Jaw Pain TMJ – TMD Sioux City
The temporomandibular joint (TMJ) is a hinge joint that allows the jaw to move up and down. The hinge motion is also coupled with a slight gliding motion, which makes the TMJ very unique. The TMJ is a connection between the temporal bone on the skull and the mandibular bone. This joint allows the jaw to move up and down to chew, talk, yawn, or open your mouth wide. Just like any other joint in the body, it can become injured with overuse or trauma. Problems can develop with the muscles in the face that control jaw movements. Injuries to the jaw are called temporomandibular disorders (TMD). TMD is commonly incorrectly called TMJ by the public, after the joint affected instead of the disorder name.
TMD can occur from acute trauma, such as a blow to the jaw, or associated with a whiplash injury. It is commonly injured with chronic activities such as grinding or clenching the teeth. Clenching the jaw produces a tremendous amount of stress across the joint. Many people clench their teeth when under stress or while sleeping. Over time, clenching damages the disc inside the TMJ. Arthritis can also develop within the joint over time and with excessive clenching or grinding.
Symptoms of TMD
TMD can begin as tightness and stiffness in the jaw, especially first thing in the morning after clenching or grinding all night. The mild stiffness progresses to dull or severe pain with movement. Some people develop TMD on one side of the face, while others experience injuries to both sides of the face. It is more common in women than men, and generally affects people between the ages of 20 – 40.
TMD symptoms commonly include pain or tenderness at the TMJ, neck, or shoulders. Pain can radiate to the ears or towards the eye. The pain is worse when chewing, speaking, or opening your mouth wide. Some people experience tension or migraine headaches with TMD.
The jaw can feel like it is locked in the open or closed position. It also feels stuck and does not want to move. Other people experience clicking or popping sounds when opening or closing the mouth. At times the clicking can be painful. Many people feel the muscles around the jaw are tight, tired, or fatigued, especially with chewing or talking. In severe cases, people may experience swelling on the side of the face.
Not all cases of TMD present with jaw pain. Other people feel like they may have toothaches, headaches, dizziness, earaches, hearing problems, ringing in the ears (tinnitus), or neck pain.
Evaluation & Diagnosis of Temporomandibular Disorder
Diagnosing temporomandibular disorders requires an examination of the jaw. Physical exam findings may include tenderness around the TMJ. Your dentist or physician will listen for clicking or popping sounds with jaw movements and will watch your jaw as it opens and shuts several times. He or she is looking for mandibular deviation (shifting to the side) as the jaw opens or closes. Normally the jaw should open and close in a straight line. Oftentimes disorders that affect the temporomandibular joint cause the jaw to shift or deviate during movement. Your dentist will also check for problems with any facial muscles and your bite.
Your dentist may take x-rays for further evaluation of the jaw and tempormandibular joints. X-rays will also help to rule out any tooth problems. Advanced imaging such as magnetic resonance imaging (MRI) or computer tomography (CT) may be utilized for further evaluation. An MRI is used to further evaluate the Temporomandibular joint disc and muscles. A CT is used to evaluate the bony details of the joint and mandible.
Referrals may be made to an oral surgeon or maxillofacial surgeon for further care and treatment. A recommendation may be given to see an orthodontist for further evaluation of the teeth, muscles, and joints.
Home Treatments for TMD
Several home treatments are easily performed to reduce TMD pain and symptoms. Nonsteroidal anti-inflammatory drugs, or NSAIDs, are often used to relieve muscle pain and swelling. Over-the-counter medications such as naproxen or ibuprofen are commonly recommended for many joint injuries, and this includes to the TMJ. Cold ice packs can be applied to the side of the face and jaw for 15 minutes to decrease pain and swelling. Applying ice several times a day often relieves some of the pain and discomfort associated with the joint pain. Moist heat can be used to increase blood flow to help relax the facial muscles.
