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DESCRIPTION OVERVIEW
"TMJ" is an acronym for an anatomical body part, the temporomandibular joint. "TMJ" is not technically a syndrome, nor a disease, but is merely a designation for the human jaw joint. TMJ dysfunction is also known as TMJ Syndrome, TMJD, and TMD (temporomandibular joint dysfunction). To say someone "has TMJ" is the same as saying someone "has knee". Temporomandibular joint disorders (TMJ disorders) is an umbrella term covering medical problems or symptoms related to the joints that connect your lower jaw to your skull.
TMJ disorders are a major cause of facial pain and dysfunction and are an important and appropriate focus of attention by health care providers. TMJ disorders consist of a family of problems that relate to your jaw joint complex. These problems involve complicated anatomical structures such as muscles, ligaments, tendons, the mandible (lower jaw), teeth, nerves, blood vessels and other structures. When your TMJ and associated structures are in good health, the jaws open and close smoothly and comfortably in talking, chewing and use in other functions.
TMJ FUNCTION
The TMJ connects the lower jaw (mandible) to the skull (temporal bone) in front of the ear. The TMJ is comprised of muscles, blood vessels, nerves, and bones. You have two TMJs, one on each side of your jaw. Certain facial muscles control chewing. Problems in this area can cause head and neck pain, a jaw that is locked in position or difficult to open, problems biting, and popping sounds when you bite.
Muscles involved in chewing (mastication) also open and close the mouth. The jawbone itself, controlled by the TMJ, has two movements: rotation or hinge action, which is opening and closing of the mouth, and gliding action, a movement that allows the mouth to open wider. The coordination of this action also allows you to talk, chew, and yawn.
If you place your fingers just in front of your ears and open your mouth, you can feel the joint and its movement. When you open your mouth, the rounded ends of the lower jaw (condyles) glide along the joint socket of the temporal bone. The condyles slide back to their original position when you close your mouth. To keep this motion smooth, a soft disc (or disk) of cartilage lies between the condyle and the temporal bone. This disc absorbs shock to the temporomandibular joint from chewing and other movements. Chewing creates a strong force. This disc distributes the forces of chewing throughout the joint space.
TMJ DYSFUNCTION PROBLEMS
The jaw joint is embedded in an intricate web of nerves and muscles. The force of chewing and clenching or gritting the teeth creates enormous tension and pressure in that region of the face. The cartilage disk that cushions the joint may become displaced or wear out. This causes the bones of the temporomandibular joint to rub against one another, rather than gliding smoothly past each other. In some instances, a misalignment of the jaw and teeth prevents smooth operation of the joint.
Temporomandibular joint disorder (TMJD, TMJ or TMD), or TMJ syndrome, is acute or chronic inflammation of the temporomandibular joint, which connects the mandible to the skull. The disorder and resultant dysfunction can result in significant pain and impairment. Because the disorder transcends the boundaries between several health-care disciplines - in particular, dentistry, neurology, physical therapy, and psychology there are a variety of treatment approaches.
The temporomandibular joint is susceptible to many of the conditions that affect other joints in the body, including ankylosis, arthritis, trauma, dislocations, developmental anomalies, and neoplasia.
In the early 80's, TMJ was often claimed to be the result of an auto accident, although there was no medical or scientific basis for how TMJ could have been caused by any auto accident, let alone those in which it was being claimed. Many of these claims were denied without payment, and some resulted in claimants, their attorneys, and their providers all being referred to their respective fraud bureaus. Attorneys were disbarred, providers lost their licenses, and claimants were prosecuted, to such an extent that TMJ is very seldom part of an auto bodily injury claim any more. TMJ is most often associated with fraudulent claims of soft tissue injuries, including "whiplash."
ANATOMY OF TMJ COMPLEX - STRUCTURE & FUNCTION OF THE JAW
Structures that make it possible to open and close the jaw are specialized and work together when you chew, speak, and swallow. These structures include the muscles, bones, and joints of the jaw.
- Five pairs of muscles allow you to open and close your mouth. They also control forward, backward, and side-to-side movement of the lower jaw. The temporomandibular joint has two sections that make possible the hinge action and gliding action needed to open the mouth widely. Any problem that prevents this system of muscles, bones, and joints from working together correctly may result in the TMJ disorder.
- The masticatory muscles surrounding the joint are groups of muscles that contract and relax in harmony so the jaws function properly. When the muscles are relaxed and flexible, and not under stress, they work in harmony with the other parts of the TMJ complex.
- The teeth and occlusion involve the way the teeth fit together and their possible effect on the TMJ complex. A poor occlusion (bite relationship) may cause the muscles to malfunction and ultimately cause damage to the joint itself. A stable occlusion with good tooth contact and interdigitation provides maximum support to the muscles and joint. Instability of the occlusion can increase the load or pressure on the joint causing damage and degeneration.
- The temporomandibular joint is the joint where the lower jaw articulates with the base of the skull and allows movement of the lower jaw. This joint is made up of the mandibular condyle which is the round end of the mandible that moves and rotates during talking, eating, etc. The temporal fossa is the socket where the condyle fits. The disc or meniscus is situated between the condyle and fossa and is made up of cartilage-like dense collagen. It provides the sliding action between the lower jaw and the fossa (or top part of the joint). Ligaments hold the disc to the condyle and help stabilize the joint. Connective tissue holds the disc to the back of the joint and contains blood vessels and nerves. Connective tissue also forms the joint capsule which surrounds the joint.
The illustration above demonstrates the "normal" relationship of this disc to the surrounding joint structures. While many patients may have discs which are displaced from this position and NOT have any symptoms, it is very common that those who have TMJ pain and dysfunction also have displaced discs. It is therefore likely that this displacement plays a significant role in the development of such problems.
This is the normal anatomic relationship of the disc to the condyle and fossa. Here, the disc is displaced anteriorly (forward) but reduces back into place with opening. This is a non-reducing disc which stays displaced and causes a closed lock.
SIGNS & SYMPTOMS OF TMJ DISORDER
TMJ Disorder has many signs and symptoms. Signs and symptoms of temporomandibular joint disorder vary in their presentation and can be very complex. Often the symptoms will involve more than one of the numerous TMJ components: muscles, nerves, tendons, ligaments, bones, connective tissue, and the teeth.
TMJ pain disorders usually occur because of unbalanced activity, spasm, or overuse of the jaw muscles. Symptoms tend to be chronic, and treatment is aimed at eliminating the precipitating factors. Many symptoms may not appear related to the TMJ itself. The following are the most common symptoms:
THE EARS & RELATED STRUCTURES
Ear pain associated with the swelling of proximal tissue is a symptom of temporomandibular joint disorder. Dull aching pain around the ear, this pain often radiates into the face. Pain in the facial muscles and jaw joints may radiate to the neck or shoulders. Joints may be over-stretched. You may experience muscle spasms from TMJ syndrome. You may feel pain every time you talk, chew, or yawn. Pain usually appears in the joint itself, in front of the ear, but it may move elsewhere in the skull, face, or jaw.
TMJ disorder may cause ear pain (earache), ringing in the ears (tinnitus), and hearing loss. Sometimes people mistake TMJ pain for an ear problem, such as an ear infection, when the ear is not the problem at all. About 50 percent of patients with a TMJ disorder notice ear pain and do not have signs of ear infection. The ear pain is usually described as being in front of or below the ear. Often, patients are treated multiple times for a presumed ear infection, which can often be distinguished from TMJ disorder by an associated hearing loss or ear drainage (which would be expected if there really was an ear infection). Because ear pain occurs so commonly, ear specialists are frequently called on to make the diagnosis of a TMJ disorder.
