TMJ / TMD

Do you know what TMJ and TMD stand for?

The temporomandibular joint (TMJ) is the joint that connects the jaw to the temporal bones of the skull. Temporomandibular joint disorder, known more commonly as TMD, occurs when there are problems with the muscles and jaws in the face.

Dislocation of The Temporomandibular Joint (TMJ)

What Is It?

The temporomandibular joint (TMJ) is located just in front of the lower part of the ear. This joint allows the lower jaw to move. It is a ball-and-socket joint, just like the hip or shoulder. When the mouth opens wide, the ball (called the condyle) comes out of the socket and moves forward. It goes back into place when the mouth closes.

The TMJ becomes dislocated when the condyle moves too far. Then, it can get stuck in front of a section of bone called the articular eminence. The condyle cannot move back into place. This happens most often when the ligaments that normally keep the condyle in place are somewhat loose. The surrounding muscles often go into spasm and hold the condyle in the dislocated position.

Symptoms

The jaw locks in an open position and you cannot close your mouth. You may have discomfort until the joint returns to the proper position.

Diagnosis

At the Surbiton Smile Centre ® we will base our diagnosis on the position of your jaw and whether you are able to close your mouth. X-rays will confirm our clinical diagnosis.

Expected Duration

The problem remains until the joint is moved back into place. However, the area can be tender for up to a few weeks.

Prevention

TMJ dislocation can continue to happen in people with loose TMJ ligaments. To keep this from happening too often, we will recommend that you limit the range of motion of your jaws. For example, if you have this problem you should place a fist under your chin when yawning in order to stop your mouth from opening too widely.

Conservative surgical treatments can help to prevent the problem from returning. Some people have their jaws wired shut for a period of time. This causes the ligaments to get tighter and restricts their movement.

In certain cases, surgery may be necessary. One procedure is called an Eminectomy. It removes the articular eminence so the ball of the joint no longer gets stuck in front of it.

Treatment

The muscles around the TMJ need to relax so that the condyle can return to its normal position. To make this happen, some people need an injection of local anaesthetic in the jaw joint. This may be followed by a muscle relaxant to stop the spasms. The muscle relaxant is given intravenously (into a vein in the arm).
If the jaw muscles are relaxed enough, a doctor or dentist can move the condyle back into the correct position. He or she will pull the lower jaw downward and tip the chin upward to free the condyle. Then the ball is guided back into the socket.

Rarely, someone may need to have the dislocation fixed in the operating room under a general anaesthetic. In this case, it may be necessary to wire the jaws shut or use elastics between the top and bottom teeth to limit the movement of the jaw after the dislocation has been fixed.

You should follow a soft or liquid diet for several weeks afterward. This reduces jaw movement and stress. Avoid foods that are hard to chew, such as tough meats, carrots, hard biscuits or ice cubes. Also, be careful not to open your mouth too wide.

When to call a Professional

If your TMJ becomes dislocated, visit your doctor, the Surbiton Smile Centre ® or hospital emergency room right away to have the joint put back in place. You may be referred to an oral and maxillofacial surgeon for treatment.

Prognosis

The outlook is excellent for returning the dislocated ball of the joint to the socket. However, in some people, the joint may continue to become dislocated. If this happens, you may need surgery.

What is TMD?

TMD, or temporomandibular joint disorder, means that the hinge connecting the upper and lower jaw is not working properly. This hinge is one of the most complex joints in the body, responsible for moving the lower jaw forward, backward and side-to-side. Any problem that prevents this complex system of muscles, ligaments, discs and bones from working will feel like your jaw is popping or clicking or even “getting stuck” for a moment.

The exact cause of a person’s TMD is often difficult to determine. Your pain may be due to a combination of factors, such as genetics, arthritis or jaw injury. Some people who have jaw pain also tend to clench or grind their teeth (Bruxism see our website for further information), although it must be said that many people habitually clench or grind their teeth, but never develop TMD.

In most cases, the pain and discomfort associated with TMD is temporary and can be relieved with self-managed care or nonsurgical treatments. Surgery is typically a last resort after conservative measures have failed, but some people with TMD may benefit from surgical treatments.

How is TMD treated?

While there is no single cure for TMD, there are different treatments you can follow that may reduce your symptoms dramatically. At the Surbiton Smile Centre ®, we may recommend one or more of the following:

• Try to eliminate muscle spasm and pain by applying moist heat or taking medication such as muscle-relaxants, aspirin or other over-the-counter pain-relievers, or anti-inflammatory drugs.
• Reduce the harmful effects of clenching and grinding by wearing an appliance, sometimes called a bite plate or splint. Custom-made to fit your mouth, the appliance slips over the upper teeth and keeps them from grinding against the lower teeth.
• Learn relaxation techniques to help control your muscle tension in the jaw. We may suggest you seek training or counselling to help eliminate stress.
• When the jaw joints are affected and other treatments have been unsuccessful, jaw joint surgery may be recommended.

Symptoms

There are many sign and symptoms of TMD. It is hard to know for sure if you have a relevant one,as one or all of these symptoms can also be present for other problems.

At the Surbiton Smile Centre ®, we can help make a proper diagnosis by taking a complete medical and dental history and performing a detailed investigation with the use of associated X-rays.