It is often recommended to avoid foods such as sunflower seeds, nuts, or anything that requires a significant amount of pressure from the jaw. Soft foods often help relieve some of the pain because less stress is applied to the jaw while eating. Substituting or adding food such as yogurt, mashed potatoes, soups, cottage cheese, fish, and cooked fruits and vegetables are commonly recommended. Crunchy foods, such as hard pretzels, carrots, seeds, nuts, or chewy foods like caramels and taffy, often increase TMJ pain. Many patients find they do significantly better when avoiding chewing gum or ice.
All injured joints in the body respond to rest. Excessive movement or strain will aggravate the temporomandibular joint. Likewise, allowing the jaw to rest will help reduce the daily stress and strain. Avoiding extreme jaw movements such as yawning or singing further reduces daily stress or strain.
When the teeth are touching there is more strain applied to the temporomandibular joint. Therefore keeping the teeth slightly apart helps relieve some of the strain. Simple mouth guards can be made at home and used during the day or night. Many people feel better when they reduce their stress and learn relaxation techniques. Biofeedback, massage therapy, and physical therapy are common recommendations to help reduce the stress and strain in the head, neck, face, and jaw.
Medications. Your dentist or physician may prescribe stronger doses of NSAIDs to reduce pain and swelling. Muscle relaxers may be prescribed to help reduce the grinding or clenching. Some patients respond to antianxiety or antidepressant medications to reduce stress.
Splint or night guards. Your dentists can create a custom plastic mouth guard that fits over your teeth to reduce the effects of clenching or grinding at night. As previously mentioned, a mouthguard will create space between the teeth which reduces the strain on the TMJ. Many patients who wear a night guard for several weeks notice a significant reduction in jaw tightness, soreness, and pain first thing in the morning. When these patients forget to wear their night guard they notice more soreness the next day.
Trigger point injections. Injections can be performed on the muscles that control jaw movement and also for the head and neck muscles. The temporalis and masseter muscles are two large and powerful muscles that control mandibular movements. These muscles often develop painful trigger points that cause radiating pain to the jaw, eye, neck, or back of the head. By injecting pain medication or anesthesia into the muscle, the trigger point pain decreases.
Conservative treatments for TMD
Many muscle and joint injuries respond to chiropractic and physical therapy treatments. These treatments focus on decreasing pain, inflammation, and muscle spasms across joints. The treatments help restore normal joint motions and movements to improve function.
Traditional physical medicine treatments include TENS or electric therapy. Electric therapy helps decrease pain and muscle spasms. TENS units, or transcutaneous electrical nerve stimulation devices, can be used at home to help relieve pain and muscle spasms.
Ultrasound therapy produces a deep heat to the joint and surrounding muscles to relieve pain and inflammation. Decreasing inflammation in and around the joint allows the muscles to relax and lengthen. Ultrasound therapy also speeds tissue healing and cellular repair.
Low-level laser, or cold laser therapy, is a treatment that helps decrease pain and inflammation. Class IV cold lasers emit a significant amount of energy or joules into the tissue to stimulate cellular activities. Cold lasers have been found to decrease pain and inflammation in muscles, tendons, and joints. Cold lasers are also used to decrease pain and enhance cellular healing. Class IV cold laser treatments are applied in a series of 8 to 12 sessions over several weeks. Most patients find improvement within 2 to 3 weeks.
Massage therapy helps decrease muscle spasms and tenderness in the muscles that control jaw movements. In addition, many patients with TMD also have corresponding neck and shoulder spasms and pain. Reducing neck and shoulder stress and strain helps many patients with their painful TMD symptoms.
Chiropractic treatments can be performed to help relieve and reduce joint dysfunction in the neck and jaw joints. Several chiropractic adjustive techniques can be utilized in the neck and TMJ. Activator technique utilizes a handheld device to gently tap joints to increase their motion and movement. This is very commonly and easily performed to the TMJ. After an Activator adjustment, patients often feel they can open their mouth wider and with less pain. They may also notice less lateral deviation when opening or closing their jaw.
Temporomandibular disorders can be exceptionally painful and limiting. Most people do not realize how much they use their jaw until an injury affects the temporomandibular joint. Several medical and conservative treatments can be applied to the head, neck, and face to help reduce and relieve pain and functional limitation.