Temporomandibular Joint (TMJ) Dysfunction and Facial Pain
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The only ‘joint’ of the head region is the temporomandibular joint (TMJ). There are two TMJ’s which connect the lower jaw to the temporal bones. You can feel the joints moving when you place your fingers just in front of your ear lobes and open and close your mouth. These joints are responsible for allowing your lower jaw to move.
TMJ dysfunction can be caused by a myriad of problems, the most common being bruxism (teeth grinding) and trauma. It is characterised by facial pain, restricted lower jaw movement, clicking sounds or a grating sensation in the TMJ’s.
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Diagram from tmj.org
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TMJ dysfunction treatment
TMJ disorders are commonly of a transient nature and therefore are best treated conservatively. Treatment is often palliative, with a goal of reducing the symptoms.
First line treatment for patients with TMJ dysfunction is the prescription of an occlusal splint (night guard).
An occlusal splint that is worn to bed whilst you sleep will act as a physical barrier to protect the teeth and may de-program the neuromuscular complex responsible for the grinding initiation.
Other TMJ dysfunction advice
Avoid extreme jaw movements such as chewing gum, yawning, yelling and adopt a soft diet.
Physiotherapy – There are physiotherapists trained with an interest in TMJ dysfunction management that provide therapy, massage and strengthening exercises.
Warm or cold packs – the application of heated or cooled packs can assist in muscle relaxation and also provide a soothing effect.
Relaxation and stress management – This is almost ‘tongue in cheek’ since we all have unavoidable stress in our lives, however, an increased level of stress has been shown to cause an increased frequency and force of bruxism.
Muscle Relaxant Medication – muscle relaxing medication such as valium or mersyndol may be prescribed on a short term basis.
Bruxism
Bruxism is a fancy term for the unproductive grinding of teeth or clenching of teeth together. It is highly prevalent in society with some studies reporting the incidence to be as high as 50%. Most commonly, the bruxer is completely unaware of the habit and even denies the existence of the diagnosis.
Studies have also shown that the amount of force that a bruxer can exert on their teeth whilst sleeping is in some cases up to 10 times greater than they can achieve whilst awake!
Bruxism is an extremely large problem in dentistry and can lead to many problems with teeth.
Accelerated tooth wear – as teeth get worn down there is loss of facial height, wrinkles appear and you appear older.
Fractured teeth and fillings – bruxers break everything, often ‘blaming’ the dentist for poor quality work. They will have a lifetime of broken teeth, fillings and crowns.
Tooth sensitivity and devitalisation of the dental pulp – Often the forces of clenching and grinding will lead to cracks in the tooth which may propagate to the dental pulp which may ultimately result in the tooth becoming infected and requiring root canal treatment.
Temporomandibular joint dysfunction (TMJ) – damage to the TMJ’s
Muscle pain -with not only the muscles involved with chewing, but even those of the neck and upper back. Tension headaches and apparent ear aches are also common.
Treatment of Bruxism
As it is often impossible to cease the actual habit of nocturnal bruxism, the treatment is purely protective. The treatment of bruxism is discussed in detail in TMJ dysfunction. The first-line treatment is the fabrication of an occlusal splint (nocturnal – night splint), a protective mouthguard that the patient wears to bed. It acts as a physical barrier to protect the teeth and may de-program the neuromuscular complex responsible for the grinding initiation. An impression is taken of your mouth using a ‘play dough – like’ material and the splint is fabricated by a dental technician.
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