A significant amount of the population suffer from recurrent or chronic Temporomandibular Disorder (TMD) symptoms. Here at Rigby Advanced Dental in Austin, Texas we take careful measures to help treat and alleviate these symptoms. Dr. Brent Rigby utilizes his additional training and knowledge as a prosthodontist to diagnose and treat TMD symptoms. Lets take a closer look at the Temporomandibular Joint (TMJ), the symptoms of TMD and interventions with today’s post.
Temporomandibular disorders (TMD) occur as a result of problems with the occlusion, jaw joint (temporomandibular joint, or TMJ) and surrounding facial muscles that control chewing and moving the jaw.
WHAT IS THE TEMPOROMANDIBULAR JOINT?
The temporomandibular joint is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull, which is immediately in front of the ear on each side of your head. The joints move smoothly up and down and side to side and enables you to talk, chew and yawn. Muscles attached to and surrounding the jaw joint control its position, movement and articular disc location.
WHAT CAUSES TMD?
The cause of TMD is not clear, but dentists believe that symptoms arise from problems with the muscles of the occlusion and/or with the parts of the joint itself.
Injury to the jaw, temporomandibular joint, or muscles of the head and neck, such as from a heavy blow, from sports injuries can cause TMD. Other possible causes include:
- Grinding or clenching the teeth (which puts a lot of pressure on the TMJ).
- Dislocation of the soft cushion or disc between the ball (mandibular condyle) and socket (temporal fossa).
- Presence of osteoarthritis or rheumatoid arthritis in the TMJ.
- Stress……one of the most common causes and often difficult to treat. When stressed a person tends to tighten facial and jaw muscles or clench the teeth leading to TMD symptoms.
WHAT ARE THE SYMPTOMS OF TMD?
People with TMD can experience severe pain and discomfort that can be temporary or last for many years. TMD is seen most commonly in people between the ages of 20 and 40, and occurs more often in women than in men.
Common symptoms of TMD include:
- Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide
- Limited ability to open the mouth very wide
- Jaws that get “stuck” or “lock” in the open- or closed-mouth position
- Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain)
- A tired feeling in the face
- Difficulty chewing or a sudden uncomfortable bite – as if the upper and lower teeth are not fitting together properly
- Swelling on the side of the face
Other common symptoms include toothaches, headaches, neckaches, dizziness, and earaches and hearing problems.
HOW IS TMD DIAGNOSED?
Because many other conditions can cause similar symptoms — including a toothache, sinus problems, arthritis, or gum disease — Dr. Rigby, or your dentist, will conduct a careful patient history and clinical examination to determine the cause of your symptoms. Your temporomandibular joints will be examined for pain or tenderness: listened to for clicking, popping, or grating sounds during jaw movement; looked at for limited motion or locking of the jaw while opening or closing the mouth; and examined for bite and facial muscle function.
Sometimes panoramic x-rays (radiographs) will be taken. These full face x-rays allow Dr. Rigby, or your dentist, to view the entire jaws, TMJ, and teeth to make sure other problems aren’t causing the symptoms. Sometimes other imaging tests, such as magnetic resonance imaging (MRI) or computed tomography (CT), are needed. The MRI views the soft tissue such as the TMJ disc to see if it is in the proper position as the jaw moves. A CT scan helps view the bony detail of the joint.
Dr. Rigby, or your dentist, may decide to send you to an oral surgeon (also called an oral and maxillofacial surgeon) for further care and treatment. This healthcare professional specializes in surgical procedures in and about the entire face, mouth, and jaw area.
WHAT TREATMENTS ARE AVAILABLE FOR TMD?
Treatments range from simple self-care practices and conservative treatments to injections and open surgery. Most experts (prosthodontists, physical therapists and chiropractors) agree that treatment should first begin with conservative nonsurgical therapies and the more aggressive surgical interventions should be left as methods of last resort. Many of the conservative basic treatments listed below often work best when used in combination.
Apply moist heat or cold packs – Depending on what provides symptom relief, apply a hot compress or ice pack to the side of your face and temple area for approximately 10 minutes. Doing this several times a day and paying attention to what feels best can help alleviate TMJ symptoms. It may also be of worth to do a few simple stretching exercises for your jaw (as instructed by your dentist or physical therapist).
Eat soft foods – Eat soft foods such as yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans, and grains. In addition, cut foods into small pieces to decrease the amount of chewing required. Avoid hard and crunchy foods (like hard rolls, pretzels, raw carrots), chewy foods (like caramels and taffy) and thick and large foods that require your mouth to open wide to fit.
Take medications – To relieve muscle pain and swelling, try nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil, Motrin, Aleve), which can be bought over-the-counter. Your dentist can prescribe higher doses of these or other NSAIDs, or other drugs for pain such as narcotic analgesics. Muscle relaxants, especially for people who grind or clench their teeth, can help relax tight jaw muscles. Anti-anxiety medications can help relieve stress that is sometimes thought to aggravate TMD. Antidepressants, when used in low doses, can also help reduce or control pain. Muscle relaxants, anti-anxiety drugs, and antidepressants are available by prescription only.
