or not your jaw swings to one side while opening and closing. Is there any pain present?
- Slide your jaw from side to side, make note of any pain you may experience.
Check for muscle sensitivity:
Place your fingers in front of your ears on the joint and apply pressure.
- Also apply pressure to the cheek area
- If you notice discomfort or pain have your jaw joint checked by a dentist who treats patients with jaw joint disorders!