Temporo-Mandibular Joint (TMJ) Disorder

By Dr. Presley-Nelson

Sometimes referred to as TMJ or TMD, this is a common malady in today’s high stress world. If you have tenderness in the joint area in front of your ears, pain or headache in the temple region, or tired aching jaws in the morning, you may have TMD.

This joint, which is the “hinge” between your lower jaw and your skull, can be the most over worked joint in your body. It is used for chewing, speaking, facial expression, and swallowing. Some people even work this joint unnecessarily by chewing gum or clenching and grinding due to stress. And, if your bite is not perfect it is thought that you may even stress your joint just trying to get all your teeth together at once. Some doctors relate grinding to sleep apnea, others to stress and still others to neurological tics.  Whatever the cause, the joint is likely to be over-worked.  One interesting way that the temporomandibular joint can be over stressed occurs when folks think that their teeth should touch when resting, but a normal jaw rest position is with the teeth 2 to 5 mm apart (called freeway space). Not allowing freeway space at rest can irritate the joint. Also, habits, like popping your joint on purpose or posturing with your jaw jutted forward or sleeping with your jaw jammed sideways can cause trouble.

Signs and symptoms of trouble include popping or clicking upon opening, locking open, or difficulty opening, and, of course . . . pain. If you think you have TMD tell your dentist.

What Can Be Done?

Well the first line of defense when the situation is acute are a group of palliative measures:

  • Soft foods
  • Small bites
  • Warm compress
  • Stop gum chewing . . . or other bad habits (see above)
  • Be aware of clenching or grinding and . . . take steps to reduce it.

The use of non-steroidal, anti-inflammatory agents like Nuprin, Advil, or Alleve; perscription anti-inflammatory agents are also good.

The next step (after a good exam), might be to have a night-guard (TMJ Splint) made to hold your jaw slightly apart in a restful position, (freeway space). This is a small appliance similar to a retainer, usually worn at night and easily tolerated. It can ease the stress of clenching or grinding habits (bruxism). While worn, it evens out a bad bite. This plus attempts to control stress may be all that is necessary. In most cases, a night-guard and the above palliative measures bring symptoms under control.

Occasionally TMD may become more complicated. Teeth that hit “high” or first may need to be altered to reduce bite discrepancies. In some more extreme cases help from a TMD Clinic at a Dental School or a consult with a Specialist may be necessary. Special joint X-rays or MRIs may be needed. Arthritis should be ruled out. Biofeedback, sleep studies and/or counseling may accompany night-guard or other appliance therapy and in some cases surgery to the joint may be an option. Seek treatment early to avoid permanent joint damage. Remember, you are not alone if you are suffering with TMD and help is for the asking.

Besides damaging the joint, chronic clenching and grinding habits can damage teeth, and their support mechanisms. Cracked tooth syndrome can be the result. Ruminating tooth sensitivities that come and go may be a clue that you have a clenching or grinding habit.