Welcome back to TGIF Dr Euan blogpost!
Have you suffered from ear pain and been surprised to find that your ears are normal? Do you experience pain and clicking in and around your ears? Do you sometimes yawn and get a sharp twang of pain?
Well then, you may have issues with your Temporo-Mandibular Joint or TMJ
In this blog post, we will look more deeply into the TMJ and how it works / can give you pain and other problems when things go wrong.
With the added stress and strain of our modern lives, TMJ problems are becoming more and more frequent.
What is TMD?
Temporomandibular disorders (TMD) is a term used to describe a group of dental or medical conditions affecting the temporomandibular joints (TMJ) in the jaw and the facial muscles that control jaw movement.
TMDs are a common cause of non-tooth-related facial pains and are more prevalent in women rather than men. TMDs can also display unexplained headaches, and pain in the jaw, or even the ears. As the symptoms of TMDs often overlap with other medical conditions, they are often under or misdiagnosed.
What is TMJ?
The temporomandibular joint (TMJ) is the joint that connects your lower jaw (mandible) to the skull’s bone. Situated on each side of the head and in front of the ears, it is a flexible joint that can move side to side, and up and down. These joints enable us to chew, talk and yawn. There are two joints, one on each side of the jaw.
The muscles attached to and surrounding the TMJ control its position and movement. A soft disc lying between the rounded end of the joint (condyle) and the joint socket (glenoid fossa) helps to keep jaw movements smooth, absorbing stress and shocks to the TMJ as we chew and perform other jaw functions.
The TMJ is richly innervated, mainly by the Trigeminal nerve (5th Cranial Nerve) but also by many other nerves.
The innervation to the temporomandibular joint (TMJ) is by branches from the mandibular division of the trigeminal nerve (CN V3), mostly through the auriculotemporal branch, along with branches from the masseteric and deep temporal nerves. The articular tissues and the dense part of the articular disc have no nerve supply.
Therefore, there is an overlap of sensory nerves with the ear and the ear canal. This explains why patients with TMD often experience ear pain. This is a form of referred otalgia.
What causes TMD?
The cause of TMD is not always clear and can vary between people, also at different stages of life. So symptoms may wax and wane.
TMD is usually the result of a few factors:
Bruxism: The unconscious clenching or grinding of teeth during sleep or when awake.
Trauma: Injury to the face and/or jaws, prolonged or wide mouth opening, biting on hard food, etc.
Habits: Gum chewing, eating on one side, poor jaw posture, etc.
Bad bite and jaw relationships: Poorly aligned teeth, skeletal problems, etc.
Diseases: Systemic arthritis, certain neurological conditions, tumours, etc.
Emotional: Stress, anxiety, depression, etc.
Symptoms of TMD
TMD can significantly affect your quality of life if symptoms are left untreated
The indicators of TMD can include:
Headaches
Ear symptoms: Ear pain, blocked feeling, ringing sounds, partial hearing loss, dizziness
Jaw pain or tenderness: Painful jaw joints or chewing muscles located in temples and cheeks
Jaw joint sounds: Clicking, popping and grating sounds
Jaw function difficulty: Difficulty chewing, yawning, talking, and opening the mouth
Abnormal jaw opening: Restricted opening, irregular movement, jaw catching and locking
Bite and teeth problems: Change in fit of teeth, sore and cracked teeth
Neck and shoulder pain
How is TMD diagnosed and managed?
TMD is diagnosed through comprehensive medical history, physical examination and psychological screening (where applicable). Routine or special X-rays like MRI and CT scans are sometimes used to diagnose the condition.
TMD management depends on the type and duration of TMD you are suffering from and the extent of tissue damage. Generally, treatment is aimed at reducing pain, decreasing adverse loading of the jaw joints and muscles, restoring function and allowing you to return to normal activities. Treatment begins with conservative therapies that are not invasive and include:
Education and self-care practices
Behaviour modification of harmful habits
Psychotherapy, including stress management and relaxation techniques
Medications
Physical therapy
Dental splint therapy
Image of a dental splint
If TMD is chronic, long-standing or associated with major structural changes and/or significant psychological distress and disability, the following may be advised:
Jaw joint surgery
Bite (occlusal) therapy
Orthodontics
Self-care tips for TMD
Most of the reasons that cause your jaws and chewing muscles to hurt are not life-threatening. They can, however, be distressing and affect your quality of life.
The following self-care practices can help you manage TMD:
Rest your jaw muscles and joints:
Avoid clenching and grinding your teeth. Relax your jaw by resting the tip of your tongue against the palate, keeping your teeth apart with face and jaws relaxed.