A feeling of fullness of the ear. About 33 percent of patients with a TMJ disorder describe muffled, clogged, or full ears. They may notice ear fullness and pain during airplane takeoffs and landings. These symptoms are usually caused by eustachian-tube dysfunction, the structure responsible for the regulation of pressure in the middle ear. It is thought that patients with TMJ disorders have hyperactivity (spasms) of the muscles responsible for regulating the opening and closing of the eustachian tube.
Ringing in the ear (known as tinnitus) may occur. For unknown reasons, 33 percent of patients with a TMJ disorder experience noise or ringing in the ears (tinnitus). Of those patients, half will have resolution of their tinnitus after successful treatment of their TMJ disorder.
Dizziness. Of patients with a TMJ disorder, 40 percent report a vague sense of dizziness or imbalance (usually not a spinning type vertigo). The cause of this type of dizziness is not well understood.
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TMJ MUSCLES
Tenderness of the jaw muscles. Dull, aching pain in the face. The face and mouth may swell on the affected side. Jaw pain or tenderness of the jaw may be felt. There may be trouble swallowing because of the muscle spasms. Biting or chewing difficulty or discomfort may be experienced.
Disorders of the muscles of the temporomandibular joint are the most common complaints by TMJ disorder patients. The two major observations concerning the muscles are pain and dysfunction. The dysfunction can present as trismus or limitation of jaw movement ranging from minor to severe. In milder cases, the only representation may be joint sound such as clicking or popping. These symptoms of TMJ disorder are often caused by over-usage of the muscles of mastication. Common causes include chewing gum continuously, biting habits (fingernails and pencils), grinding habits, and clenching habits.
Most cases of TMJ disorder, however, are not so simple. Deep-space infections with resulting trismus or neoplasms about the joint may mimic TMJ dysfunction. Muscle pain can sometimes be associated with trigger points in muscle tissue. These trigger points can be localized by digital palpation, both intraorally and extraorally. This is known as Myofascial pain syndrome.
Any dysfunction of the muscles may cause the teeth to occlude (bite) with each other incorrectly; if teeth are traumatized by this, they may become sensitive, demonstrating one of the many interplays between muscle, joint, and tooth.
TMJ RELATED HEADACHES
Certain types of headaches or neck aches are commonly associated with TMJ dysfunction. Headache and dizziness may be experienced. There may be feelings of nausea or vomiting may occur. Approximately 80 percent of patients with a TMJ disorder complain of headache while 40 percent report facial pain. Pain is often made worse while opening and closing the jaw. Exposure to cold weather or air-conditioned air may increase muscle contraction and facial pain.
TEMPOROMANDIBULAR JOINTS
The temporomandibular joints are arguably the most complex set of joints in the human body. Unlike typical finger or vertebral junctions, each TMJ actually has two joints, which allow it to both rotate and to translate (slide). With use, it is common to see wear of both the bone and cartilage components of it. Clicking is common, as are popping motions and deviations in the movements of the joint. It is considered a TMJ disorder when pain is involved. In a healthy joint, the surfaces in contact with one another (bone and cartilage) do not have any receptors to transmit the feeling of pain. The pain therefore originates from one of the surrounding soft tissues. When receptors from one of these areas are triggered, the pain causes a reflex to limit the mandible's movement. Furthermore, inflammation of the joints can cause constant pain, even without movement of the jaw.
Clicking or popping noise may be heard when opening or closing the mouth and when the joints move while chewing or talking and is related to the dysfunctional relationship between the condyle of the mandible and the disk. Clicking and popping are common, meaning the disc may be in an abnormal position. The sounds produced by this dysfunction are usually described as a "click" or a "pop" when a single sound is heard and as "crepitation" or "crepitus" when there are multiple, rough sounds. Sometimes no treatment is needed if the sounds give you no pain. A grinding or crunching sounds may be heard and a grating sensation may be experienced while chewing. Others may also be able to hear the sounds. The sounds of grinding, crunching, or popping is medically termed crepitus and are common for patients with a TMJ disorder. These sounds may or may not be accompanied by increased pain.
There is commonly a reduced ability to open or close the mouth. With limited or abnormal opening of the mouth, The jaw may lock wide open (then it is dislocated), or it may not open fully at all. Also, upon opening, the lower jaw may deviate to one side. You may find yourself favoring one painful side or the other by opening your jaw awkwardly. These changes could be sudden. Your teeth may not fit properly together, and your bite may feel odd.
Due to close proximity of the ear to the temporomandibular joint, TMJ pain can often be confused with ear pain. The pain may be referred in around half of all patients and experienced as otalgia (earache). TMJ disorder is an important possible cause of secondary otalgia. Treatment of TMJ disorder may then significantly reduce symptoms of otalgia and tinnitus, as well as atypical facial pain. Despite some of these findings, some researchers question whether TMJ disorder therapy can reduce symptoms in the ear, and there is currently an ongoing debate to settle the controversy.
TEETH DISORDERS
Disorders of the teeth can contribute to TMJ dysfunction. Tooth mobility and tooth loss can be caused by destruction of the supporting bone and by heavy forces being placed on teeth. Movement of the teeth affects how they contact one another when the mouth closes, and the overall relationship between the teeth, muscles, and joints can be altered. Pulpitis, inflammation of the dental pulp, is another symptom that may result from excessive surface erosion. Maybe the most important factor is the way teeth meet together. The equilibration of forces of mastication and therefore the displacements of the condile.
PRECIPITATING FACTORS
There are many external factors that place undue strain on the TMJ. These include but are not limited to the following:Over-opening the jaw beyond its range for the individual or unusually aggressive or repetitive sliding of the jaw sideways (laterally) or forward (protrusive). These movements may also be due to parafunctional habits or a malalignment of the jaw or dentition. This may be due to:
- Modification of the occlusal surfaces of the teeth through dental neglect or accidental trauma.
- Speech habits resulting in jaw thrusting.
- Excessive gum chewing or nail biting.
- Excessive jaw movements associated with exercise.
- Repetitive unconscious jaw movements associated with bruxing.
- Size of foods eaten.
Many other problems of the TMJ disorder can have similar symptoms. Consult your health care provider or dentist to determine the cause of your symptoms by a series of diagnostic tests. These may include a complete medical history, clinical examination, x-rays, and/or casts of your teeth. Proper diagnosis is an important step before treatment and it can save you time and money by insuring that you receive the treatment appropriate for your particular problem.
TMJ SELF-TEST
Place your little finger in your ears so that hearing is obstructed. Then slowly and steadily open and close your jaw. If at any point you are hearing a clicking, popping, and/or grinding noise, the jaw may be out of alignment, and examination by a professional experienced in diagnosing and treating TMJ disorder is advisable.
CAUSES OF TMJ DISORDERS
The temporomandibular joint (TMJ) is the area directly in front of the ear on either side of the head where the upper jaw (maxilla) and lower jaw (mandible) meet. There are two matching temporomandibular joints - one on each side of your head, located just in front of your ears. The abbreviation "TMJ" literally refers to the joint but is often used to mean any disorders or symptoms of this region. Within the TMJ, there are moving parts that allow the upper jaw to close on the lower jaw. This joint is a typical sliding "ball and socket" that has a disc sandwiched between it. The TMJ is used throughout the day to move the jaw, especially in biting and chewing, talking, and yawning. It is one of the most frequently used joints of the body.
