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What is TMJ?

The TMJ is the temporomandibular joint, commonly referred to as the jaw joint. This joint connects the lower jaw to the rest of the skull and ensures that your jaw functions properly to speak, eat, and yawn. If the TMJ becomes stressed, misaligned, or otherwise damaged, it can cause a condition called TMJ disorder, or TMD. Common symptoms of TMJ disorders include:

  • Frequent tension headaches and migraines
  • Pain in the face, back, neck, jaw, and shoulders
  • Difficulty or pain when chewing and biting
  • Ear pain and ringing in the ears
  • Clicking, grinding, or popping sounds in the jaw
  • Difficulty opening your mouth wide

How do you treat TMJ?

If you suffer from a TMJ disorder, our trained dentist may recommend TMD treatment. Dr. Marla Wilson may provide a custom-made mouth guard that prevents teeth grinding and clenching and relieves stress on the TMJ. We may also recommend jaw exercises or bite therapies as part of your TMJ treatment in Indianapolis, Indiana. To learn more about TMJ treatment, please contact us at Premier Dental Care today.

The Patient With Chronic Unresolved Head, Neck And Face Pain

“Once we know the WHAT, the WHERE, and the WHY of a patient’s complaint, we are in a position of planning a rational and effective therapy—and without that information, we simply have to guess and hope. Once we have that information, we make our differential diagnosis, which is the first step in rational therapy.”
-Weldon Bell

More than 50% of all visits to the family physician per year are for the treatment of some variety of head or back pain. In addition, 43% of all “healthy” patients suffer from some kind of head or back pain, and 11% have both. Quite often these visits result in the referral of patients to one or more groups of medical specialists in search of a cause for their pain. After careful examination of the patient by the specialist, these may still be negative findings, and diagnosis can become difficult, if not impossible. Unfortunately, it is sometimes advised by the doctor to seek a psychiatric consult in order to rule out a psychosomatic etiology to the pain, or advice is given that a patient will “simply have to learn to live with their pain and cope with it as best they can.”

If you are currently treating patients who suffer from chronic headaches, neck pain, otalgias, vertigo, tinnitus, shoulder pain, and stiffness, and the etiology of their condition remains baffling after all routine tests have been completed, perhaps you are being faced with the clinical manifestations of temporomandibular joint dysfunction syndrome or myofascial pain syndrome.

Temporomandibular joint dysfunction syndrome or myofascial pain syndrome are distinct and separate clinical entities, although the two terms are often used synonymously. Myofascial pain syndrome can occur in any muscle group throughout the body. However, when it occurs in the cervical and stomatognathic musculature, the symptomatology can mimic that of a temporomandibular joint dysfunction syndrome.

Myofascial Pain Syndrome

MPD syndromes are recognized medical entities which can affect single or large muscle groups anywhere in the body. Myofascial pain syndromes affecting the stomatognathic musculature are unrelated to occlusal discrepancies. When myofascial pain causes the development of a reflex myospasm, the e term myofascial pain dysfunction then applies. As stated in the July 1978 issue of the New England Journal of Medicine, MPD syndromes are a psycho physiologic condition primarily caused by tension habits that create spasm of the masticator musculature with the resultant development of an occlusal disharmony caused by the myospasm.

Temporomandibular Joint Syndromes

TMJ syndromes have their primary etiology in the temporomandibular joint mechanism itself. The actual joint pathology may involve the ligaments, capsule (Meniscus), or osseous structures, and can result from either extrinsic or intrinsic trauma. Extrinsic injury can result from a blow to the face, jaw, or the temporomandibular joint complex. Whiplash is another very common cause of extrinsically induced trauma to the TMJ. Direct traumatic injuries to the face, jaw, or joint complex can result in inflammation, fracture, hemarthrosis, and ankylosis of the joint. In cases of whiplash injury, the temporomandibular joint condyle is pulled into a non-physiologic relationship with the glenoid fossa of the temporal bone by the resulting myospasm. If undiagnosed or untreated, which is unfortunately the most common case, the long term presence of this chronic condylar displacement may lead to the development of degenerative osteoarthritis of the temporomandibular joint mechanism.

Intrinsic trauma to the temporomandibular joint complex may be caused by the presence of occlusal or craniomandibular discrepancies. Such discrepancies may result from drifting of the dentition (due to failure to replace teeth following extraction), inadequate or unfinished orthodontic therapy, or the placement of iatrogenic dental restorations.