Avoid chewy or hard food.
Avoid chewing gum, biting your nails or other objects.
Avoid eating on the side that hurts.
Avoid opening your mouth too wide
Suppress your yawn to prevent your mouth from opening too wide.
Cut food into small pieces.
Avoid long dental appointments. Inform your dentist of your condition/s and take frequent breaks during appointments.
Apply hot or cold compresses, perform stretching exercises
Cold packs are used immediately following an injury (up to two days) while heat packs are used for long-term, lingering pain.
Apply a hot or cold pack directly to the painful area of your jaw for
five minutes.
Gently massage and stretch your mouth open and close five times without hurting yourself. Repeat five times.
Manage your stress
Stress decreases your body’s tolerance and “happy-pain-killing” hormones.
Most people react to stress by clenching or grinding their teeth. This is accompanied by tightening of the facial and neck muscles.
Choose a stress relief method that best suits you and stick to it.
Practice relaxation (e.g. deep breathing exercises) throughout the day.
Posture
Be aware of your posture throughout the day. Keep shoulders, back and head upright and maintain good back support.
Avoid slopping your shoulders.
Avoid crossing your legs for prolonged periods. Keep feet flat on the floor.
Sleep
Sleep on your back or side. Sleeping on the stomach puts pressure on your jaws.
Get adequate sleep.
Practice good sleep hygiene.
Massage your face and neck before bed.
Exercise
Choose low-impact exercise to avoid trauma to your joints, e.g. swimming, brisk walking, etc.
Avoid clenching your teeth during exercise.
Take the opportunity to exercise and stretch.
Nutrition
Avoid caffeine, alcohol and tobacco.
Drink plenty of water throughout the day.
Eat your meals regularly, especially if you are taking aspirin, Synflex or ibuprofen.
Use of your dental splint
Your dental splint is designed to protect, unload and/or stabilise your jaw muscles and joints. It should help you feel more comfortable and facilitate healing.
To obtain maximum benefit, please note the following:
When to use your splint
Your splint should be worn when you are asleep where bite forces are the greatest.
Daytime wear may be recommended if you experience severe stress or pain.
Avoid wearing your splint for 24 hours unless instructed to do so.
Do not wear your splint when you are eating.
Do not bite down on your splint
Your teeth should not touch the splint when you are awake.
Monitor your jaw position and try to break this habit.
Getting used to your splint
In the first few days of using your splint, you may salivate more or experience a temporary increase in jaw tension or noises. You may also subconsciously remove it in the middle of the night.
If your splint is causing your teeth to hurt, remove it and have it readjusted.
Increase the frequency of your splint wear until you reach the recommended wear schedule.
Relaxation of your jaw muscles
Your jaws may take a few minutes to adjust back to the way it was when you removed your splint after wearing it. This is usually caused by the relaxation of your jaw muscles and the settling in of your teeth after a night of clenching and/or grinding.
If you had an orthodontic treatment or have a severe bite problem, your new relaxed jaw position may be more comfortable than your original one.
This may be associated with bite changes and the need for bite therapy. Please inform us immediately should the latter occur.
When you are not wearing your splint
• Place your splint in a safe place and in a protective container.
• Avoid leaving it in a warm place. This prevents distortion.
• Store it in a moist environment if you are not wearing it for more than eight hours. Place it in a container of tap water, a zip-lock bag or a container with a few drops of water or a wet piece of facial cotton.
Cleaning your splint
• Clean the inside and outside of your splint with a toothbrush and some toothpaste daily.
• Soak your splint in a denture-cleaning solution once a week.
Splint review and modifications
• Your splint needs to be periodically reviewed and adjusted due to changes in your jaw position. It also allows your dentist to check the wear and tear of your splint.
• Remember to bring your splint with you to each appointment.
When to stop using your splint
• Your duration of wear will depend on your specific condition/s and symptoms.
• While some patients can stop wearing splints after a pain-free period, others have to wear them for years.
At Euan’s ENT Surgery & Clinic, we usually partner with a Dental or Oromaxillofacial specialist to manage your TMD. They will provide dental splints which are custom-made to fit your teeth and jaw.
If you require immediate attention, don't hesitate to get in touch with the clinic during office hours, Euan's ENT Surgery & Clinic to make an appointment or call our clinic number 6694 4282.
Well, I hope this post has given you an insight into the TMJ and TMD, and how it may affect you / your loved ones.
Have a restful weekend :-)
Here is a list of references in case you want to delve even deeper into the topic:
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