TEMPOROMANDIBULAR JOINT DISORDERS

The temporomandibular joint (TMJ) is where the jaw bone is hinged on the skull. It is a sliding hinge type of joint and can easily be dislocated in some patients. A temporomandibular joint disorder refers to the situation when the patient feels pain around the jaw, difficulty chewing or locking of the jaw either in opened or closed position. Some patients may even experience clicking or grating sound of the jaw; when opening or closing the mouth. However if there is no pain then no further treatment is required.
The cause of TMJ disorder can be difficult to elicit. It can be due to various underlying factors such as  osteoarthritis of the joint, traumatic injury, habit of teeth grinding, jaw clenching, habit of munching on hard food such as peanuts, stress and chewing gum. An abnormal dental bite can also contribute to TMJ disorders.

Treatment options

• Pain killers such as non-steroidal anti-inflammatory drugs such as mefenamic acid, diclofenac etc. However these painkillers should be taken with advice given by your doctor. Sometimes stronger painkillers are needed.
• Muscle relaxants to help relax the jaw muscles which are often tensed up due to pain.
• Sedatives may be needed for a short period of time
• Oral splints especially those with nightime teeth grinding
• Physiotherapy with heat or ice and even ultrasound can help ease the inflammation and pain
• Surgical procedures are rarely needed but may be considered in some patients eg joint injection

Home care advice

Patients are advised to take soft diet or to cut up their foods into small pieces to reduce chewing; which can aggravate the acute TMJ problem.

Applying heat or ice to the side of the face may help with the pain

Jaw exercises aimed at relaxing the jaw muscles and yet strengthen them at the same time

TMJ DISORDERS- PAIN IN THE EAR?

TMJ stands for temporomandibular joint. It’s the joint that allows our jaws to open and close. By anatomical position, it is situated in front of the ear canal. And like any joints it can give rise to pain when inflammed. However symptoms of TMJ disorder are unlike other usual joints. Most patients will present with ear pain, headache or ear pain on chewing.

Symptoms of TMJ disorder

Ear pain Headache Pain on chewing Jaw pain Facial pain Uncomfortable bite Locking of jaw Clicking sound during mouth opening

Why does it happen?

Most of the time, it is difficult to determine the actual cause or trauma that relates to TMJ disorder. There are certain risk factors associated such as it occurs more commonly in women between 30 to 50 years of age and those with jaw deformity. It can also be related to rheumatoid arthritis, teeth grinding during sleep or fibromyalgia.

During the doctor’s consultation

A thorough history is taken to assess the condition. Examination of the ear, nose, throat and face area is done to ascertain other causes for the symptoms. The TMJ on both sides is assessed and often is tender on palpation. Clicking or grating sounds can also be heard during mouth opening. Further imaging studies may be required to assess the joints.

Treatment

Treatment often consists of painkillers and medication to help ease the pain and relax the jaw muscles. Certain jaw exercises can also help, which will be taught by the doctor. These exercises will help to stretch the jaw muscles and reduce the pain.

If there is a very abnormal bite or teeth grinding then the patient is advised to seek corrective dental treatment and use bite guards.  Surgery is reserved for very advanced joint disease.

TAKE AWAY ADVICE

Avoid chewing gum or other chewing habits Eat soft food in small sizes Avoid eating nuts Ice packs applied over joint area Relaxation to reduce stress and jaw clenching