TMJ / TMD

TMJ (Temporomandibular joint)-This is the joint between the lower jawbone (mandible) and the temporal bone of the skull. TMJ is the one responsible for our jaw movement and enables chewing, talking and yawning. Temporomandibular disorders refers to a group of conditions characterized by pain in the jaw area and limited movement of the mandible. The TMD may be caused by problems in the joints itself or in the muscles surrounding the joint. Problems in the joint include:

• Arthritis
• Inflammation
• Internal derangements (disc displacement)

When the problem is in the muscles, the condition is called myofascial pain syndrome. It is very common and can occur in patients with a normal temporomandibular joint. The syndrome is characterized by the presence of hyperirritable spots located in skeletal muscles called trigger points. A trigger point can be felt as a nodule of muscle with harder than the normal consistency. Palpation of trigger points may elicit pain in a different location. This is called referred pain. Trigger points are developed as a result of muscle overuse. Commonly, the muscles of chewing or mastication are overworked when patients excessively clench or grind their teeth unconsciously during sleep. The medical term for this condition is NOCTURNAL BRUXISM. A trigger point is composed of many contraction knots where individual muscle fibers contract and cannot relax. The sustained contraction of muscle sarcomeres compresses local blood supply resulting in energy shortage of the area. This  metabolic crisis activates pain receptors generating a regional pain pattern that follows a specific nerve passage. The pain patterns are therefore consistent and are well documented to the cheeks, lower jaw, upper and lower molar teeth, eyebrow, inside the ear and around the tmj area, trigger points in the temporalis are also associated with headache and toothache from upper teeth. The main culprits of myofascial pain in the TMJ area are the pterygoid muscles that refer to the TMJ region in front of the ear, inside the mouth and upper outside of the neck. They may also manifest as sore throat and difficulty swallowing. Pain from lateral pterygoid trigger points can be felt in front of the ear and on the upper jaw.

Treatments available:

• Medications like pain killers, muscle relaxants or botox injections
• Therapies to encourage relaxation i.e stress management, behavior therapy, biofeedback
• Trigger points technique such as needling
• Splints and mouthguards to protect the teeth from any damage

Depending on the severity of your TMJ issue, you might be referred to a specialty clinic to get a treatment or your general dentist can offer you the treatment within her/his office.