Some of the facial muscles which control chewing are also attached to the lower jaw. Problems experienced in this area may lead to neck and head pain, headaches, ear pain, and facial pain.
TMJ Disorder (aka TMJD or just TMJ) is a common dysfunction of the hinge that connects each side of the lower jaw to the skull, together referred to as the temporomandibular joint. Some 90% of cases are in women ages 18-44.
The TMJ, short for temporomandibular joint, is made up of bones, nerves, blood vessels and muscles. Everyone has two TMJs, one on each side of the jaw.
The temporomandibular joint (TMJ) connects the lower jaw or mandible to the skull via the temporal bone found before the ear.
The TMJ is involved in chewing, which works by a hinge action, opening and closing the jawbone with the TMJ as the pivot point. The TMJ also supports the gliding function so that the mouth can open wider, enabling yawning and talking.
When you put your fingers before you ears and open your mouth, then you will feel the TMJ moving. If you open your mouth with the rounded ends of a lower jaw or condyles, it will glide over the joint sockets over the temporal bone. Condyles will slide back in their position if you close the mouth. To keep the motion smooth, there is a soft cartilage disk which is found between the temporal bone and condyle. This disk will absorb the shock from TMJ that is caused by chewing or other movements. The chewing may create a stronger force. The disk will distribute the force from chewing to the joint space.
What is TMJ syndrome?
TMJ syndrome is a pain felt within the jaw joint, which may be the result of different medical problems.
It may be a result of wear or tear caused by oral habits and aging or trauma.
Microtrauma like a punch to the jaw or impact in an accident may break a jaw, and it may lead to dislocation of the TMJ. TMJ pain may also be brought about by dental work or if the joint has been stretched open for a long period. Massage with heat application after the dental procedure may be helpful in alleviating pain.
When do you need a doctor for TMJ disorder?
When you suffer pain in the jaw or over the chewing muscle on occasion, it may not be a reason for concern. However, you need to see a TMJ expert if the pain is too severe or if it refuses to go away.
TMJ may appear in healthy individuals. Some sensory and psychological factors may put some individuals at greater risk of suffering TMJ pain. In particular, women are at high risk of suffering from TMJD. There is also a difference in how men and women respond to pain medications.
Women who are between 18-44 are at a high risk of suffering TMJ. Also, studies suggest that people who are more sensitive to pain are at greater risk of suffering TMJ syndrome.
What are the symptoms of TMJ Disorder?
You may hear a popping or clicking noise when you open and close your mouth. At other times you might not even be able to open or close it. The muscles around the hinges may feel stiff or you could be experiencing pain on the side of the face or feel a swelling. The muscles in your shoulders and your upper back could feel sore, as well. You might hear an occasional (not constant) ringing in your ears or feel congestion there. You may be feeling dizzy at times and suffer from headaches. TMJD will often cause unconscious clenching of teeth and this can wear them down, while some teeth may also be unusually sensitive. These symptoms could be due to other underlying problems and there are other possible indicators of TMJD, which is why you should have an examination by your dentist for a diagnosis.
What causes TMJD?
Researchers believe the high incidence of TMJ in pre-menopausal women is partly caused by vitamin and mineral deficiencies due to menstruation. Getting sufficient calcium and magnesium entirely in the diet is a challenge and lack of these minerals can cause loss of bone, including at the hinges. Studies have also found that women who use oral contraception or are undergoing hormone replacement therapy experience pain at the joints. Also, the type of collagen protein in women that holds the disk between the joints and sockets in place is easily dislocated. Other contributing causes of TMJD can be physical traumas like a blow to the head or whiplash, emotional stress, chewing gum excessively, missing teeth that can cause the normal bite to become misaligned, and arthritis or fibromyalgia.
How can TMJD be treated?
The primary solution that helps many cases is an oral appliance known as an orthotic splint, to be worn during the day or when you sleep to gradually adjust and realign the bite. We can also teach you simple neuromuscular exercises to relax the jaw and explain how to use hot, moist compresses for temporary pain, along with ibuprofen. Of course, any underlying issues have to be addressed, such as arthritis, trauma, stress, or missing teeth,. We may also prescribe muscle relaxers or anti-inflammatories and can refer you for physical therapy or ultrasound and laser therapy, if necessary.
I've heard women are far more likely to have Temporomandibular Disorder. Why?
Yes, 90% of the cases of TMJ Disorder (the dysfunction of the hinge that connects the lower jaw to the upper) is among women 18-44. Pre-menopausal women often have calcium and magnesium deficiencies that affect bone density, including any joints like the TMJ. The protein known as collagen that hold disks in place between the joint’s ball and sockets is weaker in women than men, making the joints more likely to dislocate. There is some evidence menstruation may cause vitamin deficiencies that contribute to TMJD. Rheumatoid arthritis and osteoarthritis are much more common in women and can damage the joints and cause joint pain.
Women who undergo hormone replacement therapy or take oral contraceptives report more jaw pain, which suggests a link.
Emotional stress is often a factor in developing TMJD and it isn’t hard to imagine the special stresses women experience managing careers and families. Stress can cause clenching of teeth or grinding them, which can throw the jaw out of place. Excessive chewing of gum, often a way to deal with stress, can do the same thing.
Of course, both genders can have their TMJ dislocated due to head trauma, poor bite alignment, or missing teeth.
How is TMJD diagnosed?
According the WebMD, the TMJ is one of the most complex joints in the body. The most common symptoms of dysfunction are difficulty in opening and closing the mouth, accompanied by popping or clicking sounds when attempted, and pain in the joints, on the side of the face, neck or shoulders. There can also be muscle spasms, stiff muscles in the jaw, swelling on the side of the face, and patients may experience dizziness, headaches, earaches, and occasional ringing in the ears (not all the time, as in tinnitus). The dentists at Wilshire Smile Studio are very familiar with such signs that can be confirmed during a full dental exam. If there is some question about the diagnosis, a digital x-ray can provide evidence.
What relief for TMJD can Wilshire Smile Studio provide?
Often we can create an orthotic splint, a plastic oral appliance worn during the day, which will gradually adjust the bite to its proper place. If grinding teeth when you sleep is a habit that is contributing to misalignment, we can create a customized nightguard to wear when you go to bed. We also can teach you some simple exercises to stretch and relax the jaw and will advise you to avoid chewing gum or your nails. Those who have a tendency to TMJD should more soft foods and avoid those that require a lot of chewing. The underlying issue may also require dental surgery, Invisalign orthodontic trays, or crowns or bridges to improve the bite. We can also refer you to medical specialists, chiropractors, acupuncturists, physical therapists, ultrasound or laser therapy.
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