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The temporomandibular joint is little but it can cause big problems

Two little joints in your jaw can cause big problems. When not working properly, the temporomandibular joint (TMJ), located on either side of your head, can cause what is usually called TMD, a painful and potentially recurring condition.

The two joints, which can move forward, backward and side to side, play a critical role. They connect the jawbone to the skull and help you to chew, swallow, speak and yawn. Like the joint after which it is named, TMD, short for temporomandibular joint disorder, is a complex condition. “TMD actually encompasses a group of disorders linked to the joint, and arriving at a diagnosis can take some time,” says Dr. Stacie Saunders, a dentist in Bedford, NS, who has completed a residency in orofacial pain.

Cause

It’s unclear what causes TMD, and researchers have spent the last century struggling to answer that question. For some time, it was believed that TMD was connected to having a bad bite, an imbalance in way the jaw and skull work together. “We now know this is not the case,” says Dr. Saunders. “The evidence has proven the bite is rarely the problem.”

In fact, there is no singular cause for TMD. A combination of factors are usually at the root of the problem. Jaw injuries and joint disease, such as arthritis, can be linked to the disorder. Clenching or grinding your teeth and head or neck tension may be a factor. Inadequate sleep, poor nutrition, anxiety, whiplash and even caffeine can all play a role. Even improperly fitting dentures and fingernail biting can contribute to TMD.

“There are also genetic and hormonal influences,” notes Dr. Saunders, one of only a handful of dentists in Canada certified by the American Board of Orofacial Pain, which includes TMD.

Symptoms

Symptoms can be equally diverse. According to the Newfoundland and Labrador Dental Association (NLDA), signs of TMD includes pain and tenderness in or around the ear, the jaw joint, or the muscles of the jaw, face or temples. Problems opening or closing your mouth, and a clicking, popping, crunching or grinding noise when you chew, yawn or open your mouth may indicate TMD. The disorder may also be linked with neck pain and headaches.

Diagnosis

The range of symptoms and their possible indication of other conditions such as sleep apnea or a neurological disorder can make it difficult for a dentist to determine if an individual has TMD. “For some people, the diagnosis is quite straightforward. In other cases, we need to work through dental and medical issues to rule out other problems,” says Dr. Saunders, who often refers patients to a sleep clinic, for example, to ensure the issue is not sleep related.

To determine if an individual has TMD, the dentist will take a thorough patient history and do a hands-on examination of the neck and the surrounding muscles. The patient may be referred to their doctor or another health professional for additional tests and information. “A lot of things can present as TMD,” says Dr. Saunders.

Treatment

Treatment can be controversial, she adds. Dr. Saunders advises patients to opt for non-invasive, cost-effective, and reversible measures. “Most patients will have to modify their lifestyle.”

This can include not chewing gum for any length of time, putting an end to nail biting, maintaining good posture, and reducing caffeine intake. As well, the NLDA recommends placing a cold or warm compress on your jaw and gently massaging the jaw muscles to help ease soreness. Eating a soft diet, cutting food into small pieces, and avoiding hard, chewy or sticky foods can also help. As well, try not to open your mouth too wide, even when yawning.

Relaxing your jaw is the most important step, the NLDA points out. When your jaw muscles are relaxed, your teeth should be slightly apart and your tongue should rest on the floor of your mouth with your lips barely touching or slightly apart. There should be a small space between your upper and lower teeth.

If you have TMD, your dentist will develop a treatment plan in collaboration with you. This may include relaxation techniques, a referral to a physiotherapist, a chiropractor or a behavioural therapist to ease muscle pain. Other treatment options may include medicine for pain, inflammation or tense muscles or acupuncture. If getting a good night’s sleep is a problem, a number of approaches to improve sleep may be used.

A bite plane may also be helpful, says the NLDA. Made of clear plastic and fits over the biting surfaces of the teeth so that you bite against the splint rather than your teeth. This often helps jaw joints and muscles to relax.

Dr. Saunders cautions individuals to be prudent if invasive treatments are recommended. “If the suggested treatment is expensive or irreversible, seek a second opinion,” she says. “It helps to talk with different practitioners including your dentist, your doctor and a physiotherapist.”

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