TMJ/TMD

Temporo Mandibular Joint (TMD or TMJ)

TMJ Dysfunction Treatment

Many people suffer from teeth grinding, headaches and tenderness of the jaw muscles and joints. Although stress is often a factor, these symptoms are usually related to problems with the jaw muscles and the jaw, or TM (TemporoMandibular) Joint. TM Joint disorders are more easily diagnosed and treated than they were in the past. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important. No one treatment can resolve TMJ disorders completely and treatment takes time to be effective. Dr. Carlson can help you have a healthier and more comfortable jaw.

Trouble With Your Jaw?

TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM Joint. Or, you may have a damaged jaw joint due to injury or disease. Whatever the cause, the results may include excessive tooth wear, clicking or grinding noises in the TM Joint, as well as pain or difficulty in opening or closing one’s mouth.

Do You Have a TMJ Disorder?

  • Are you aware of grinding or clenching your teeth?
  • Do you wake up with sore, stiff muscles around your jaw?
  • Do you have frequent headaches or neck aches?
  • Does the pain get worse when you clench your teeth?
  • Does stress make your clenching and pain worse?
  • Does your jaw click, pop, grate, catch, or lock when you open your mouth?
  • Is it difficult or painful to open your mouth, eat or yawn?
  • Have you ever injured your neck, head or jaws?
  • Have you had problems (such as arthritis) with other joints?
  • Do you have teeth that no longer touch when you bite?
  • Is it hard to use your front teeth to bite or tear food?
  • Are your teeth sensitive, loose, broken or worn?

What is TMJ?

TMJ is an acronym for the temporomandibular joint. But TMJ has been used by many people through the years to actually describe TMD, which is an acronym for temporomandibular joint disorder. TMD describes many symptoms related to the jaw and supporting structures. This disorder is a subgroup of orofacial pain disorders that include many different types of pain in the head and neck. The TM joint itself is located directly in front of the ear and is commonly called the “jaw joint.” Common symptoms of TM disorders are pain or discomfort around the ear, jaw, jaw joints and facial muscles — headaches, temple pain, throat pain, pain with opening, chewing, locking, limited opening, clicking, popping and grating noises. If you have any of these symptoms for more than a month, you should seek treatment from your dentist.

What causes TMD?

Usually several factors are involved, and there is rarely one single symptom. Some factors include trauma to the face or jaw, arthritis, bruxism or neck conditions. The most common cause is clenching of the jaw. There are many causes of clenching, which is at the core of any treatment plan. Any or all of these can perpetuate TMD symptoms and need to be addressed. TMD and facial pain are a chronic, degenerative condition that must be managed to reduce the aggravating factors. There is no “quick fix.”

Does TMD cause my headaches?

It could be one possible contributing factor, but there are many causes for headaches. The contracture of the facial muscles can produce a headache cycle that is sometimes difficult to stop. TMD is but one possible cause of headache, or it might be the effect of some other contributing factors, such as migraine. If you suffer continually from headaches, chances are that you are also developing a clenching habit that can put undue stress on the temporomandibular joint.

How many headaches are normal?

Normal is about 0-2 headaches per month, with a pain level of 1-2 out of 10. More frequent or greater pain should be evaluated. Countless hours of work and quality time with your family can be lost because of headaches, not to mention how having headaches affects your quality of life. Your headaches are treatable! Something else that you should consider is that all the medication taken for headaches (Advil, aspirin, Motrin & Ibuprofen) can cause major stomach disorders. Also, more than four to six Advil a day can lead to liver disorders. Once your stomach becomes sensitive to these anti-inflammatories, you will be severely compromised in your ability to deal with inflammation in the future.

Will I have to have TMJ surgery?

Conservative, mainstream treatment for TMD does not include surgery as a first line of treatment. Surgery is the very last treatment to consider. Non-surgical treatment options for this condition are consistent with other orthopedic or rheumatologic conditions, such as a painful knee or shoulder. The goals of management are to decrease pain, reduce pressure loading of the joint and to restore function of the joint (40mm opening between front teeth without pain) and normal activity for the patient.

What do you do for TMD?

It depends on your symptoms and the different factors that are contributing to those symptoms. Again, as with other musculoskeletal conditions, medication, physical therapy, behavioral modification and orthopedic appliances are all used in combination or alone (depending on the etiology ) to achieve good function and decrease pain. Long-term, the key to a healthy joint is movement and lubrication (synovial fluid). Anything less can lead to arthritis in the joints and internal derangement of the joints.

My jaw only clicks, but I have no pain. Can it get worse?

Clicking may or may not be a symptom of a future problem. If it is occasional, with no pain, then it may not present a future problem. The key here is whether there is a progression of clicking, changes in the click intensity or frequency or if it has just started. However, if it clicks every time you chew or open your mouth, or if it changes in nature, then it may be an early symptom of a more severe problem. You should consult your dentist before it progresses to a locked jaw.

My jaw locks occasionally, usually in the morning, but I can work it open. Is this normal?

No! Even an occasional lock is cause for concern. Joints are designed to move. A joint that locks up, even occasionally, is a joint under stress, unstable and not being lubricated properly. Episodic locking is very difficult to treat and should be treated as soon as possible. You could run the risk of being permanently locked, which would diminish your treatment options. Please see your dentist as soon as possible if you have this condition.

I already have a splint that does not work. What more can be done?

The splint only addresses one contributing factor of your headaches or pain. There may be others that need to be identified. Once they are identified, they can be treated. However, during the treatment of these other factors, it is critical that a good working splint is in place, because as these other factors resolve themselves, the facial muscles will be affected, and the splint needs to be changed in order to respond to these changes.

Are all splints created equal?

No! There are many different types of splints, all for different purposes. There are soft splints (such as the ones you can purchase at drug or sporting goods stores), which are designed to protect the teeth but in most cases actually increase muscle activity and forces on the joint, causing increased pain. There are different types of hard, acrylic splints that are designed to accomplish different results. Dr. Carlson can determine which type is the best for you.

Physical Therapy

TMD pain is often associated with the muscles in the head and neck. A lot of the time there has been past trauma to this area that was forgotten about. It may just require a change in posture at work. Certain muscles may have knots that need stretching and relaxing. To help with the muscles of the jaw, neck and shoulders we find it helpful to request the help of a physical therapist. Brian, at Active PT, has a lot of experience with head and neck muscles. We work closely with him on a lot of cases.

How can TMJ syndrome be treated?

Common TMJ treatment steps include pain relief, stress reduction, and dental procedures such as bite guard therapy and bite correction to relax jaw muscles. If you feel you might be suffering from TMJ syndrome it is best to consult with Dr. Carlson on both the correct diagnosis and method of treatment for you. Dr. Carlson will perform a thorough history and examination in order to build the proper series of steps to help manage your symptoms. Often a special bite guard is very helpful in reducing jaw muscle soreness. Dr. Carlson has extensive training in the use of bite guards.