Wear a splint or night guard — Splints and night guards are plastic mouthpieces that fit over the upper and lower teeth. They prevent the upper and lower teeth from coming together, lessening the effects of clenching or grinding the teeth. They also correct the bite by positioning the teeth in their most correct and least traumatic position. Avoid splints that are soft, as they may unintentionally encourage you to clench, chew or grind on them.
The main difference between splints and night guards is that night guards are only worn at night and splints are worn full time (24 hours a day for 7 days). Your dentist will discuss with you what type of mouth guard appliance you may need.
Correct dental problems – Replace missing teeth; use crowns, bridges, or braces to balance the biting surfaces of your teeth or to correct a bite problem.
Avoid extreme jaw movements — Keep yawning and chewing (especially gum or ice) to a minimum and avoid extreme jaw movements such as yelling or singing. Do not rest your chin on your hand or hold the telephone between your shoulder and ear. Practice good posture to reduce neck and facial pain.
Just breath — If you feel yourself clenching or over stimulating the joint……relax, take a deep breath in and blow it out. Doing this will separate your teeth, relieve pressure on the joint and help your body to relax and release stress. To control clenching or grinding during the day, try placing your tongue between your teeth and make a conscious effort to keep your teeth apart.
Learning relaxation techniques to help control muscle tension in the jaw. Ask Dr. Rigby, or your dentist, about the need for physical therapy or massage. Stress reduction therapy, with biofeedback may be recommended.
When or if the basic treatments listed above prove unsuccessful, Dr. Rigby, or your dentist, may suggest one or more of the following alternative therapies:
Transcutaneous electrical nerve stimulation (TENS) – This therapy uses low-level electrical currents to provide pain relief by relaxing the jaw joint and facial muscles. This treatment can be done at the dentist’s office or at home.
Ultrasound – Ultrasound treatment is deep heat that is applied to the TMJ to relieve soreness or improve mobility.
Trigger-point injections – Pain medication or anesthesia is injected into tender facial muscles called ‘trigger points” to relieve pain.
Radio wave therapy – Radio waves create a low-level electrical stimulation to the joint, which increases blood flow. The patient experiences relief of pain in the joint.
Surgery — Surgery should only be considered after all other treatment options have been tried and you are still experiencing severe, persistent pain. Because surgery is irreversible, it is wise to get a second or even third opinion from other dentists. There are three types of surgery for TMD: arthrocentesis, arthroscopy, and open-joint surgery. The type of surgery needed depends on the TMD problem.
- Arthrocentesis – This is a minor procedure performed in the office under general anesthesia. It is performed for sudden-onset, closed lock cases (restricted jaw opening) in patients with no significant prior history of TMJ problems. The surgery involves inserting needles inside the affected joint and washing out the joint with sterile fluids. Occasionally, the procedure may involve inserting a blunt instrument inside the joint. The instrument is used in a sweeping motion to remove tissue adhesion bands and to dislodge a disc that is stuck in front of the condyle (the part of your TMJ consisting of the “ball” portion of the “ball and socket”).
- Arthroscopy – Patients undergoing arthroscopic surgery are given general anesthesia. The surgeon then makes a small incision in front of the ear and inserts a small, thin instrument that contains a lens and light. This instrument is hooked up to a video screen, allowing the surgeon to examine the TMJ and surrounding area. Depending on the cause of the TMD, the surgeon may remove inflamed tissue or realign the disc or condyle. Compared with open surgery, this surgery is less invasive, leaves less scarring, and is associated with minimal complications and a shorter recovery time. Depending on the cause of the TMD, arthroscopy may not be possible, and open-joint surgery will need to be considered.
- Open-joint surgery – Patients undergoing open-joint surgery also are given a general anesthesia. Unlike arthroscopy, the entire area around the TMJ is opened so that the surgeon can get a full view and better access. There are many types of open-joint surgeries. This approach may be taken if the bony structures that comprise the jaw joint are deteriorating, there are tumors in or around your TMJ, or there is severe scarring or bone chips in the joint. Compared with arthroscopy, open-joint surgery results in a longer healing time, and there is a greater chance of scarring and nerve injury.
The temporomandibular joint (TMJ) is the site where the upper jaw (maxilla) and lower jaw (mandible) meet. TMJ disorders are a group of complex problems with many possible causes. Symptoms of TMJ disorders include headache, muscle soreness, ear pain, dizziness, and fullness or ringing in the ear. There are many treatment options for TMJ disorders. Please see a trained professional for proper diagnosis and treatment recommendations.
We enjoy being able to provide the best dental care possible to the people of Bee Cave, Lakeway and other surrounding Lake Travis areas! Our dental office is located in The Offices at the Hill Country Galleria. If you have any questions, feel free to call and schedule and appointment today (512) 992-2822. Rigby Advanced Dental is here to take care of all your dental needs.