Open and shut
Open your mouth as wide as you can and then shut it. You have just used one of the most important parts of your body, your temporomandibular joint, which connects your jaw to the side of your head. Even though it is only a small disc of cartilage, it separates the bones so that the mandible, or lower jaw, may slide easily whenever you talk, swallow or chew. Therefore, damage to this complex structure in front of your ear can cause considerable discomfort. It’s unknown how many people have TMJ disorders, but some estimates suggest that over 10 million Americans are affected. The condition appears to be more common in women than men. For most people, pain in the area of the jaw joint or muscles does not signal a serious problem. Generally, discomfort from these conditions is temporary, often occurring in cycles. The pain eventually goes away with little or no treatment. Some people, however, develop significant, long-term symptoms.
Cause often unknown
Because it combines a hinge action with sliding motions, the temporomandibular joint is one of the most complex joints in your body. The lower jaw has rounded ends that glide in and out of the joint socket when you talk, chew or yawn. The parts of the bones that interact in the joint are covered with cartilage and are separated by a small shock-absorbing disk, which keeps the movement smooth. Trauma to the jaw sometimes plays a role in TMJ disorders, but in most cases the cause of the disorder is unknown. Most experts suggest that certain tasks may cause or aggravate TMJ. Most discomfort is caused from overuse of the muscles, specifically clenching or grinding teeth, also known as bruxism. These excessive habits tire the jaw muscles and cause headaches or neck pain. Patients may also experience a combination of muscle and joint problems. This is why diagnosing TMJ disorders can be complex and may require different diagnostic procedures.
Sharp or dull pain
The most common symptom of temporomandibular joint disorders, commonly known as TMJ, is pain, particularly in the chewing muscles or jaw joint. The pain may be sharp or it may be dull and constant. It hurts over the joint, immediately in front of the ear, but pain can also radiate elsewhere. It often causes spasms in the adjacent muscles that are attached to the bones of the skull, face, and jaws. Then, pain can be felt at the side of the head, the cheek, the lower jaw, and the teeth. Many patients will see ear specialist, convinced that their pain is from an infection. When the earache is not associated with a hearing loss and the eardrum looks normal, the doctor will consider the chance that the pain comes from TMJ. TMJ disorders can also cause a clicking sound or grating sensation when you open your mouth or chew. But if there’s no pain or limitation of movement associated with your jaw clicking, you probably don’t have TMJ.
Because the most common jaw joint and muscle problems are temporary and do not get worse, simple treatment is all that is usually needed to relieve discomfort. Eating soft foods, applying ice packs and avoiding extreme jaw movements, such as wide yawning and gum chewing, will be helpful in easing TMJ symptoms. For many people with TMJ disorders, short-term use of over-the-counter pain medicines, such as ibuprofen, may provide temporary relief from jaw discomfort. When necessary, your dentist or doctor can prescribe stronger pain medications or anti-depressants to help ease symptoms. Your doctor or dentist may recommend an oral appliance, called a stabilization splint or bite guard, a plastic guard that fits over the upper or lower teeth. Stabilization splints are widely used for TMJ disorders although they should be used only for a short time. If a splint causes pain, stop using it and see your health care provider.
Remember that for most people, discomfort from temporomandibular joint disorders will eventually go away on its own. Simple self-care practices are often effective in easing symptoms. If treatment is needed, it should be based on a reasonable diagnosis, be conservative and reversible, and be customized to your special needs. Avoid treatments that can cause permanent changes in the bite or jaw. If irreversible treatments are recommended, be sure to get a reliable second opinion. Because there is no certified specialty for TMJ disorders in either dentistry or medicine, finding the right care can be difficult. Look for a health care provider who understands musculoskeletal disorders, ailments that affect muscle, bone and joints, and who is trained in treating pain conditions. Pain clinics in hospitals and universities are often a good source of advice, particularly when pain continues over time and interferes with daily life.
Trusted by thousands of listeners every week, T. Glenn Pait, M.D., began offering expert advice as the host of UAMS’ “Here’s to Your Health” program in 1996. Dr. Pait began working at UAMS in 1994 and has been practicing medicine for over 20 years.