This article first appeared in the July 2013 issue of Ezyhealth magazine. We have reproduced it for the information of those of you who missed it when it was published.
TEMPORARY JOINT DISORDER (TMD, TMJ Disorder or Jaw Joint Disorder) is a common condition which affects the jaw joints (TMJ) and the muscles and structures around the joint. Most people know someone who has suffered from this disorder.
There are many contributory factors to TMJ Disorder, such as chronic pain syndrome, psychological factors, muscle over-activity, and dental malocclusion (improper bite). Stress is also a major contributory factor. Bruxing (grinding of the teeth) and clenching are common expressions of stress in a person and thus, those who have TMJ Disorders may find that this condition worsens at stressful times. Stress can also express itself in other ways, including mouth ulcers, alopecia (hair loss) and eczema (an autoimmune skin condition).
Other less common causes include arthritis or osteoarthritis of the joint, tumours and external or internal trauma due to yawning widely or undergoing prolonged dental treatment. Surveys show that a TMJ Disorder affects 6% to 12% of the population at some stage and has a bias towards women and young adults.
Three Classic Symptoms of TMJ Disorder
Pain – Pain around the TMJ is usually located around the front of the ear, temple and along the jaw line.
Restricted jaw motion – The jaw is limited in movement in any direction, and opening it increases the pain. The jaw feels stiff and can lock in an open or clsoed position, indicating possible misalignment of the joint.
Noises from the TMJ – Clicking or cracking noises are very common. However, these noises by themselves are not indicative of a problem that requires treatment, but when observed with the other symptoms may indicate a TMJ disorder.
There can be other syptoms such as tinnitus or dizziness, headaches, neck pain and locking episodes of the joints when the patient has to “manoeuvre” the jaw to close or open normally.
Treatment and Management
In the past, treatment for this condition involved analysing the bite to “correct” it and jaw surgery. However, this is no longer the first line treatment and has been shown to be very destructive to the teeth and tissues. Nowadays, the treatment and management are much more conservative, focusing on educating the patient about their condition, use of muscle relaxant drugs and pain killers to manage the acute phases, jaw exercises (physiotherapy), soft diets, massage and other relaxation techniques.
There are many types of splint or mouth guards available for treatment of TMJ Disorderes, ranging from full to partial coverage to fit the lower or more usually the upper jaw, and each claims its own benefits. However, studies have shown variable effectiveness compared with other treatments. Fitting a mouth guard or splint may not stop the grinding, and some may even encourage it.
Mouth guards are made of either soft or hard acrylic (plastic). The soft ones are more comfortable and easier to get used to, but less effective, while the hard ones take longer to get used to, but are more effective. The mouth guards are kept clean with a normal toothbrush and hand-soap or over the counter denture cleaners.
Probably the most useful aspect of mouth guards is protection against fracturing teeth or fillings due to the heavy bite forces when grinding. Typically, a well-made mouth guard should last three years or more depending on the level of grinding. Heavy bruxers will return with a mouth guard full of holes, and it is generally the time to get a new one. Mouth guards are initially difficult to get used to as it is essentially a foreign object in the mouth and the natural reaction is to want to remove it. A common complaint is that it increases salivation until the patient gets used to it. However, once accustomed to it, patients become quite dependent on them and will feel the difference in their teeth if they forget to put it in one night.
If you find yourself suffering from any of the symptoms described, then a proper dental and oral examination is the first step to managing this chronic conditionn. Whatever treatment is provided, it is aimed at preventing further damange to the jaw joints and teeth and can aid recovery of normal joint function.
Dr. Steven Soo is a UK Prosthodontist at Specialist Dental Group®. He was formerly a Clinical Lecturer at the Eastman Dental Institute and Clinical Teacher at the GKT Dental Institute, both of which are affiliated with the University of London. Dr Soo has a special interest in prosthetic and implant restorative dentistry. For more information, visit www.specialistdentalgroup.com