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What are the TMJs?
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The TMJs are the joints between the lower jaw and the skull. There is one on each side situated just in front of each ear.
The two bony components of each joint are separated by a disc of cartilage.
Ligaments surround the joints and muscles are attached to the bone and the disc to allow movement of the joints.
The 'mechanical process' of chewing includes larger muscles which can sometimes be involved in TMJ disorders.
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Causes of TMJ problems
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- Stress: At times of increased stress, the chewing muscles can be tensed up, the teeth may be clenched or grinding of teeth may occur. All of these may lead to TMJ symptoms. Some patients have the habit of clenching their teeth during sleep and are not aware of it.
- Trauma: If an injury is sustained to the jaw, this may in some cases lead to TMJ problems. Overworking of the joint, e.g. excessive opening may also play a part.
- Occlusion (the way the teeth meet): If the occlusion is unbalanced, caused for example by missing teeth, this can exert stress on the TMJ.
- Anxiety and depression: TMJ problems may also arise in people suffering with anxiety and depression.
- Systemic disease: The TMJ may be affected by systemic illness that involves the joints, for example arthritis.
- Idiopathic: Some patients have no obvious cause for their symptoms.
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Symptoms include
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- Pain: This can be localised to the area overlying the joint, or may radiate to other areas, e.g. temple, cheek or neck muscles.
- Trismus: This is restricted opening of the jaw due to joint and muscle pain and is a protective mechanism.
- Clicking: This is due to lack of co-ordination of the disc within the joint. A sudden movement of the disc produces the sound. This may occur without other symptoms.
- Crepitus (grating): Less common than clicking, this is a prolonged continuous noise in the joint during movement usually due to wear and tear on the joint.
- Locking: This occurs due to displacement of the disc, preventing normal movement of the lower jaw. In the main, this can be prevented by avoiding excessive movements.
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Available treatments
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In the majority of cases, no active intervention is required and simple measures help alleviate the symptoms. These include:
- Soft diet, i.e. nothing that requires too much chewing.
- Avoid opening wide - when yawning put your hand under your chin to stop yourself opening wide - cut fruit up into little pieces.
- Avoid habits such as chewing gum, biting pen/pencil tops or biting your nails.
- Use pain killers as required. If you have not been prescribed any then providing you have not been told by your doctor not to take it, Neurofen has been found to be the best kind of analgesic for this type for pain.
- If you are shown a set of jaw exercises to carry out, it is important that you do so regularly.
- A warm towel placed over the painful area often helps relieve the pain.
- You may have a splint made which fits over your top or bottom teeth. These are designed principally to help patients who grind or clench their teeth.
- In some cases you may be prescribed anti-depressants - these are helpful in reducing muscular tension and pain.
- You may be referred to a physiotherapist for treatment.
- Surgery is only indicated in a very small number cases and only after other measures do not improve the situation.
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Summary
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TMJ disorders have various causes, some of which will decrease over time. Therapy is available which can eliminate or reduce symptoms. As with other joint problems, TMJ disorders may be chronic in spite of treatment and the patient may have to accept some limitation of function from time to time.
If you are at all concerned, or would like further information, please contact your consultant Maxillofacial surgeon.
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