TMJ (temporomandibular joint) disorders are a family of problems related to your jaw joint. If you have had symptoms like pain or a “clicking” sound, you’ll be glad to know that these problems are more easily diagnosed and treated than they were in the past. These symptoms occur when the joints of the jaw and the chewing muscles do not work together correctly. TMJ stands for temporomandibular joint, which is the name for each joint (right and left) that connects your jaw to your skull. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.
No one treatment can resolve TMJ disorders completely and treatment takes time to become effective.
Trouble With Your Jaw?
TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. You may have a damaged jaw joint due to injury or disease. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. As a result, the disk, which is made of cartilage and functions as the “cushion” of the jaw joint, can slip out of position or become worn thin. Whatever the cause, the results may include a misaligned bite, pain, clicking, or grating noise when you open your mouth, or trouble opening your mouth wide.
Do You Have a TMJ Disorder?
- Are you aware of grinding or clenching your teeth?
- Do you wake up with sore, stiff muscles around your jaws?
- Do you have frequent headaches or neck aches?
- Does the pain get worse when you clench your teeth?
- Does stress make your clenching and pain worse?
- Does your jaw click, pop, grate, catch, or lock when you open your mouth?
- Is it difficult or painful to open your mouth, eat, or yawn?
- Have you ever injured your neck, head, or jaws?
- Have you had problems (such as arthritis) with other joints?
- Do you have teeth that no longer touch when you bite?
- Do your teeth meet differently from time to time?
- Is it hard to use your front teeth to bite or tear food?
- Are your teeth sensitive, loose, broken or worn?
The more times you answered “yes”, the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they are treated.
There are various treatment options that Dr. Cromwell can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, Dr. Cromwell will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care combined with professional care.
The initial goals are to relieve the muscle spasms and joint pain. This is usually accomplished with a pain reliever, anti-inflammatory, or muscle relaxant. Steroids can be injected directly into the joints to reduce pain and inflammation (by referral). Self-care treatments can often be effective as well and include:
- Resting your jaw
- Keeping your teeth apart when you are not swallowing or eating
- Eating soft foods
- Applying ice and heat
- Exercising your jaw
- Practicing good posture
Stress management techniques such as biofeedback or physical therapy may also be recommended, as well as a temporary, clear plastic appliance known as a splint. A splint (or nightguard) fits over your top or bottom teeth and helps keep your teeth apart, thereby relaxing the muscles and reducing pain. There are different types of appliances used for different purposes. A nightguard helps you stop clenching or grinding your teeth and reduces muscle tension at night. It also helps to protect the cartilage and joint surfaces. An anterior positioning appliance moves your jaw forward, relieves pressure on parts of your jaw, and aids in disk repositioning. It may be worn 24 hours/day to help your jaw heal. An orthotic stabilization appliance is worn 24 hours/day, or just at night, to move your jaw into proper position. Appliances also help protect tooth wear.
What About Bite Correction or Surgery?
If your TMJ disorder has caused problems with how your teeth fit together you may need treatment such as bite adjustment (equilibration), orthodontics with or without jaw reconstruction, or restorative dental work. Surgical options, such as arthroscopy and open joint repair restructuring, are sometimes needed, but are reserved for severe cases. Dr. Cromwell does not considerreferral for TMJ surgery unless the jaw can’t open, is dislocated and non-reducible, has severe degeneration, or the patient has undergone appliance treatment unsuccessfully.
Bruxism is an oral parafunctional activity that commonly occurs in most people at some point in their lives. The two main characteristics of this condition are grinding of the teeth and clenching of the jaw. These actions usually occur during a person’s sleeping hours, but occasionally they occur during the day.
Bruxism is one of the most common known sleep disorders. Chewing is a neuromuscular activity controlled by a subconscious process, but more highly controlled by the brain. During sleep, the subconscious process may become active, while the higher control is inactive (asleep), resulting in bruxism. The most common symptoms are earaches, headaches, depression, eating disorders, anxiety, and chronic stress.
Why should I seek treatment for Bruxism?
- Gum recession. Bruxism is a leading cause of gum recession and tooth loss. Grinding can damage the soft tissue directly and lead to loose teeth and deep pockets where bacteria are able to colonize and decay the supporting bone.
- Facial pain. Grinding can eventually shorten and blunt the teeth. This can lead to muscle pain in the myofascial region and in severe cases, incapacitating headaches.
- Occlusal trauma. The abnormal wear patterns on the occlusal (chewing) surfaces of the teeth can lead to fractures, which, if left untreated, may require restorative treatment at a later time.
- Arthritis. In the most severe cases, bruxism can eventually lead to painful arthritis in the temporomandibular (TMJ) joints that allow the jaw to open and close smoothly.
Though there is no known cure for bruxism, there are a variety of devices and services available through our office to help treat bruxism:
- Mouthguards. An acrylic mouthguard can be designed from teeth impressions to minimize the abrasive grinding action during normal sleep. Mouthguards must be worn on a long-term basis to help prevent tooth damage.
- NTI-tss device: This device only covers the front teeth and must be fitted at our office. The idea behind the NTI-tss is to prevent grinding the rear molars by limiting the contraction of the temporalis muscle in the jaw.
- Botox®: Botox® can be injected into the muscles responsible for bruxing by disabling them enough to prevent grinding, but not enough to disrupt normal functions like speaking and chewing. A referral to an oral surgeon is needed for this service