The temporomandibular joints are complex and are composed of muscles, tendons, and bones. Each component contributes to the smooth operation of the TMJ. When the muscles are relaxed and balanced and both jaw joints open and close comfortably, we are able to talk, chew, or yawn without pain.
We can locate the TMJ by putting a finger on the triangular structure in front of the ear. The finger is moved just slightly forward and pressed firmly while opening the jaw. The motion felt is from the TMJ. We can also feel the joint motion if we put a little finger against the inside front part of the ear canal. These maneuvers can cause considerable discomfort to a person who is experiencing TMJ difficulty, and health care providers use them for making the diagnosis.
Many TMJ-related symptoms are caused by the effects of physical and emotional stress on the structures around the joint. These structures include:
- Cartilage disk at the joint.
- Muscles of the jaw, face, and neck.
- Nearby ligaments, blood vessels, and nerves.
- Teeth.
TMJ dysfunction can be caused by trauma, disease, wear due to aging, or habits. TMJ disorder results when the chewing muscles in the temporomandibular joint do not work together correctly. The muscles will often go into a spasm or cramp. This spasm can then become part of a cycle that results in tissue damage, pain, and muscle tenderness. Although accidents or diseases such as arthritis may result in other kinds of TMJ problems, factors relating to the teeth and bite are the most common causes of TMJ disorders. Other possible causes of TMJ-related symptoms include arthritis, fractures, dislocations, and structural problems present since birth.
TMJ disorders are a group of complex problems of the jaw joint. TMJ disorders are also sometimes referred to as myofacial pain dysfunction and Costen's syndrome. Because muscles and joints work together, a problem with either one can lead to stiffness, headaches, ear pain, bite problems (malocclusion), clicking sounds, or locked jaws. The following are behaviors or conditions that can lead to TMJ disorders.
TRAUMA OR INJURY TO THE JAW
Trauma can cause injury to the joint in the form of fracture to the condyle, torn ligaments, torn cartilage, displacement of articular discs, damage to muscles and other injuries. Previous fractures in the jaw or facial bones can lead to TMJ disorders. Repeated or hard blows to the jaw or chin or whiplash can also lead to TMJ disorders.
Trauma is divided into microtrauma and macrotrauma. Microtrauma is internal, such as bruxism (grinding the teeth) and clenching (jaw tightening). This continual hammering on the temporomandibular joint can change the alignment of the teeth. Muscle involvement causes inflammation of the membranes surrounding the joint. Teeth grinding (bruxism) and clenching are habits that may be diagnosed in people who complain of pain in the temporomandibular joint or have facial pain that includes the muscles involved in chewing (myofascial pain). Macrotrauma, such as a punch to the jaw or impact in an accident, can break the jawbone or damage the disc.
DISEASES
Certain diseases such as rheumatoid arthritis can effect the joint surfaces and certain muscular diseases can effect function.
- Osteoarthritis: Like other joints in the body, the jaw joint is prone to undergo arthritic changes. These changes are sometimes caused by breakdown of the joint (degeneration) or normal aging. Degenerative joint disease causes a slow progressive loss of cartilage and formation of new bone at the surface of the joint. Cartilage destruction is a result of several mechanical and biological factors rather than a single entity. Its prevalence increases with repetitive microtrauma or macrotrauma, as well as with normal aging. Immunologic and inflammatory diseases contribute to the progress of the disease.
- Rheumatoid arthritis: Rheumatoid arthritis causes inflammation in joints and can affect the TMJ, especially in children. As it progresses, the disease can cause destruction of cartilage and erode bone, deforming joints. It is an autoimmune disease involving the antibody factor against immunoglobulin G (IgG). Chronic rheumatoid arthritis is a multi-system inflammatory disorder with persistent symmetric joint inflammation.
- A contributing factor is hypoglycemia. People tend to clench and grind their teeth more when their blood sugar is low.
STRESS
Stress is often a cause of TMJ pain. Stress frequently leads to unreleased nervous energy and it can be commonly manifested by consciously or unconsciously clenching and over-stressing the muscles, the jaw joints and other structures around the jaw as a way of releasing this nervous energy. This can be seen as pain, muscle spasm, and damage to the joints. For example, daily stress can lead you to clench and grind your teeth, both during the day and at night while you sleep. Clenching means you tightly clamp your top and bottom teeth together, especially the back teeth. The stressful force of clenching causes pressure on the muscles, tissues, and other structures around your jaw.
Many people who clench also grind their teeth. Grinding is when you slide your teeth over each other, generally in a sideways, back-and-forth movement. This action may wear down your teeth and can be noisy enough at night to bother sleeping partners.
Poor posture can also be an important factor in TMJ. For example, holding the head forward while looking at a computer all day strains and stresses the muscles of the face and neck. Other factors that might make TMJ symptoms worse are poor diet, and lack of sleep.
All of these stresses can result in "trigger points". These are contracted muscles and pinched nerves in your jaw, head, and neck. Trigger points can refer pain to other areas, causing a headache, earache, or toothache.
HABITS
Oral habits such as grinding the teeth (bruxism, especially at night) or clinching the teeth can tire the muscles and cause them to spasm. This spasm causes pain, which in turn causes more spasms. The end result is the spasm, pain, spasm cycle causing muscle and joint problems which can lead to the TMJ disorder.
Teeth grinding and teeth clenching increase the wear on the cartilage lining of the TMJ. Those who grind or clench their teeth may be unaware of this behavior unless they are told by someone observing this pattern while sleeping or by a dental professional noticing telltale signs of wear and tear on the teeth. Many patients awaken in the morning with jaw or ear pain.
Teeth grinding as a habit can result in muscle spasm and inflammatory reactions, thus causing the initial pain. Changes in the normal stimuli or height of the teeth, misalignment of the teeth, and changes in the chewing muscles may cause temporomandibular joint changes. Generally, someone who has a habit of grinding his or her teeth will do so mostly during sleep. In some cases, the grinding may be so loud that it disturbs others.
Someone who clenches continually bites on things while awake. This might be habitual chewing gum, a pen or pencil, or fingernails. The constant pounding on the joint causes the pain. Stress is often blamed for tension in the jaw, leading to a clenched jaw.
Occupational tasks such as holding the telephone between the head and shoulder may contribute to TMJ disorders.
BITE OR OCCLUSION PROBLEMS
Dental problems, poor dental work and orthodontia, thumb sucking, malaligned teeth (malocclusion), missing teeth, and malalignment of the jaws can create an imbalance of muscular and joint function which can lead to discomfort and joint damage. These occlusal disharmonies or problems in the way the teeth fit together or bite can place the chewing muscles under great stress and cause them to go into spasm, again setting off the harmful cycle. Frequently, oral habits and problems with the bite work together to cause the TMJ disorder.
Patients may complain that it is difficult to find a comfortable bite or that the way their teeth fit together has changed. Chewing on only one side of the jaw can lead to or be a result of TMJ problems.
PREVENTION
Many of the home-care steps to treat TMJ problems can prevent such problems in the first place. If you tend to have occasional bouts with jaw pain:
- Avoid chewing gum or biting on objects, such as pens or fingernails.
