Temporomandibular joint (TMJ) disorder is a general term covering various syndromes and disorders that involve the bones, muscles, ligaments and nerves of the jaw joints and the muscles that operate the jaw.

All of the following terms may be used (almost interchangably) to describe the most common kind of TMJ disorder:

• TMJ
• TMJ Syndrome
• TMD (Temporomandibular disorder) (Temporomandibular dysfunction)
• TMJD
• MPD (Myofascial pain and dysfunction)

Less common TMJ conditions include the same conditions that may affect other joints in the body, such as:

• Ankylosis
• Arthritis
• Trauma
• Dislocation
• Developmental problems
• Neoplasia

Our jaw joints are some of the most complex joints in the human body due to the asymetric, reciprocal, elliptical movements involved in chewing and parafunction. Parafunction includes habits or movements, sometimes involuntary, that occur outside of normal function. Bruxism (teeth clenching or grinding) and nail biting are two common types of parafunction.

It is estimated that over 10 million Americans suffer from TMJ disorder at some time during their life. TMJ disorder can be episodic, meaning that its’ symptoms come and go almost for no understandable reason at different times. Typical symptoms may include:

• Pain in the TMJ area on one or both sides
• Pain when opening wide or closing the mouth
• Pain when chewing
• Difficulty opening wide
• Headaches, especially in the morning
• Sore jaw muscles, especially in the morning
• Radiating pain to the temporal area
• Earache

Note that popping, clicking or grinding sounds when opening the jaw wide are not necessarily indicative of a TMJ problem. These sounds occur in about 70% of the patients with TMJ syndrome, but also occur in about 70% of the normal population to some degree. So if you hear a sound, but have no other symptoms, don’t worry. It doesn’t necessarily indicate something is wrong.

Causes

We don’t know the precise etiology (cause) for TMJ disorder. Some factors that are generally considered contributory are:

• Bruxism – repetitive unconscious clenching or grinding of teeth, often at night in sleep
• Trauma – a blow to the chin can bruise the TMJ joint
• Excessive gum chewing, ice chewing or nail biting
• Malalignment of the chewing surfaces of the teeth due to defective dental restorations, eg. a new filling that is “too high.”
• Malalignment of the chewing surfaces of the teeth due to severe gum disease which loosens teeth and allows for excessive movement
• Malalignment of the chewing surfaces of the teeth due to loss of one or more teeth

Treatment

Restoration of the occlusal (chewing) surfaces of the teeth - If the occlusal surfaces of the teeth have been altered, the proper occlusion may need to be restored. Patients with bridges, crowns, or new fillings should be checked for bite discrepancies. These discrepancies, if present, may cause a person to make excessive contact with back teeth during sideways chewing motions. These inappropriate contacts are called interferences, and if present, they can cause a patient to subconsciously avoid those motions, as they will provoke a painful response. The result can be strain or spasms of the chewing muscles. Treatment could include adjusting the restorations or replacing them.

Splint therapy – Splints, also called nightguards or mouth guards are plastic appliances custom made to fit over the teeth (usually only upper teeth) that force the teeth cusps to disengage (like putting a car gearshift in neutral) and thus reduce nightime bruxism.

Professionally designed nightguards - Our custom, bilayer, bruxism nightguard splints are made with a soft internal liner and a hard co-polyester external layer. They are made using accurate plaster models of your teeth which are mounted on a special machine called an “articulator” that simulates the movement of your jaws when bruxing. The simulated movement serves as a guide for the contours of the nightguard surface. This complex fabrication process and very specialized materials are essential to a successful nightguard appliance and are the reason why homemade OTC (over the counter) products almost always fail. The homemade “boil and bite” materials can even result in appliances that do more damage and increase TMJ symptoms.

Do not confuse bruxism / TMJ nightguards with sports mouthguards. They are very different, made of different materials and do not function similarly. You should not use a sports mouthguard for a TMJ problem.

The same advice goes for orthodontic retainer appliances or teeth whitening trays. Different purposes, different materials, different functions. Not to be used for TMJ problems.

Other treatments- TMJ disorder, especially when associated with parafunction, is best treated conservatively and inexpensively. If major joint surgery, major full mouth reconstruction with multiple crowns, or long and expensive courses of biofeedback or chiropractry have been recommended, we suggest a second opinion and more research. The more expensive TMJ treatments are controversial among dentists and medical doctors due to success rates no better than the less costly conservative treatment.

Here is a list of simple things we have found to be helpful with TMJ disorder:

1. Sleeping on your back – In order to sleep on your back, the natural curvature of the spine must be preserved. Place a pillow underneath your knees and a small pillow or rolled up towel underneath your neck for support.
2. Application of moist heat – Apply to the areas that ache using a heating pad that supplies moist heat or a dry heathing pad in combination with a moist towel. Do this for 20 minutes twice a day.
3. Limit your intake of sugar, caffeine, and nicotine – Sugar and caffeine are stimulants to the nervous system which cause increased muscle activity. In most cases we are trying to rest muscles in order to heal painful spasms. Nicotine causes blood sugar to rise, which again increases muscle activity.
4. Avoid clenching your teeth together – Try to keep in mind the phrase, “lips together, teeth apart.” If you are having a particularly stressful time during your day, close your eyes, and slowly take five deep breaths, concentrating on slow exhalation with teeth apart.
5. Avoid foods which require a lot of chewing or wide mouth opening - For example- chewing gum, apples, Big Macs, or excessively hard or sticky foods.
6. Beware of opening your mouth excessively wide - This tends to stretch muscles and ligaments within the jaw joint beyond their capacity to heal. It is expecially helpful to support the lower jaw with your fist underneath your chin while yawning.
7. Take any pain meds or muscle relaxants as prescribed by Dr. Loshin
8. Find an outlet for stress - Activities such as jogging, aerobics or even just a brisk walk can help. Other activities such as Yoga, relaxation exercises, or Tai Chi can be helpful. Find what works for you and follow through.
9. Wear your nightguard appliance if one has been prescribed and finally remember – In most cases TMJ distress subsides with conservative therapy as outlined above. Complex dental or surgical interventions for this common problem are usually not necessary.