TEMPOROMANDIBULAR (JAW) DISORDERS AND DYSFUNCTION (TMJ)

Definition:  The term TMJ Disorder is a collective term which includes a number of problems that involve the head, neck and temporomandibular/jaw joints.

Symptoms:  The primary symptoms of temporomandibular dysfunction are (1) pain in the head, neck or jaws; (2) inability or difficulty to move the jaws easily or smoothly; (3) a bad bite or teeth that do not fit together properly; (4) frequent headaches; (5) clicking sounds in the jaw joints; (6) locking of the jaws.

Incidence:  Epidemiological studies have shown that approximately 75% of the population have at least one sign of temporomandibular dysfunction.

Causes:  TMJ problems are most often caused by: (1) trauma from a motor vehicle accident or blow to the jaw; (2) a bad bite/malocclusion or poorly fitting teeth; (3) bruxism or grinding of the teeth; (4) diseases such as arthritis; (5) psychological factors such as stress, anxiety or depression.

Treatment:  The treatment of TM disorders involves a team approach involving several health-care specialists.  The basics of TM treatment involves:

1)  Patient education and self care including resting the jaw, eating soft foods and limiting jaw movement; applying ice and heat, and gentle exercise.

2)  Medications including pain relievers, anti-inflammatory medications and muscle relaxants.

3)  Physical therapy including massage, physiotherapy and chiropractic.

4)  Stress management including relaxation therapy, biofeedback and counseling.

5)  Occlusal splint therapy or night-guard treatment which separates the jaws to allow neuromuscular relaxation.

6)  Bite correction therapy which could involve adjusting or correcting the bite, orthodontic therapy or braces to reposition the teeth, restorative or crown and bridge treatment to rebuild or replace missing teeth to provide a proper bite.

7)  Surgical therapy which could involve corrective jaw surgery or joint restructuring.

 

TREATING YOUR JAW

The following recommendations are an important and necessary part of managing your temporo-mandibular joint dysfunction (TMJ) - jaw problem.  In order for your jaw problem to improve it requires a period of rest.  The following recommendations are important to create the conditions that will allow the jaw muscles and joints to recover.  This usually requires a change of habits and behaviours on a day-to-day basis.  This is part of the treatment and is important since there is no medicine or treatment procedure that cures the problem.  It is unlikely that you will experience improvement without addressing these potential sources of strain on the jaw.

1.  Awareness of habits or jaw use patterns.

The top and bottom teeth make contact during eating and swallowing but should not touch at other times.  When the jaw is not working during eating, swallowing, yawning and talking, the teeth should be apart and the jaw should be at rest.

• Notice any contact your teeth make.
• Notice any positions your jaw continually returns to.
• Notice any clenching, grinding, gritting, tapping of teeth or tensing of jaw muscles.
• Be aware of whether you are able to chew on either side of the jaw.
• Notice when tooth contacts occur or the jaw muscles are tense, such as during driving, studying, reading, social situations, conversations, fatigue, overwork, stress, emotional upsets, work, sports.

2.  Positioning the jaw to avoid tooth contacts.

Place the tip of the tongue just behind the top front teeth and keep the teeth slightly apart.  Maintain this position whenever the jaw is not being used.

3.  Diet Modifications

Softer foods place less stress on the jaw muscles and joints.  Avoid eating hard foods such as whole apples or thick sandwiches that require opening wide and biting with the front teeth.  Cut foods into small pieces and eat them on the back teeth.

Do not chew gum or sticky soft foods that require excessive jaw movements.

During the treatment period, do not return to to chewing hard or chewy foods as soon as the jaw starts to feel better.  The jaw will still need recovery time before you return to a normal chewing diet.

4.  Avoid wide jaw openings

Excessive movements of the jaw will place stress on the joint and the muscles.

5.  DO NOT TEST THE JAW!

You may feel the need to periodically check whether you are making progress and see if the soreness is resolving.  This usually requires moving the jaw beyond the comfortable range or eating harder foods.  When you move your jaw to the point where you produce pain and discomfort, you have added to the stress on your muscles and joints, and this can perpetuate the problems you are trying to eliminate.

6.  Dental Treatment

Avoid any dental treatment not related to active tooth decay and gum disease until your jaw symptoms are under reasonable control.  Wide mouth opening required for dental procedures is a significant stress.  This includes dental cleaning.  Discuss this with Dr. Kantarovich if you are planning elective dental treatment.

7.  Sleep Patterns

Avoid sleeping on your stomach, which puts considerable pressure on the jaw.  Propping pillows beside you may be helpful in avoiding unconsciously moving onto your stomach.

Avoid sleeping positions where the jaw is rested on a hand or arm which also applies considerable pressure to the jaw.

8.  Support the jaw during yawning

Place your index finger and thumb or back of your hand under your chin to provide extra stability to the jaw during yawning.

9.  Avoid leaning on your chin or jaw at any time

Avoid cradling the phone with your shoulder to free up your hands.  There may be other factors contributing to jaw dysfunction.  This guide may have overlooked something that is contributing to your problem.  Please report anything that you think may be contributing.  Your input is important.

10.  Heat or  Cold Applications:  Jaw muscles and joint problems respond to heat applications.  In some instances people find cold applications more soothing.  Start by applying heat.  Try cold application if heat is not helpful.

Heat:   Heat the area of the face around your cheek, jaw and temple.  These are the locations of key jaw muscles.  Moist heat is considered more penetrating.  Heat-packs found in medical supply stores, hot water bottles, or towels heated in hot water can be used.  Heat should be applied at least two times each day for 10 to 20 minutes each time.  During episodes when pain is worse, heat should be used more frequently.

Cold:  Cold applications can be helpful especially after a new or additional injury to a jaw muscle or joint.  A cold gel-pack, bag of frozen peas, or plastic bag filled with ice and wrapped with a kitchen towel can be applied to the sore area for 10 to 15 minutes, three times a day, or every two hours for two days after a recent injury.