- Avoid eating hard or chewy food.
- When you yawn, support your lower jaw with your hand.
- Learn relaxation techniques to reduce overall stress and muscle tension.
- Drink plenty of water every day and get plenty of sleep.
- See your dentist if you grind your teeth at night or find yourself clenching your jaw.
- Use safety measures to reduce the risk of fractures and dislocation.
- Maintain good posture, especially if you work all day at a computer. Pause often to change position, rest your hands and arms, and relieve stressed muscles.
DIAGNOSIS
A good diagnosis is of primary importance so that the proper treatment may be precisely directed to the correct TMJ dysfunction.
- Extracapsular Disorders: These are disorders that exist outside of the joint itself. These patients often have little or no mechanical problems within the TMJ but suffer the effects of the structures outside of the joint.
- Myofascial Pain Dysfunction: This is the most common TMJ dysfunction and usually involves a muscle imbalance with muscle spasm and pain. This has a multitude of causes such as stress, grinding of teeth, instability of the bite and others.
- Diseases & Pathology Of The Surrounding Area: This can include tumors of the jaw, salivary glands and associated structures, neurologic disorders, systemic disorders effecting the head and neck, and referred pain from the neck, back, and associated structures.
- Internal Joint Disorders: Damage or disease to the joint itself such as the disc, condyle, ligaments, or synovium (lining of the joint).
- Disc Displacement: A displaced disc may cause popping and clicking due to the disc being displaced forward so that the condyle clicks or pops in its translation during opening. A displaced disc may block the condyle from translating forward during opening and restrict the opening. This is sometimes called a "closed lock".
- Adhesions: Scar tissue may have developed between the condyle and disc or the disc and fossa that restricts jaw movements.
- Disc Perforations (Holes or Tears In The Disc): This occurs when the disc is torn or worm through by continual overloading of the joint. This often causes a grinding sensation or a gravel-like sound.
- Arthritic Conditions: Advanced wear and breakdown of joint surfaces causing pain, grinding noises and general joint dysfunction.
- Hypermobility: Sometimes the joint becomes too loose and the posterior ligament is structured to allow the condyle and disc to advance forward beyond the socket. This can cause the jaw to lock open. This sometimes called an "open lock".
- Synovitis: The synovial lining, which produces lubrication to the joint, may become inflamed for a variety of reasons. This often causes an acutely tender and painful joint.
The first step in arriving at a treatment plan involves a fact finding program. This collects the necessary information to arrive at a diagnosis.
MEDICAL HISTORY
The dental and medical history provides information about your overall health, any history of accidental injuries, symptoms you are experiencing, treatment you have received, medication you are taking, and much more. It helps determine lifestyle, habits, stress factors, and family history. All of this information is important. In diagnosing your jaw problem, the health care provider will most likely ask the following questions:
- What kind of pain do you have?
- Is it an ache or a throbbing pain or a sharp stabbing pain?
- Is the pain continuous or intermittent?
- Can you outline the area of pain on your face with your finger?
- What helps to alleviate the pain? What aggravates the pain?
- Do you grind or clench your teeth?
- Do you bite your nails or chew on any objects, such as pens or pencils?
- Do you hold the telephone with your shoulder against your ear for a long time?
- Do you chew gum often? For how long?
- Do you have any oral habits that you have not mentioned?
PHYSICAL EXAMINATION
A physical exam helps identify your symptoms and malfunctions. It may involve examination of your muscles and joint for tenderness. Jaw function is carefully measured. The joint can be examined for noises and sounds by various listening devices. Your teeth and occlusion may be examined to determine the stability of your bite.
During the physical examination, the health care provider will examine your head, neck, face, and temporomandibular joints, noting any of the following:
- Feeling the joint and connecting muscles for tenderness (pain) and its location.
- Pressing around the head for areas that are sensitive or painful.
- Sounds, such as clicking, popping, grating.
- The mandible (lower jaw) range of motion and whether it is easy to open and close and can move from side to side and forward-backward without any pain
- Your assessment of pain on a scale from 0 (no pain) to 10.
- A dental examination to show if you have poor bite alignment. This includes how your teeth fit together:
- Normal.
- Open bite.
- Crossbite.
- Overbite.
- Dental restorations.
- Skeletal deformity.
- wear and tear on the buccal cusps of the mandibular teeth, especially the canine teeth.
- The rigidity and or tenderness of the chewing muscles.
TMJ pain and symptoms may need to be checked by more than one medical specialist, such as your primary care provider, a dentist, or an ear, nose, and throat (ENT) practitioner, depending on your symptoms. Some dentists specialize in TMJ diagnosis and treatment. In some cases, the results of the physical exam may appear normal.
EXAMS & TESTS
A variety of tests help confirm or rule out a diagnosis of temporomandibular joint disorders. Imaging tests may be performed to assist in diagnosis:
- X-rays may be taken of the mouth and jaw to show abnormalities. Various x-rays (tomograms, transcranials and others) show an image of bony contours of the joint. These films may reveal fractures, tumors or damage to the bony surfaces of the joint.
- CT or MRI of the jaw area may also be used. A MRI (magnetic resonance imaging) produces images of both hard and soft tissues and may reveal damage or displacement of the disc or ligaments. The MRI was designed for soft tissue and, therefore, will show the location of the TMJ disc in relationship to the jaw and skull bones giving the practitioner a better idea as to the proper treatment approach.
- Arthrography may be used to diagnose TMJ disorder. This is a procedure that involves dye being injected into the joint and then viewed with fluoroscopy.
Dental casts may be performed. These are models of your teeth that may help determine if there is instability of your bite relating to your disorder. It may also reveal a joint disorder that has effected the way your teeth fit and line up.
TMJ TREATMENT OPTIONS
Simple, gentle therapies are usually recommended first. If those don't work, mouth guards and more aggressive treatments may be considered. Surgery is generally a last resort. Fortunately, there are many steps you can take at home long before that point. home-care therapies, such as moist heat or cold packs on the face, vitamin supplements, or biofeedback are useful for some people. Exercising several times each week may help you relax, strengthen your body, increase flexibility, and increase your ability to handle pain.
Many people, more women than men, have TMJ syndrome. However, the full TMJ disorder develops in only a few. Most of the symptoms disappear in two weeks because your jaw joint rests and recovers when you are unable to chew.
Treatment may involve a series of treatments. A step-by-step plan is in your best interest, because in many cases only minor corrective treatment may be needed. If pain and other symptoms persist, a more involved treatment such as changing the way your teeth fit together or even surgery may be indicated. The types of treatment include:
HOT COMPRESSES TO ELIMINATE SPASMS & PAIN
Apply warm compresses on the area of pain. This can be done by applying moist heat to the face. Home therapy includes mandible (lower jaw) movements, such as opening and closing the jaw from side to side. Try this after a warm compress is applied for 20 minutes. The lower jaw movements should be repeated three to five times a day, five minutes continuously each time, for about two to four weeks.
Another option is the he Battle Creek Petite Thermophore Automatic Moist Heat Pack (or similar device) is a convenient method of applying intense moist heat to the painful area. Simply plug the unit into a 110-volt household socket, place the center of the Petite under the chin with each side of the Petite extending up and connecting with the fastening strips across the patient's head. By pushing down on the spring-loaded switch you will receive a 160°F of moist heat in approximately 6 minutes. Turning the momentary switch off and on as more heat is needed can control the temperature. It is recommended that you use this kind of treatment for 20 to 30 minutes several times a day to relax the muscle tension, which is causing the spasm and pain through the jaw muscles. Work at total relaxation when applying the moist heat for the best results.