Signs and symptoms of TMD may include:

• Pain or tenderness of your jaw
• Your jaw “gets stuck” locked or goes out of place
• Headaches (often like migraines), earaches, pain and pressure behind your eyes
• Pain in one or both of the temporomandibular joints (TMJ)
• Aching pain in and around your ear
• Difficulty chewing or pain while chewing
• Facial pain, ear pain and/or jaw pain
• Trouble chewing and biting
• Swelling of your face
• Tenderness of jaw muscle.
• Pain brought on by yawning, opening the mouth widely or chewing.
• Locking of the joint, making it difficult to open or close your mouth
• A sudden change in your dental occlusion (the way the upper and lower jaw fits together).

TMD can also cause a clicking sound or grating sensation when you open your mouth or chew. But if there is no pain or limitation of movement associated with your jaw clicking, you probably do not need treatment for a TMJ disorder.

Causes

The Temporomandibular joint (TMJ) combines a hinge action with sliding motions. The parts of the bones that interact in the joint are covered with cartilage and are separated by a small shock-absorbing disk, which normally keeps the movement smooth.

Painful TMJ disorders can occur if:

• The disk erodes or moves out of its proper alignment
• The joint’s cartilage is damaged by arthritis
• The joint is damaged by a blow or other impact
• If you grind your teeth
• General wear and tear of the joint
• A blow to the head or face
• Stress
• An uneven bite

In many cases, however, the cause of TMJ disorders are not clear.

Diagnosis

The proper diagnosis of TMD:

At the Surbiton Smile Centre ® our dental staff will carry out a proper and thorough medical and dental examination and may take certain X-rays (panoramic) to evaluate the jaw joint and surrounding structure and also check your occlusion. Our Dentist may check the muscles and tissues of your head and neck to test for inflammation. Certain exercises and movements may be involved, and you may get a referral to an oral maxillofacial surgeon or further evaluation and diagnosis.
While there is no single cure for TMD, there are different treatments that may reduce your symptoms dramatically. Our Dentist may recommend one or more of the following:

• Try to eliminate muscle spasm and pain by applying moist heat or taking medication, such as muscle relaxants, aspirin, other over-the-counter pain-relievers or anti-inflammatory drugs.
• Reduce the harmful effects of clenching and grinding by wearing a night guard or splint. Custom-made to fit your mouth, the device slips over the upper teeth and keeps them from grinding against the lower teeth.
• Learn relaxation techniques to help control muscle tension in the jaw. Our Dentist may suggest you seek training or counselling to help eliminate stress.
• Transcutaneous electrical nerve stimulator (TENS) uses low-level electrical currents to relax joint and facial muscles and provide relief. Low-level laser therapy will assist in helping the neck to move more freely.
• A dentist may prescribe non-steroidal anti-inflammatory drugs to relieve pain and swelling.

How to ease TMD symptoms yourself:

TMD Exercise:

A: First, stand in front of a mirror:

1. Open and close your mouth slowly.
2. Keep your head straight. If you suffer from TMJ dysfunction, your jaw will usually open to one side.
3. Concentrate very hard on opening your mouth straight. This will be difficult at first because the muscles on one side of your mouth or jaw are weak and will not function properly.
4. Keep trying and you will get there. Be patient! After all you are undoing many repetitions of opening it wrongly.
5. Open and close your mouth correctly 10 times, then take a rest.
6. Do 10 repetitions of this TMD exercise 3 times a day. This exercise will help the jaw re-learn to open and close correctly. Repetition is the key to the re-training of your jaw.To ease muscle pain around your jaw due to tight jaw muscles, try this following TMJ exercise:
7. Slowly open your mouth as wide as you can, and then slowly close it.
8. Slowly open your mouth to the right as wide as you can, then slowly closes it.
9. Slowly open your mouth to the left as wide as you can, then slowly close it.
10. Repeat this sequence 5 times, 3 times a day or until you feel a degree of relief from your jaw pain. If at any stage your symptoms increase seek professional help.

B: Other remedial actions:

1. Eat soft food
2. Take paracetamol or ibuprofen
3. Hold an ice pack or heat packto your jaw, whichever feels better for you
4. Massage your jaw muscles
5. Try to relax
6. Do not chew chewing gum
7. Do not bite food with your front teeth
8. Do not open your mouth too wide
9. Avoid nail biting
10. Avoid clenching your teeth. Apart from when eating, your teeth should be apart
11. Do not rest your chin on your hand

Here is some advice:

Try and develop an awareness of your tension-related habits. For example, clenching your jaw, grinding your teeth or chewing pencils. This will help you reduce the frequency of these habits.

When to see a GP

You should seek medical attention if you have persistent:

• pain or tenderness in your jaw, or
• if you cannot open or close your jaw completely.
• Your GP, the dental staff at the Surbiton Smile Centre ® can discuss possible causes and treatments for your problem.
• You are unable to eat or drink
• the pain is affecting your life
• the pain is affecting your sleep
• the pain and discomfort keep coming back

Risk factors

Factors that may increase the risk of developing TMJ disorders include:

• Various types of arthritis, such as rheumatoid arthritis and osteoarthritis
• Jaw injury
• Long-term (chronic) grinding or clenching of teeth
• Certain connective tissue diseases that cause problems that may affect the temporomandibular joint

Our TMJ / TMD Specialists

Dr. Simin Soltani (Principal dentist) DDS . MSC . Sweden Dr Shima Mahdavi-Izadi DDS, MClinDent MEndo, Specialist Endodontist