WHAT IS TEMPOROMANDIBULAR JOINT DISORDER (TMD)?

Problems with your jaw and the muscles in your face that control it are known as Temporomandibular Disorders (TMD). You may hear it wrongly called TMJ -- which is the term for the joint itself. Your temporomandibular joint (TMJ) is a hinge that connects your jaw to the temporal bones of your skull and is located in front of each ear. It allows you to open and close your jaw, and move it side to side, so you can talk, chew, and yawn.

WHAT CAUSES TMD?

Dentists believe symptoms arise from problems with the muscles of your jaw or with the parts of the joint itself.

TMJ Disorders can involve any combination of three areas: muscles of the head, neck, and face, the TMJ capsule (directly in front of each ear), and postural issues (primarily involving positioning of the neck with the head. It can be temporary or last many years and it might affect one or both sides of your face. More women than men tend to develop TMD. The disorder is most common among people between the ages of 20 and 40, but it can occur in older individuals as well. 

Usually, TMD is the result of microtrauma, which is a history of clenching or grinding the teeth, or macrotrauma, which is an injury to your jawbones, the joint, or the muscles of your head and neck from a fall, an auto accident, a heavy blow to the skull, or whiplash.  

Common Signs and symptoms of TMJ disorders may include:

• Jaws that get "stuck" or "lock" in the open-or-closed-mouth position
• Clicking, popping, or grinding sounds in the jaw joint when you open or close your mouth or chew, which may or may not be painful.
• Headaches
• Head or neck pain
• A tired feeling in your face
• Trouble chewing or a sudden uncomfortable bite -- as if the upper and lower teeth are not fitting together properly
• Swelling on the side of your face
• Pain or tenderness in your face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide
• Ear stuffiness and ringing (tinnitus) or stuffiness in the ears.

Recent studies indicate that 50% of the time the source of TMD can be a sleep-related breathing problem. As a protective mechanism to open the airway when it is blocked during sleep, the lower jaw moves forward, moving the tongue forward that is attached to it, and the lower teeth clench against the upper teeth. It is also believed that the arousals during sleep due to an airway obstruction also cause teeth grinding.

As these events happen repeatedly night after night, the cumulative effect over time can cause signs and symptoms of TMD.

HOW DO YOU ‘FIX’ TMD?

At Pittsburgh Dental Sleep Medicine (PDSM), our treatment for disorders of the TMJ is a very conservative, methodical, and non-surgical approach. The consultation and examination are designed to identify the source(s) causing the signs and symptoms. Treatment is then directed at the source of the disorder to restore proper jaw function, substantially reduce or eliminate pain, and re-establish harmonious relations between the jaws, head, and neck. 

Conservative therapies in our practice can successfully manage many TMD problems and may include "properly-designed" mouthguards, jaw and postural exercises, specialty medicaments, ultrasound treatments, and correctional nutritional and medicinal recommendations. For more involved cases, we offer a unique range of injection therapies that can quickly soothe painful muscles in the head and face, and rebuild and strengthen ligaments and tendons around the TMJ for improved and painless function.

One form of more advanced therapy that is used when muscular-related symptoms linger, despite the methodical, conservative approach, involves injections of unique, anti-inflammatory medications into facial muscle "trigger points". This will reduce inflammation that is causing the pain and will allow the muscle to relax from a more contracted state.  

Prolotherapy, also referred to as Regenerative Injection Therapy (RIT), may be a stand-alone treatment, or as needed to complement more conservative therapies. It is well documented that RIT can heal injured TMJs and related musculature as the alternative to more aggressive treatments or invasive, surgical procedures. Research on RIT supports the use and benefits in the treatment of TMJ disc dislocations, painful and arthritic TMJoints, tinnitus (ear ringing), and clicking or grinding sounds in the TMJoints. 

A broad list of other behavioral activities that your dentist at PDSM may recommend to help manage TMD symptoms, until more professional therapies can be used, are:

• Use of over-the-counter medications - Anti-inflammatory drugs like naproxen or ibuprofen can help relieve muscle pain and joint pain and reduce swelling.
• Use of moist heat or cold packs - Apply an ice pack to the side of your face and temple area for about 10 minutes. Complete simple jaw exercises as instructed by your dentist or physical therapist. After completing, hold a warm towel or washcloth to the side of your face for about 5 minutes. Perform this routine a few times each day.
• Eat soft foods - Eggs, cooked vegetables, yogurt, tofu, apple sauce, mashed potatoes, cottage cheese, soup, beans, and oatmeal to your dietary regimen. Cutting food into smaller pieces can help you chew less and don’t require your jaw to open as much.
• Avoid putting weight or pressure on your chin - Don’t rest your chin on your hand or wedge the phone between your shoulder and ear. Practice good posture to reduce neck and facial pain.
• Keep your teeth slightly apart - Put your tongue between your teeth to prevent clenching or grinding during the day.
• Learn relaxation technique – Meditation, for example, can help loosen the tension on your jaw.

GETTING STARTED

Since there is no "quick fix" in resolving disorders of the TMJoints, the best place to start is by speaking to a professional who can guide you through what can be a complicated process.

At Pittsburgh Dental Sleep Medicine Dr. Michael Hnat, DMD, DABDSM, DABCDSM, brings exceptional knowledge, training and experience in the treatment of TMD and sleep-related breathing disorders. His training includes completion of the prestigious mini-residency in TMJ disorders from Tufts University School of Dental Medicine.  

Click HERE to schedule an appointment with Dr. Hnat at our McMurray, PA location, or call (724)230-8220. 

Blog content source: Dr. Michael Hnat, DMD, DABDSM, DABCDSM

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