TMJ (Temporomandibular Joint Disorder)

It is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the mandible to the skull. The disorder and resultant dysfunction can result in significant pain and impairment. Because the disorder transcends the boundaries between several health-care disciplines — in particular, dentistry and neurology — there is a variety of treatment approaches and the discomfort does not always last long.
The temporomandibular joint is susceptible to many of the conditions that affect other joints in the body, including ankylosis, arthritis, trauma, dislocations, developmental anomalies, and neoplasia.
Symptoms: main symptoms include:

• Biting or chewing difficulty or discomfort
• Clicking, popping, or grating sound when opening or closing the mouth
• Dull, aching pain in the face
• Earache (particularly in the morning)
• Headache (particularly in the morning)
• Hearing loss
• Migraine (particularly in the morning)
• Jaw pain or tenderness of the jaw
• Reduced ability to open or close the mouth
• Neck and shoulder pain
• Tinnitus (ringing in the ears)
• Pain behind the eyes
• Dizziness (Vertigo)
• Sensitive teeth
• Facial pain

Cause: there are many external factors that place undue strain on the TMJ. Some are:

• Over-opening the jaw beyond its range.
• Unusually aggressive.
• Repetitive sliding of the jaw sideways or forward.

These movements may also be due to perverse habits or a poor alignment of the jaw or dentition. This may be due to:

• Trauma
• Bruxism
• Mal-alignment (poor alignment) of the teeth due to dental defect or neglect.
• Jaw thrusting (causing unusual speech and chewing habits).
• Excessive gum chewing or nail biting.
• Size of food bites eaten.
• Degenerative joint disease.
• Myofascial pain dysfunction syndrome
• Lack of overbite

Treatment

Restoration: if the occlusal surfaces of the teeth or the supporting structures have been damaged due to dental neglect, periodontal diseases or trauma, the proper occlusion should be restored. E.g. Patients with bridges/crowns should be checked for improper height of the dental work, which could result in misalignment of the top and bottom teeth. Occlusal restoration reduces TMJ symptoms for some patients.

Splints (Night or Mouth Guard): reduce nighttime clenching in some patients. While splints do prevent loss of tooth enamel from grinding, use of a splint can worsen TMJ disorder symptoms for some people.

Pain Relief: while conventional analgesic pain killers such as acetaminophen based medication can provide relief for some sufferers, the pain is often more neurologic in nature, which often does not respond well to these drugs.

An alternative approach is for pain modification. Biofeedback using EMG (electromyography) is successful in balancing these muscles. A mirror can be used as a biofeedback device: Draw a vertical line on mirror. Relax the jaw by relaxing as you exhale. See the jaw relax in the midline. Practice the breathing and relaxing daily using the mirror. When the jaw does open midline the symptoms should reduce.

Long-Term Approach: before the attending dentist commences any plan or approach using medications or surgery, he would recommend you to perform a thorough search for inciting perverse jaw habits. Correction of any discrepancies from normal can then be the primary goal.