Temporomandibular Joint Disorders
The temporomandibular joint, on either side of one’s jaw, connects the jawbone to skull. Without this joint, we would not be able to move our jaw up or down, left or right-- actions such as talking, chewing, and yawning would not be possible. However, some may face pain in their jaw joint and the muscles that control jaw movement, which is classified as temporomandibular joint disorder (TMD). Unfortunately, the exact causes of TMD are unknown, as it could result from any combination of genetics, arthritis, jaw injury, teeth grinding or clenching, misalignment of jaw or teeth, and/or stress. This makes it difficult to pinpoint a specific cause for TMD, thus those suffering from it may find it frustrating.
There are four categories of the common signs and symptoms of TMD-- pain, sounds, motion limitation, and catching or locking. Pain is the most common symptom of the four categories, and can be found in the jaw joint, nearby muscles, and temples. Pain in the jaw joint can occur even without activity or movement of the jaw. For many patients, the pain will eventually disappear, but it may also persist for a longer period of time. Sounds include clicking and popping of the jaw (discrete sounds), and grating and grinding (continuous sounds). It is important to be aware that clicking and popping do not necessarily point to TMD, as it could also be a sign of a displaced articular disc.
A common complaint from TMD patients is the inability to open mouths wide without facing pain. When measuring the distance, the opening should be less than 40 mm and lateral movement less than 7 mm. This difficulty in opening may be due to muscle tension or strain, or less commonly, a displaced articular disc. In the case of the latter, there will be a deviation to one side upon opening as well as pain. Lastly, catching and locking can result from the opening or closing of the mouth. Catching is momentary, but multiple episodes can occur. Locking can be continuous from a few seconds to weeks, or also occur in multiple episodes. About 15% of TMD patients have reported at least one locking episode, accompanied with pain.
There is a quick questionnaire that can be answered to facilitate the diagnosis of TMD. It tracks the presence of pain, duration of pain, and activities related to the pain over the last thirty days. Positive answers would be followed with more questions and clinical assessments. Following diagnosis of TMD, there are many treatment options one can undergo. Many find that changing oral behaviors and taking medical treatments can relieve their symptoms, while some find that little to no change in lifestyle could also relieve symptoms. In terms of oral behaviors, patients should avoid opening their mouths too widely and moving it excessively from one side to the other. The usual jaw position to maintain is to relax the jaw and have the teeth slightly apart, and the tongue resting just behind the anterior teeth. Frequent self-monitoring would include avoiding grinding and clenching, and modifying one’s diet to take in smaller bites, have a soft diet/avoid crunchy and hard foods. Thermal treatments include applying heat or ice, or rotating between the two. A heat pack should be applied for 15-20 minutes, while an ice pack should be applied up until numbness is felt. If rotating between the two, heat should be applied first for five minutes, and then the ice pack until numbness is felt. There are also exercises that can be done-- one is to open the mouth as wide as possible without feeling pain, holding for 10-15 seconds, closing halfway and holding for 5 seconds, and then repeating 10-15 times. As for relieving pain, NSAIDs are most commonly taken, but if it is needed on a long-term basis, it is recommended to have a professional dental consultation.
Pain and discomfort in the jaw is discomforting and can be a disturbance in one’s everyday life, but it is in fact a very common disorder. It can be found in 10 million people or more, more so in women than men. TMD is definitely treatable, and there are many techniques that can be used to relieve symptoms. Of course, a professional dental opinion is best and should be sought after if extreme pain and discomfort is felt.
References:
https://www.hopkinsmedicine.org/health/conditions-and-diseases/temporomandibular-disorder-tmd
https://www.mayoclinic.org/diseases-conditions/tmj/symptoms-causes/syc-20350941
https://www.dentalcare.com/en-us/professional-education/ce-courses/ce395/common-signs-and-symptoms-of-tmd
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4478082/
https://www.health.com/condition/pain/tmj-symptoms-treatment