MEDICATIONS
Medical professionals are also prescribing muscle relaxants and other medications. Muscle relaxant medications may help to decrease and control muscle spasms and muscle-related pain. Non-steroidal anti-inflammatory medications (NSAIDs) such as aspirin or acetaminophen (Tylenol) or ibuprofen (Motrin, Aleve) may ease the pain help reduce swelling (inflammation) in the jaw stemming from arthritis, TMJ disorder or other causes. While conventional analgesic pain killers such as paracetamol (acetaminophen) or NSAIDs provide initial relief for some sufferers, the pain is often more neuralgic in nature, which often does not respond well to these drugs.
Drugs may be recommended and used to help control bruxism or grinding of the teeth.
An alternative approach is for pain modification, for which off-label use of low-doses of Tricyclic antidepressant that have anti-muscarinic properties (e.g. Amitriptyline or the less sedative Nortriptyline) generally prove more effective.
PHYSICAL THERAPY
Physical therapy is becoming a widely recognized, viable treatment for TMJ disorder. You may be referred to a licensed physical therapist to help in the management of your disorder. Physical therapy promotes healing and reduces pain, swelling and inflammation. It greatly improves jaw range of motion and muscle relaxation to retrain stressed muscles. Physical therapy techniques may include jaw and tongue exercises, posture training, mobilization of joints, ultrasound and electrical stimulation to regain harmony to your jaw joints and muscles.
Therapists may make use of a transcutaneous nerve stimulator (TENS) unit, ultrasound, which promotes tissue healing, and electrogalvanic stimulation, which helps relax muscles. These types of therapy should be prescribed in conjunction with an exercise and stress-reduction program.
MASSAGE
Massaging the facial, neck, shoulder and head muscles to help muscles relax and relieve pain.
Try massaging the various muscles that may be involved. Probe all of the muscles of the face, shoulders, and back of the neck. (Avoid the area around the throat.) Press on the muscles to identify extremely painful points. Massage the painful spot with hard, slow, short strokes. Do this several times a day until the muscle is no longer painful when pressed.
To massage the masseter muscles on each side of your jaw, place your thumb inside your mouth and squeeze the thick muscle in your cheek (toward the back of your mouth) with your fingers. To get at the harder-to-reach jaw muscles inside your mouth, use your index finger to probe for tender areas behind the teeth, and use the finger to massage these spots.
COUNSELING AND BIOFEEDBACK TRAINING
Counseling is sometimes indicated along with other forms of treatment. If emotional stress is a factor that causes the clinching or grinding of teeth, that stress should be reduced or eliminated if possible. Biofeedback, a technique that teaches people to modify their physical functions, can also be helpful in reducing muscle tension in the jaws.
Some TMJ disorder sufferers have been helped by biofeedback readings taken from the masseter muscle (the muscle that opens and closes the jaw). This treatment, combined with relaxation techniques such as controlled breathing, has proven effective.
ACUPUNCTURE TMJ THERAPY
While there are numerous ways to effectively treat temporomandibular joint (TMJ) disorders, acupuncture has been shown in several well-designed studies to be very effective and relatively safe. In a 2007 study, TMJ-related short-term muscle pain was significantly improved in people receiving acupuncture. A recent British study of 70 cases of dental patients receiving acupuncture for TMJ indicated that 85 percent of patients benefited with an average reduction in pain intensity of 75 percent. A 2008 study reported high long-term patient satisfaction and improvement of symptoms 18 to 20 years following acupuncture and/or interocclusal appliance (bite plate or splint) therapy.
Acupuncture may be used alone or in conjunction with other treatment approaches. Medications for TMJ disorders can include anti-inflammatories, analgesics (pain killers), muscle relaxants, as well as local injections of corticosteroids in severe cases, maybe recommended by your health care provider or dentist. Acupuncture does not interact with these modern medical treatments and can often replace them as therapy without a their risks of side effects.
Unfortunately, pharmaceutical treatments only provide symptomatic relief of temporomandibular joint (TMJ) disorders. However, acupuncture can target the root cause of the condition by balancing the mind and body through a network of energy channels called meridians, helping to reset the neuromuscular tension in the jaw. Often TMJ is due to underlying stress held in the jaw or contracted muscles in the jaw and face. Acupuncture can help to both relax these targeted muscles and decrease the overall stress level in the body to relieve TMJ discomfort.
DIETARY CHANGES
Eating a diet of only soft, non-chewy foods to eliminate these muscle spasms and pain. Avoid biting into hard things, such as a whole apple with your front teeth. Rather, cut it smaller so that you do not have to open your mouth as wide. See more information about dietary and nutritional recommendations further down on this page.
DENTAL CORRECTION, BITE PLATE OR OCCLUSAL SPLINTS
A dentist or health care provider may prescribe a bite plate or occlusal splints can also be made. Splints fit over your teeth to help establish harmony between your muscles and joints. This treatment helps to eliminate the harmful effects of clinching or grinding the teeth, which is the cause of the muscle spasms. A splint is a clear plastic guard or appliance that fits over your upper and lower teeth, much like a mouth guard in sports. The splints primarily aid in the stabilization of the bite and can help prevent, control, and reduce clenching and teeth grinding, especially if worn at night. This will ease muscle tension. The splint should not cause or increase your pain. If it does, do not use it.Mouth guards, also called splints or appliances, have been used since the 1930's to treat teeth grinding, clenching, and TMJ disorders. Many people have found them to be useful, but the benefits vary widely. The guard may lose its effectiveness over time, or when you stop wearing it. Other people may feel worse pain when they wear one.
Most splints are constructed by your general dentist or a dentist who specializes in non-surgical TMJ management. Most splint therapy lasts for 1-3 months or more.
There are different types of splints. Some fit over the top teeth, while others fit over the bottom teeth. They may be designed to keep your jaw in a more relaxed position, prevent clenching, or provide some other function. If one type does not work, another may.
A bruxism splint is worn primarily at night to aid in grinding and clenching habits. It helps reduce muscle tension and discomfort. An orthopedic stabilization splint lets your jaw move in the correct position, stabilizes the bite, relaxes musculature and reduces pressure on the TMJ.
For example, a new type of splint is called the NTI-tss. It fits over just a couple of top, front teeth. The idea is to keep all of your back teeth completely separated, under the theory that most clenching is done by these back teeth. With the NTI splint, the only contact is between the tiny splint and one bottom front tooth.
Proper wear of your splint as directed by your health care provider is most important in the treatment of your dysfunction. The splint is in place between the upper and lower teeth. It will act to perfect the bite artificially and prevent excessive force from being transmitted to the TMJ as the patient clenches or grinds. It will help with force dissipation even in the absence of these parafunctional activities and encourages the joints to repair themselves. The greatest advantages of this therapy are that most people will be helped to some degree, and the therapy is safe and reversible.
Be cautious about any non-reversible treatment method that permanently alters your bite. However, if a mouth guard does not work, your dentist may recommend orthodontics to help re-align your teeth.
Orthodontics - If your TMJ disorder is caused or greatly effected by the way your teeth fit together, it may be necessary to correct your occlusion. If your bite is incorrect it can be adjusted by selective grinding of the teeth. Orthodontic appliances (braces) and other dental procedures may also be used to reduce problems caused by incorrect tooth contact.
