TMJ disorders: aren't you suffering from jaw pain?
Today, I want to talk about temporomandibular joint (TMJ) disorders. TMJ disorders cause pain and tenderness in the temporomandibular joint - the hinge joint that connects the lower jawbone to the skull. This joint allows us to eat, talk and yawn.
People who are suffering from TMJ disorders may have pain on opening or closing their mouth, radiating pain to their ear, jaw and posterior neck. It is commonly described as a dull ache worsened by chewing. Clicking or noise at TMJ is common, but it is not a marker of the severity. Headaches are another common symptom complained by many patients.
TMJ disorders most commonly occur in young women, between the ages of 30 and 50. And only one joint is usually involved. It can be categorized as intracapsular or extracapsular. Extracapsular disorders are far more common, and are known as TMJ syndrome or TMJ myofascial pain syndrome. Intracapsular disorders include osteoarthritis, rheumatoid arthritis, and articular disc displacement. These disorders should be excluded by a physician when you have persistent pain or tenderness in your TMJ or if you can’t open or close your jaw completely.
In most cases, the pain can be relieved with self-managed care or nonsurgical treatment. But some TMJ disorders may need surgical interventions if there are significant internal joint derangements or degenerative joint disease (less than 5 percent of TMJ patients). Overall, 50 percent of TMJ patients may get improvement in one year, and 85 percent will get complete improvement in three years.
If you are suffering from jaw pain, you can try the followings. They are effective in 80 percent of cases.
- No chewing gum or ice
- Soft diet
- Local massage, heating pad
- Elevate head of bed to 30 degrees or more
- Bite guard
- Jaw opening exercise
A bite guard is important especially when you grind your teeth in your sleep. It can prevent your teeth from meshing together. Many people with TMJ disorders have nocturnal grinding of the teeth or unconscious jaw clenching. One study revealed that 78 percent of patients with TMJ disorders had tooth grinding.
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Second step is pushing the jaw forward against the hand, holding and then relaxing. Last step is pushing the jaw to one side against resistance, hold in this position and then relaxing. Every each step needs to be repeated at least five times.
To get joint and muscle relaxation, place tongue on roof of mouth as far back as possible. Slowly open mouth as far as possible, tongue on the roof. Repeat many times as needed daily.
If your symptoms persist, you may need some medications such as simple analgesics, tricyclic antidepressants or muscle relaxants. Taking simple analgesics with jaw opening exercises may be beneficial, but analgesics used alone are not as helpful. In a short term study, naproxen was superior to celecoxib for pain relief and TMJ range of motion.
Amitriptyline 25mg (a tricyclic antidepressant) also showed greater reduction of TMJ pain than the placebo (75 versus 28 percent, respectively).
Additionally, botulinum toxin injections into the jaw muscles, corticosteroid injections into the joint space, or cognitive behavior therapy can be recommended in some patients. Above all, you don’t need to wait to see any dentists or TMJ specialists if you are suffering from jaw pain.
The author is a clinical instructor at the Seoul National University Hospital International Healthcare Center (SNUH-IHC).