Temporomandibular joint- A joint used everyday

By Aishwarya Jayadeep

A few years back when I had my third molars extracted the healing didn't happen as anticipated. So while eating I started chewing on one side. As it took a while to heal, chewing on one side became a practice which I continued, may be for another six months without really noticing it. But like any overused or say abused joint my Temporomandibular  joint decided to bring my bad chewing habit into notice; you may ask how? I started experiencing a feeling of gnawing pain in my temporomandibular joint area. Luckily, I knew what was the reason and started chewing food on both the sides and soon I got rid of the pain for ever. Now you would be wondering what this "mouth full" of a joint is.. to know more keep reading....

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. 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.

What are TMJ disorders (TMD), and how are TMJ disorders caused?


TMJ disorders are a group of complex problems of the jaw joint. TMD 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.

1. Teeth grinding and teeth clenching (bruxism) 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.
2. Habitual gum chewing or fingernail biting
3. Dental problems and misalignment of the teeth (malocclusion). 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.
4. Trauma to the jaws: Previous fractures in the jaw or facial bones can lead to TMJ disorders.Or even I have come across people with TMD because of biting into a bone or stone in the food unknowingly.
5. Stress frequently leads to unreleased nervous energy.It is very common for people under stress to release this nervous energy by either consciously or unconsciously grinding and clenching their teeth.
6. Occupational tasks such as holding the telephone between the head and shoulder may contribute to TMJ disorders.

What are common TMD symptoms?


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 common symptoms.

• Headache: Approximately 80% of patients with a TMJ disorder complain of headache, and 40% 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.
• Ear pain: About 50% 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.
• Sounds: Grinding, crunching, or popping sounds, medically termed crepitus, are common for patients with a TMJ disorder. These sounds may or may not be accompanied by increased pain.
• Dizziness: Of patients with a TMJ disorder, 40% 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.
• Fullness of the ear: About 33% 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 (tinnitus): For unknown reasons, 33% 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.

What can I do to treat TMD?

The majority of cases can be treated by unloading (resting) the joint, taking a nonaspirin pain reliever and practicing stress management and relaxation techniques. It's important to break bad habits to ease the symptoms. Most treatment for TMD is simple, often can be done at home, and does not need surgery. For example, control clenching or grinding during the day by sticking your tongue between your teeth. If you still experience pain, you may be grinding or clenching your teeth at night. So see your dentist for a nighttime mouth-guard.

Most people will experience relief with minor treatment. More severe cases may be treated with physical therapy, ice and hot packs, posture training and orthopedic appliance therapy (splint). Eating soft foods and avoiding chewing gum also help relax the muscles.

Is TMD permanent?

The condition is often cyclical and may recur during times of stress, good or bad. As the patient, you should be active in your treatment, by being aware of the causes of your jaw problems after seeing a dentist for a diagnosis regime. Make routine dental appointments, so your doctor can check TMD on a regular basis