- Orthodontics (braces) may be needed to reposition your teeth in order to establish a stable bite.
- If your bite problem is primarily due to a malalignment of the jaws or a discrepancy between the upper and lower jaws you might need orthognathic surgery. This would realign the upper and lower jaws (usually in combination with orthodontics) to create a stable occlusion.
- Restorative dental procedures may be necessary by your general dentist to replace missing teeth, repair existing teeth or change the shape and size of teeth. If the occlusal surfaces of the teeth or the supporting structures have been damaged due to dental neglect, periodontal diseases or trauma, the proper occlusion should be restored.
INJECTION PROCEDURES FOR PAIN RELIEF
A more invasive procedure can be performed in the health care provider's office or clinic under local anesthesia. This is carried out by inserting two needles in the temporomandibular joint to wash it out. One needle is connected to a syringe filled with a cleansing solution, and the fluid exits via the other syringe. This procedure can be done in the office. Most people find relief from the pain and return to almost normal. Sometimes, pain medication can be injected into the joint in a similar procedure.
Alternatively, a simple injection of cortisone medication can be very helpful in relieving inflammation and pain.
SURGERY
A last option, surgery, is often irreversible and should be avoided when possible. If necessary, surgery can be used to replace the jaw joints with artificial implants. The National Institute of Dental and Craniofacial Research (NIDCR) advises that if surgery is recommended, you seek other independent opinions before proceeding.
NIDCR advises that other irreversible treatments are of little value and may not cure the problem. These include orthodontia to change the bite, restorative dentistry, and adjustment of the bite by grinding down teeth to bring the bite into balance.
If muscle spasms have occurred for long periods, the temporomandibular joint may become injured or arthritic. The bones and the soft tissues of the TMJ may slip out of normal position because of trauma or some other cause. In severe cases such as these, surgery may be necessary to correct the problem.
Reconstructive surgery of the jaw is rarely required. In fact, studies have shown that the results are often worse than before surgery.
Types of Surgery
With other modalities of treatment available, surgery is reserved for those cases which fail to satisfactorily respond to the above mentioned methods. In some cases, the joint undergoes some degree of internal joint derangement and fails to respond to non-surgical treatment. Surgery is usually indicated if non-surgical treatments have failed and clinical and diagnostic diagnoses indicate a derangement inside the TMJ. The following are several different types of TMJ surgery.
- Lysis & Lavage: This is a hydraulic distension and flushing of the joint with sterile saline and/or medications to increase the mobilization of the joint. If the disc has become adhered to the fossa surface or locked for a short period of time, this procedure may remobilize the disc. Lysis & lavage is an office procedure performed under IV sedation, which may be used to decrease discomfort and inflammation.
- Arthroscopic Arthroplasty Surgery: Oral and Maxillofacial Surgery Associates pioneered TMJ arthroscopy in the Austin region in the mid-1980's. Since that time AOMSA has been at the forefront of arthroscopic advances and new techniques. The procedure is similar to arthroscopic surgery performed by orthopedic surgeons on the knee and other joints. This procedure is usually done in a hospital setting and requires a general anesthesia and is routinely done on an outpatient basis. Most TMJ derangements can be initially treated by arthroscopic surgery. Arthroscopic arthroplasty can be done as a diagnostic tool if diagnosis is uncertain and non-surgical treatments have failed. Adhesions and scarring may be removed to increase joint mobility. If the disc is displaced, causing painful popping or locking, a repositioning procedure can be accomplished arthroscopically. Until the last several years, this required an open joint procedure but with the current state of the arthroscopic "art", many discal repositioning procedures including suturing of the disc itself, are performed without open surgery. In cases of more severe degeneration such as torn discs, discs with holes worn in them, or arthritic and generative joints, arthroscopic surgery is highly effective. This procedure requires a small 3mm incision over the joint and in front of the ear. Through this incision, the arthroscope is inserted into the joint space. Additional needles may be placed to perform the necessary procedures.
- Open Joint Reconstructive Surgery: If the joint fails to respond to the arthroscopic procedure or the condition is such that arthroscopy is not indicated, an open procedure is sometimes recommended. Under direct visualization the joint is reconstructed by smoothing the joint surfaces, repair of disc abnormality and removal of diseased tissue. A graft or artificial replacement of one or more joint surfaces may be used in the reconstruction of the joint. This procedure requires general anesthesia as well as an overnight stay in the hospital.
- Condylotomy: Sometimes the jaw is sectioned from inside the mouth and just below the condyle. This is done in certain situations to restore a stable occlusion, to decrease the pressure on the joint or to change the condyle position. This procedure requires having the jaws wired together for 7-14 days. It requires general anesthesia and an overnight stay in the hospital.
BECOME INFORMED AND CONSULT PROFESSIONALS
Read as much as you can, as opinion varies widely on how to treat TMJ disorders. Get several health care provider's opinions. The good news is that most people eventually find something that helps. Your dentist and other health professionals who provide treatment for TMJ disorder care about your health and comfort. A chiropractor trained in TMJ treatments may be of benefit for some individuals. (Note: Not all chiropractors or other health care providers may be trained to work with TMJ patients, do not be afraid to shop around until you find a practitioner that knows how to help your TMJ problems.) Follow the recommendations they give you and discuss with them any concerns you may have. Remember in many cases the pain, headaches, and other symptoms of TMJ disorder can be successfully treated.
SUPPORT GROUPS
The TMJ Association, LTD. (TMJA)
P.O. Box 26770
Milwaukee, WI 53226-0770
E-mail: info@tmj.org
Phone: (262) 432-0350
Fax: (262) 432-0375 www.tmg.org
TMJ & Orofacial Pain Society of America
American Pain Foundation
201 North Charles Street
Suite 710
Baltimore, Maryland 21201-4111
America Pain Foundation
Daily Strength Online TMJ Support Group
FURTHER EDUCATION
For additional information, two excellent books are:
- Taking Control of TMJ by Robert Uppgaard
- The Trigger Point Therapy Workbook by Clair Davies.
Other Trigger Point Books Available:
HOLISTIC, DIETARY & HERBAL RECOMMENDATIONS
CONSIDERATIONS
TMJ disorder has become a much misdiagnosed and over-treated disorder. People with ambiguous pain in various parts of their bodies (such as menstrual cramps) have been misdiagnosed as having TMJ disorder or syndrome, for example. Some health care practitioners have voiced concern that TMJ disorder may be providing inadequately trained or even disreputable practitioners with an opportunity to take advantage of patients. According to an article published in the February 1993 issue of the New York State Journal of Medicine, TMJ disorder is an area in which "dental quackery" is quite common.
Orthodontists, dentists, physical therapists, and many other "specialists" now offer various treatments for TMJ disorder. However, it is estimated that 90 percent of all cases of TMJ disorder respond to simple, inexpensive treatments, such as those recommended in this section. It therefore makes sense to try such measures before investing in expensive medical or dental treatment.
TMJ disorder is not the only disorder that can cause jaw pain. Another possible cause is rheumatoid arthritis. In this disorder, the symptoms are more severe in the morning and tend to ease somewhat as the day goes on. This is not usually the case with TMJ disorder.
A displaced disk can also cause jaw pain. Treatment for this disorder involves realigning the ligaments with a plastic splint.
