Do you suffer from debilitating headaches, neck or facial pain? These can be signs and symptoms of a TMJ disorder. Do you experience cracking or popping in your jaw with opening or chewing? Do you find yourself clenching or even holding your breath during the day? Have you had sinus like pain which was non-responsive to antibiotics? If so, you may be suffering from a TMJ disorder.
It has been estimated that millions of men, women, and children suffer with T
MD (temporomandibular disorder). Symptoms of headache and facial pain are primary but patients may experience earache, with clogging, ringing and hearing loss. In severe cases a dislodged disc in the TMJ can lock or block jaw movement. Other TMJ symptoms are grinding and clicking on opening and closing the jaw. In some cases, dental procedures can irritate the TMJ and lead to stress and strain in the surrounding musculature and intra articular structures of the TMJ. Some patients experience clicking which is non painful but may eventually lead to a locking and painful TM joint.
One of the major causes of TMD relates to chronic bruxing. Bruxing is a grinding of the upper and lower teeth which causes a strain in the hard tissue (teeth) and hyperactivity of the masticatory muscles (the muscle we use to chew). These structures can give rise to pain in the face, head and neck.
Other issues involve TMJ joint laxity which causes the TMJ support ligaments to elongate ultimately causing disc displacement (with clicking and locking).
As women are most effected (80%), estrogen receptor in the TMJ play a large role in women’s experience of pain with clenching and grinding. This micro trauma to teeth and the TMJ proper can lead to breakdowns of teeth and articular structures of the TM joint giving rise to headaches, facial and neck pain.
Other causes of pain can be traumatic falls involving the head and neck or direct trauma to the face and jaw. Dental work involving crown and bridge and tooth extraction or even dental cleanings can produce symptoms. Patents with missing teeth can lose proper structural support for the TMJ (Temporomandibular Joint).
Stress is a major feature producing a clenching and grinding habit. The effects of the habit produce a pain and spasm cycle in the head and neck which needs to be broken. Typically, if this cycle is not broken, increasing symptoms prevail and headache, facial pain and neck pain become more apparent and debilitating. This necessitates a visit to the family doctor. If this Dr is astute and familiar with these symptoms, he would refer the patient to dentist who understands this pathology.
What is the comprehensive treatment of this complex problem? Generally, this problem is the domain of the treating dentist, since the symptoms are broad in nature involving the face, head and neck joints and musculature structure. A comprehensive treatment generally involves a dentist who might order specialized X-rays and/or an MRI. An oral appliance or mouth guard may be necessary to decompress the TM joints and protect the teeth from damage due to bruxing. Appropriate medication such as muscle relaxants and anti-inflammatory medication may help to decrease muscle spasm and inflammation.
A comprehensive treatment program often includes a physical therapy evaluation and treatment. This treatment includes soft tissue work and mobilization of the TMJ and masticating musculature. Posture of the mandible and head on neck is discussed and corrected as it directly involves the outcome of dental treatment in most cases. Much time is spent teaching patients relaxation techniques and non-clench strategies which is key to the success of treatment.
Suggestions for Self Help
Patients with (TMD) temporomandibular disorders can be helped with modalities for pain relief and to facilitate healing. Moist heat and ice applications.
Moist heat applied in the a.m. can be helpful for tight and stiff facial muscles. This can be accomplished by taking 2 washcloths, one in each hand and holding them in warm water. You then apply these cloths to both sides of your face. Repeat as necessary for 2-4 minutes.
Generally speaking, we use ice for pain throughout the day to decrease pain, inflammation and swelling. Ice packs should be soft gel and are applied to both sides of the face. They should cover the TM joints and masseters on each side. Make certain the ice packs are wrapped in a soft cloth for 8-10 minutes. Again, these two modalities will assist for pain and influence healing.
Diet Recommendations
It is imperative that you avoid jaw joint and muscle micro trauma. This can be accomplished by avoiding hard and chewy foods and instituting a soft diet.
Foods to Avoid:
Bagels
Hard crust bread
Raw veggies
Thick pizza
Chewy candy
Tough meat and chicken
Whole apples
Hoagies
Also Avoid these Activities:
Gum chewing
Ice chewing
Biting your nails, pens and pencils
A significant cause of TMJ pain is the act of unconscious clenching and bruxing of your teeth. Other negative oral behaviors include jaw jutting and jaw shifting.
Again, it is important to rest your facial muscles and attempt to resolve negative oral behaviors.
A Comprehensive Treatment Includes:
Soft tissue work to the facial musculature and cervical spine. This work is done to calm muscle spasm in both areas. A program of self massage which is individualized to the patient is extremely helpful.
Conscious rest position of the mandible is instructed by a Certified Physical Therapist who is a (CCTT)a Certified Cervical and Temporomandibular Therapist. This instruction is key to a successful treatment program. Relaxation instruction helps patients learn how to deal with the stressors of their life and pain control. A postural evaluation of the head on neck with proper jaw position helps to facilitate balance of the whole system. Proper posture with activities at the desk or computer affect the musculature of the head and neck.
Other factors affecting your TMJ comprehensive program include proper sleep for healing and recovery. An oral appliance and medication including muscle relaxants and medication for pain may be ordered by your dentist.
If you have any questions please do not hesitate to call the office.