630-305-7500
1060 East Ogden Avenue,
Naperville, IL60563
WHAT IS TMJ?
TMJ stands for temporomandibular joint or the jaw joint. TMJ is a nonspecific, catch-all term for a variety of pain/dysfunction conditions of the head and neck. There are really two TMJs, one in front of each ear. The TMJ is the joint formed by the temporal bone of the skull with the lower jaw. These joints move and allow us to perform functions such as opening and closing your mouth, chewing, speaking and swallowing. The TMJ is actually a sliding joint which allows for pressures placed on the joint to be distributed throughout the joint and not just in one area. The TMJ is the most complex and one of the most frequently use of all joints in the human body. A small disc of cartilage separates the bones, much like in the knee joint, so that the mandible may slide easily; each time you chew you move it. This disc is primarily made of cartilage and in the TMJ acts like a third bone. The disc, being attached to a muscle, actually moves with certain movements of the TMJ.
HOW DOES TMJ WORK?
When you bite down hard, you put force on the object between your teeth and on the joint. More force is applied to the joint surface than to whatever is between your teeth. To accommodate the force and to prevent too much wear and tear, the cartilage between the mandible and skull normally provides a smooth surface, over which the joint can freely slide with minimal friction. TMJ diseases and disorders refer to a poorly understood set of conditions, manifested by pain in jaw area and associated muscles and limitations in ability to make the normal movements of speech, facial expression, eating, chewing and swallowing etc. The pain may be sharp and occur only when you swallow, yawn talk or chew, or it may be dull and constant. It often causes spasms in the adjacent muscles.
Alterations of oral forms result in muscular changes and alters the morphology of the tongue and throat that effects the ease of oral functions, including breathing, swallowing and speaking. This effect allows for the use of the alteration of oral forms which then allow oral functions to occur more easily. Muscle contraction pain, bruxism, postural breakdown and ongoing fight or flight feelings can all be associated with the body compensations that provide a more open throat and allow for a greater ease of oral functions. Forward head and jaw posturing each allow for a more open throat and greater ease of jaw functions since the tongue moves with the lower jaw and the back of the tongue forms the front of the throat. Oral orthotics can provide greater ease of swallowing in patients and decrease the muscle activity needed to accomplish swallowing. Dental orthotics may alter oral functions and could be expected to be related to muscular symptoms and head posture.
SYMPTOMS OF TMJ
Ear pain, face pain, jaw clicking, locking, headaches, sore jaw muscles, pain when chewing/opening/closing, neck, shoulder and back pain, and possible swelling on the side of the face. Pain is defined as any achiness, tenderness, soreness, numbness, discomfort, strain, etc. Chronic fatigue, depression, anxiety disorders or panic attacks, irritable bowel syndrome, concentration and memory loss are all conditions often associated with TMJ.
HEADACHE- One of the most common symptoms of TMJ. Clenching and grinding teeth produce muscle pain which can also cause headache pain. A displaced disc in the TMJ may cause pain in the joint which is sometimes referred into the temples, forehead or neck.
CLENCHING OR GRINDING- Because both major and minor trauma to the jaw can significantly contribute to the development of TMJ problems. If you habitually clench or grind your teeth you increase the wear on the cartilage lining of the joint. Many times you are grinding at night and completely unaware of it unless someone tells you.
EAR SYMPTOMS- Injury to the TMJ often causes various ear symptoms which may include ear pain, fullness, stuffiness, ringing and even a loss of hearing.
TMJ CLICKING- The most common symptom of TMJ is jaw joint clicking, popping or snapping. There may or may not be pain in the joint itself with the sound of a click or pop. If there is a displaced disc, as is usually the case when a click occurs, then the muscles that move the jaw while chewing are more tense than normal. This tenseness can and does cause muscle, facial, and head and neck pain. The popping or clicking occurs when the disk snaps into place when the jaw moves.
TMJ LOCKING- Locking of the TMJ may be observed by catching of the lower jaw as it opens. Sometimes, the person with a locked joint must move the jaw to one side or another in order to open wide. A person might have to open until he hears and feels a loud pop, at which point the jaw actually unlocks.
CHANGE IN BITE- A dislocated TMJ may be seen by a change in the dental occlusion, or bite. If the TMJ disc goes out of place, the bones and disc do not fit together properly and therefore, the bite of the teeth changes.
Several conditions may be related to TMJ, they vary and are often difficult to pinpoint. The joint, ligaments, and muscles used for chewing and grinding food may all be involved. In some cases, it’s not possible to clearly determine the causes. Some TMJ results from arthritis, dislocation, and injury. All of these conditions can cause pain and dysfunction. Muscles that move the joints are also subject to injury and disease. Injuries to the jaw, head or neck, and diseases might result in TMJ. Other factors that relate to the way the teeth fit together, the bite, may cause some types of TMJ. Stress is thought to be a factor.
WHAT IS FIBROMYALGIA?