Be wary of any practitioner who rigidly adheres to one single approach in treating TMJ disorder. A multidisciplinary team is a better choice. If possible, you may consider seeking help from practitioners associated with a university dental or medical school.
SELF-HELP & LIFESTYLE RECOMMENDATIONS
Self help is usually the best option to begin with. Most cases of TMJ syndrome are temporary; thus, treatment is usually conservative.
- Early therapy involves resting the jaw and may be the best treatment so it can heal the temporomandibular joints and regain stability. This may be accomplished by not clenching your teeth, practicing good posture, eating soft foods and reducing stress. Avoid chewing gum and eating hard candy or chewy foods (such as red meat and bagels). Do not open your mouth wide.
- Fast at least once a month to give the body and jaws a rest. Follow the dietary and nutritional recommendations further down on this page.
- Experiment with heat and cold therapy, and use hot or cold packs - whichever works best - for pain relief, especially if the pain is in the neck and shoulders. Apply ice to the jaw for the first 24-48 hours after symptoms are noticed. Ice packs are used first if an injury is present. Ice helps prevent swelling. Heat may be applied to tense and sore muscles. Be alternating cold and heat, muscle spasms may be relieved.
- Exercise (passive) of the jaw regains normal range and function. It increases flexibility and strengthens muscles. This should be done as a passive exercise in contrast to eating hard foods which increases the stress on the joint. Your health care provider may show you how to perform gentle muscle stretching and relaxation exercises. Here are a few exercises you may try:
TMJ EXERCISE 1
Sit comfortably in a high-backed chair back against the back rest, with the mouth lightly closed. Place the web of your thumb and forefinger against the front of the lower jaw. Use your chin to press your head backwards, neither allowing your head to flex nor extend and allowing the mouth to open slightly. Done correctly you should feel the lower teeth moving backwards in relation to the upper teeth, as your whole head moves backwards. Relax, and allow your jaw and head to move forwards again, keeping your chin on the same level. Avoid looking up and down. Repeat five times, several times a day. It should not be painful, and you will feel a light stretch deep in the jaw. Do it gently to begin with.
TMJ EXERCISE 2
As in exercise 1, sit comfortably in a chair against the back rest. Place the web of your thumb and forefinger again against the front of the lower jaw with the teeth slightly apart. As before use your chin to press your lower jaw gently backwards. Done correctly you should feel the lower teeth moving backwards in relation to the upper teeth, just as in exercise 1. Do not open your mouth any extra. Now gently push your jaw (not your whole head) forwards against your hand. Hold fast for a few seconds.
Then, relaxing your hand, push your lower jaw gently forwards, so that the lower teeth protrude. Hold for a second or two.
Repeat by gently pushing the jaw backwards again with your hand.
TMJ EXERCISE 3
With your teeth closed gently against each other, rest the tip of your tongue against the top of your mouth, just behind the front teeth.
Now run the tip of your tongue backwards along the top of your mouth, keeping the teeth closed, until you can just reach some soft tissue (the soft palate).
Lastly, and this is where you must be careful, slowly open your mouth, trying to keep the tongue against the soft palate. When you feel your tongue being pulled away from the soft palate, STOP. Do not open any further. In fact, to start with, stop before your tongue leaves the soft palate, or if it hurts, or you get clicks or pops. Hold this position for a few seconds and then relax. Repeat only once or twice to begin with.
Be gentle and do not over do it. Your muscles will tire and feel sore quite quickly.
- Massaging the three muscles, together with the TMJ exercises above, may also be beneficial.
TMJ MASSAGE
The temporalis on the side of the head is easy to locate. Press on it looking for painful nodules, massaging gently. Opening and closing the mouth a little at the same time may be helpful.
Repeat with the masseter muscle. It is located on the side of your jaw. Placing your thumb inside the mouth, and gently squeezing the nodules may be helpful.
To reach the pterygoid muscle is more difficult. Slide the tip of your index finger, pad facing outwards, between the upper teeth and the cheek, as far back as you can. You will reach a little crevice called the pterygoid pocket. Gently massage the muscle, pressing outwards, slowly moving the jaw. It is often exquisitely tender with TMJ problems.
- Stress-reduction techniques may help you manage stress and relax your jaw along with the rest of your body.
- Medications such as Motrin, Advil, aspirin or other non-steroidal anti-inflammatory drugs reduce pain and inflammation.
- Sleep on your back to give your back, shoulder, and neck muscles plenty of rest. Do not sleep on your side or lie on your stomach with your head turned to the side. Avoid propping your head at a sharp angle to read or watch television.
- If you work at a desk, check your posture periodically throughout the day. Do not lean over the desk. Keep your back comfortably straight, with your ears not too far in front of your shoulders. Try to keep your head aligned so that your cheekbones are over your shoulders.
- If you work on a computer, consider improving your computer workstation set up and switching to an optical scanner mouse. Take periodic breaks to stretch and move around to reduce stress in back, shoulder, and neck muscles.
- Use a fanny back instead of a purse to reduce shoulder stress.
- Consider seeing a physical therapist who specializes in ergonomics and posture. Do yoga postures and ergonomic stretches every day. Read and study books on yoga, repetitive stress injuries and body alignment.
DIETARY RECOMMENDATIONS
Eat a soft food diet including lightly steamed vegetables, fresh fruits, whole-grain products, white fish, skinless chicken and turkey, brown rice, and homemade soups and broths. Eating vegetable soup with a lot of vegetables and beans for magnesium, meat and sometimes broth made from animal parts (bones, tendons, etc.) for hyaluronic acid may be helpful. Cut up foods into small, easily chewed pieces before placing them into your mouth.
Include more sulfur-containing foods, such as asparagus, eggs, garlic, and onions in your diet. Sulfur is needed for the repair and rebuilding of bone, cartilage, and connective tissue. It also aids in the absorption of calcium.
Eat fresh pineapple frequently. Bromelain, an enzyme found in pineapple, is excellent for reducing inflammation. To be effective, the pineapple must be fresh. Freezing and canning destroy enzymes.
Be sure to include magnesium in with your calcium supplement (see Supplements). TMJ impacts women of childbearing age more frequently than it effects other segments of the population. TMJ commonly occurs along with fibromyalgia, tinnitus, migraines, mitral valve prolapse and other conditions linked to magnesium deficiencies. A major factor in all of these associations may be that because magnesium gets depleted through the menstruation process, women of child bearing age are more likely to be at risk for conditions linked to a deficiency of this mineral.
Avoid all high-stress foods, all forms of sugar, all white flour products, all junk foods, candy, colas, potato chips, pies, and fast foods.
Do not consume any foods or beverages containing caffeine. As a stimulant, caffeine can increase tension, which often aggravates the problem. Also avoid taking over-the-counter medications containing decongestants, which can have a similar effect.
Do not consume alcoholic beverages. These are a common contributing factor in bruxism (teeth grinding), which can cause or aggravate TMJ disorder.
HERBS
Blue Violet, Catnip, Chamomile, Hops, Kava Kava, Lobelia, St. John's Wort, Skullcap, Thyme, Passion Flower, Red Raspberry, Valerian Root, and Wild Lettuce have calming and anti-stress properties. Caution: Do not use Chamomile regularly, as ragweed allergy may result. Avoid it completely if you are allergic to ragweed. Do not take lobelia internally, on an ongoing basis.