Symptoms Of TMJ And MPD Syndromes

It is important to realize that an excess of 60% of all TMJ and MPD patients do not recover from their illness simply due to the fact that the patient is not properly diagnosed. This unfortunate fact holds true because most physicians and other health professionals fail to recognize the manifold symptoms of TMJ and MPD syndromes as being related to a dysfunction of the stomatognathic musculature or to the presence of non-physiologic condyle-fossa relationship. The patients also fail to bring their symptoms to the attention of a dentist because they cannot rationalize these chronic pain symptoms as being associated with a dysfunction of their occlusion or jaws. It is important to emphasize, however, that once properly diagnosed and treated, the prognosis for a full recovery becomes more favorable. In fact, current statistics indicate that 90% of all treated patients recover fully, and 50% experience a significant decrease in symptoms.

The following chart outlines the chief complaints presented by both TMJ and MPD patients and further substantiates the need for differential diagnosis of these two clinical entities:

TMJ
MPD
Headaches
X
X
Light Headedness
X
X
Buzzing or other sounds in the ears
X
X
Fullness in the ears and/or sinuses
X
X
Backaches (upper or lower)
X
X
Neck aches
X
X
Mandibular movement pain (opening/chewing)
X
X
Clicking sounds from the TM joint
X
X
Pain in the facial muscles
X
X
Pain from the TM joint
X
X
referred odontalgia
X
X
Pharyngeal pain
Pain in the eyes or visual disturbances
X
X
Chronic Fatigue
X
X
Pain on palpation of the joint through the external auditory meatus
X
X

 
The following are the clinical findings most commonly observed in the TMJ and MPD patient populations:

TMJ
MPD
Radiographic changes in the TM joint
X
Related to occlusal discrepancies
X
Primary etiology is stress syndrome
X

 
Thus, if a patient is classified as suffering from a TMJ dysfunction, radiographic changes and occlusal discrepancies must be documented. Such radiographic and occlusal pathology is best interpreted by a dentist knowledgeable in the science of TMJ dysfunction.

Treatment

The treatment and management of the TMJ and MPD patients must first begin with a proper diagnosis. Once diagnosed, however, both the oral and muscular components of these multi-causal syndromes must be managed. Treatment of these syndromes is approached in a multi-disciplinary manner, utilizing both orthopaedic and neuromuscular physiotherapeutic treatment regimens in addition to adjunctive pharmacologic and psychotherapeutic treatment.

The muscular component of these syndromes (myospasm of the head and neck) is treatment with muscle physiotherapy consisting of transcutaneous electroneural stimulation (T.E.N.S.), electrogalvanic stimulation, cryotherapy, counter-irritant sprays, ultrasound, moist heat myotherapy, muscle injections of local anesthetics into trigger areas, and muscle exercise therapy.

The oral component of these syndromes is effectively managed with the aid of one of several designs or oral orthopaedic TMJ appliances. These appliances not only serve to orthopaedically reposition bones into a proper relationship with each other (thus improving the function of the joint), but they also serve as neuromuscular appliances by maintaining the muscles of mastication in their proper resting length from origin to insertion.

In addition to neuromuscular physiotherapy and orthopaedic appliance therapy, the pharmacologic management of the TMJ and MPD patient must also be emphasized. Patients who are often depressed, exhibit sleep disorders, and have lowered pain thresholds require pharmacologic therapy to manage pain and stress response. Gregg states that cyclical nature of MPD episodes would tend to suggest a malfunction or perhaps exhaustion of the endorphin-serotonin response to pain and stress stimuli. Serotonin is the likely biochemical common denominator which accounts for many of the related symptoms of musculoskeletal complains in myofascial pain patients.

Psychotherapeutic treatment modalities which may be utilized in the treatment of TMJ and MPD patients are generally geared to stress reduction and behavior modification. Relaxation training and/or biofeedback may be utilized to supplement stress response reduction.

It is important to note that in addition to temporomandibular joint dysfunction or myofascial pain dysfunction syndrome, temporomandibular joint arthritis is another major cause of unresolved and undiagnosed head and neck pain. Other common symptoms of TMJ arthritis include retro-orbital pain radiating to the temporal region down the back of the neck, otalgias, loss of hearing, sinus congestions, vertigo, tinnitus, and paresthesia of the ear, face, neck, arms, and fingers. TMJ arthritis is often effectively treated with the fabrication and insertion of oral orthopaedic appliances, myotherapy to the spastic musculature and subsequent occlusal modification.