Herbal Remedies: Blue Violet Supplements & Products
Herbal Remedies: Catnip Supplements & Products
Herbal Remedies: Chamomile Supplements & Products
Herbal Remedies: Hops Supplements & Products
Herbal Remedies: Kava Kava Supplements & Products
Herbal Remedies: Lobelia Supplements & Products
Herbal Remedies: St. John's Wort Supplements & Products
Herbal Remedies: Skullcap Supplements & Products
Herbal Remedies: Thyme Supplements & Products
Herbal Remedies: Passion Flower Supplements & Products
Herbal Remedies: Red Raspberry Supplements & Products
Herbal Remedies: Valerian Root Supplements & Products
Herbal Remedies: Wild Lettuce Supplements & Products
Boswellia ( Frankincense), an Ayurvedic herb, helps to restore blood vessels around inflamed connective tissue. It also reduces inflammation.
Herbal Remedies: Boswellia / Frankincense Supplements & Products
Feverfew and Ginger are good for pain and soreness. Ginger is also a powerful antioxidant that has anti-inflammatory effects. Caution: Do not use feverfew during pregnancy.
Herbal Remedies: Feverfew Supplements & Products
Herbal Remedies: Ginger Supplements & Products
Nettle leaf has anti-inflammatory properties.
Herbal Remedies: Nettle Leaf Supplements & Products
Turmeric and Willow are good for pain and inflammation.
Herbal Remedies: Turmeric (Curcumin) Supplements & Products
Herbal Remedies: White Willow Bark Supplements & Products
SP-14 Valerian Blend from Solaray Products combats stress and is also beneficial.
NUTRITIONAL RECOMMENDATIONS
Unless otherwise specified, the dosages recommended here are for adults. For children between the ages of 12 and 17, reduce the dose to 3/4 the recommended amount. For children between 6 and 12, use 1/2 the recommended dose, and for children under the age of 6, use 1/4 the recommended amount.
TMJ SYNDROME / DISORDER SUPPLEMENTS & PRODUCTS
Information, products and supplements for TMJ Syndrome / TMJ Disorder, a condition that results in pain in the jaw and face.
Boswellia Tincture, 2 fl. oz.
Boswellia is known as a natural bursitis and arthritis treatment.Bromelain 2000 GDU, Bromelain Supplement, NOW Foods, 500 mg, 90 Tabs
NOW Foods Bromelain 2000 GDU, Bromelain Supplement, is a proteolytic digestive enzyme that can enhance absorption of protein.Chamomile Tea, Caffeine Free, NOW Foods, 30 Tea Bags
Chamomile Tea is the world's most popular evening drink because chamomile tea has a soothing effect on many.Ex-Stress Formula With Valerian, Natural Stress Relief Supplement, Nature's Way, 430 mg, 100 Caps
Relieve stress the with an all natural stress relief supplement; Nature's Way Ex-Stress Formula with Valerian. Ex-Stress combines popular herbs like Valerian, Hops and Black Cohosh traditionally used to relax the body's systems and provide general health maintenance.Glucosamine Chondroitin Liquid With Lignisul MSM, NOW Foods, 16 fl. oz.
Liquid Glucosamine & Chondroitin with MSM combines three of the most effective nutrients available today for supporting good joint health in an easily absorbed liquid form.Hyaluronic Acid Hydraplenish With BioCell Collagen, Vegetarian, Nature's Way, 60 VCaps
Hyaluronic Acid Hydraplenish contains the patented BioCell Collagen II complex for healthy connective tissue and synovial fluid.Hyaluronic Acid Hydraplenish With MSM & BioCell Collagen, Vegetarian, Nature's Way, 60 VCaps
Hyaluronic Acid Hydraplenish contains the patented BioCell Collagen II complex for healthy connective tissue and synovial fluid plus Opti MSM to support healthy hair.Joints With Glucosamine HCl, Joint Supplement, Nature's Way, 60 Caps
Joints with Glucosamine HCl Joint Supplement represents the powerful synergy of current scientific research and traditional herbal medicine.Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz.
Just An Ounce, Calcium and Magnesium Liquid can help with the development of strong bones and teeth, also prevents muscle cramping, risk of colon cancer, maintain regular heart beat, protects against osteoporosis and helps relax the central nervous system.L-Tyrosine, Pharmaceutical Grade, Free Form, NOW Foods, 500 mg, 120 Caps
L-Tyrosine is used to treat insomnia, improve muscle tone, improve skin and hair pigment and depression and anxiety. L-Tyrosine should not to be used while taking prescription antidepressants or MAO inhibitors.MSM Supplement, Pure Lignisul, Methylsulfonylmethane, 1000 mg, 120 Caps (With Free 4 oz. Lotion)
Buy MSM Supplement caps and get a 4 oz Lotion free, MSM supplement plays a beneficial role in connective tissue and joint flexibility, immune health, arthritis, osteoporosis, rheumatoid arthritis, inflammation, pain, hair, skin, nails, athletic injuries, acne, wrinkles and allergies.Multi-Vitamin Without Iron, Nature's Way, 100 Caps
The vitamins and minerals in this Multi Vitamin without Iron play many important roles in the body: antioxidants to protect fats, cells and DNA, coenzyme precursors for energy production and metabolism, and cofactors for hormones and enzymes which regulate body processes.Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.White Willow Bark Tincture, 100% Organic, 2 fl. oz.
Aspirin is a synthetic derivative of white willow bark. White Willow Bark is an analgesic, anodyne, anti-inflammatory, antiseptic, diaphoretic, and fever reducer.
Herbal Remedies: TMJ Syndrome / Disorder Information
Herbal Remedies: TMJ Syndrome / Disorder Supplements & Products
Herbal Remedies: Gingivitis Information
Herbal Remedies: Gingivitis Supplements & Products
Herbal Remedies: Tooth Decay / Cavities Supplements & Products
Herbal Remedies: Toothache Supplements & Products
NOTIFY YOUR DENTIST OR HEALTH CARE PROVIDER IF...
Occasional pain in the jaw joint or chewing muscles is common and may not be a cause for concern.
See a health care if your pain is severe or if it does not go away. Treatment for TMJ syndrome should begin when it is in early stages. The practitioner can explain the functioning of the joints and how to avoid any action or habit (such as chewing gum) that might aggravate the joint or facial pain.
See your health care provider right away if you are having trouble eating or opening your mouth. Keep in mind that a wide variety of possible conditions can cause TMJ symptoms, from arthritis to whiplash injuries. Experts who are specially trained in facial pain can help diagnose and treat TMJ.
If your jaw is locked open or closed, go to a hospital's emergency department.
- The open locked jaw is treated by sedating you to a comfortable level. Then the mandible is held with the thumbs while the lower jaw is pushed downward, forward, and backward.
- The closed locked jaw is treated by sedating you until you are completely relaxed. Then the mandible is gently manipulated until the mouth opens.
TMJ problems do not fall clearly into one medical area. There are a wide variety of treatment approaches. If you are interested in a massage-based approach, look for a massage or physical therapist trained in trigger point therapy, neuromuscular therapy (NMT), clinical massage, or pain relief, especially for TMJ pain.
See your dentist regularly to keep up on proper dental care. Dentists who specialize in evaluating and treating TMJ disorders will typically perform x-ray exams and may use a kinesiograph or EMG (electromyography). They may give you a mouth guard. Surgery is now considered a last resort by most TMJ experts.
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HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
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