Fibromyalgia is a chronic, painful muscle condition characterized by pain in the skeletal muscles, tendons, ligaments and bursa. Fibromyalgia has many symptoms, characterized by generalized muscle soreness/stiffness lasting more than three months, poor sleep with morning fatigue and stiffness, tenderness at 11 of 18 specific sites, and normal blood test results. Many common painful areas are the low cervical spine, the shoulder, the second rib, the arm, the buttocks and the knee. Symptoms are often worsened by stress or a change in the weather. Depression is also common. Physical activity increases the patient’s pain complaints and leaves them sore with intense muscle pain for days following. Fibromyalgia may be caused by a physical trauma, or as a result of an illness like the flu. Women often experience the effects of fibromyalgia due to hormonal changes after a hysterectomy or around the time of menopause. Emotional traumas may also trigger fibromyalgia.
CONDITIONS ASSOCIATED WITH FIBROMYALGIA:
TMJ, Chronic Fatigue Syndrome, Irritable Bowel Syndrome, Depression, Anxiety Disorder and Panic Attacks, Concentration and Memory Problems, Irritable Bladder, Mitral Valve Prolapse, and Fibrocystic Breast Disease and Endometriosis.
TMJ- Many patients suffering with TMJ problems also suffer with fibromyalgia. Unfortunately many doctors don’t recognize either TMJ or fibromyalgia or they fail to see the connection of these two. Fibromyalgia almost always magnifies the painful symptoms of TMJ and when one or both temporomandibular joints are dislocated, the pain of fibromyalgia in the neck and upper back are intensified. Both TMJ and fibromyalgia produce similar painful symptoms in the muscles of the neck, shoulders, back, face and head as well as often causing dizziness. When one or more of the joints are injured, the muscles in the head and neck automatically tense-up, develop trigger points, and intensify the symptoms of fibromyalgia. Depression is common with TMJ, scientific evidence shows that chronic pain patients (nearly all TMJ patients) have changes in chemicals in the brain as result of the pain. These chemicals can and do produce depression. Along with depression comes an inability to get a good night’s sleep. This may be due to TMJ pain itself or changes in the brain’s neurotransmitter chemicals which produce stimulation even thought the TMJ sufferer is asleep. Sufferers usually wake feeling like they didn’t sleep very well. TMJ patients may also suffer from photophobia, or light sensitivity. A dislocated TMJ may produce pain in and behind the eye which can cause sensitivity to light. Blurred vision and eye muscle twitching are also common.
HEADACHES
The majority of headaches do not have a serious cause. The most common complaint of those who suffer with various types of TMJ is having headaches. Headaches are generally classified into several basic types: sinus, cluster, tension and migraine. Improper occlusion (your bite) may play a significant role in certain types of headaches as well as other head and neck pain. There are 13 categories of headache pain, with TMJ and facial pain falling into the category which is headache or facial pain associated with disorder of cranium, neck, eyes, nose, sinuses, teeth, mouth, or other facial or cranial structures. There are 3 main categories into which all 13 types are divided.
1) Vascular Headaches- include classic migraine (with aura) and common (without aura) migraine headaches, cluster headaches, and several other less common vascular types of headaches. This category roughly includes only 6-8% of all headache pain
2) Traction-Inflammatory Headaches- These are generally caused by severe diseases and disorders, like brain tumors, aneurysms, infections, and neuralgias. Symptoms vary however often the pain is very severe, increases when the sufferer bends over or coughs, and may be accompanied by other neurologic symptoms. Accounts for only 2% of all headache pain.
3) Muscle Contraction (Tension) Headaches- These are the most common type of headache, it has been estimated that it accounts for 90 -92% of all headache pain. It can vary from mild to quite severe in intensity; it usually starts in the forehead, temples or back of the head and spreads over the neck and shoulders. Sleeping difficulties are common: waking without feeling rested, restlessness and trouble getting to sleep. Those who clench or grind their teeth also develop muscle contraction headaches, especially during times of stress or during the night.
Sinus pain is behind the brow bone and/or cheekbones. In cluster headaches pain is in and around one eye. Tension pain is like a band squeezing the head and migraines are characterized by severe pain, nausea and visual changes are typical of the classic form.
The tension headache is the most common, estimated by some to be the cause of as much as 90% of all headaches. They are headaches that often originate in, or pain is referred to, the muscles of your forehead.
The muscles of the temple area of the forehead are muscles that play an important part in the posturing and closing of the jaw. If your occlusion (bite) is not right, it can lead to abnormal tension in these muscles – one of the several possible causes of tension type headaches. If the bite is not corrected, the muscles may remain tense for long periods of time. The contracted muscle doesn’t get a chance to rest and soon suffers poor circulation – thus a lack of needed oxygen and the accumulation of waste products of metabolism. The result can be pain (headache).
If the indications are that your bite is a major factor, recommended treatment would involve a custom made orthotic to adjust your bite to a correct relationship. Nothing permanent at this point is done to alter your teeth or bite; you would wear this orthotic for a period of time to make sure the new bite position is correct before any consideration would be given to permanently altering your bite.
Some patients may experience symptoms for quite a while and have no apparent loss of function. They can eat and speak without problems. Some patients slowly get worse and require treatment to relieve the pain and joint function. There are several ways TMJ may be treated. Our office will recommend what type of treatment is needed for your particular problem or recommended that you be referred to an oral surgeon.
To receive a proper diagnosis a clinical examination checking the joints and muscles for tenderness, clicking, popping or difficulty moving is performed. Your complete medical history is reviewed, and a panoramic x-ray is taken. After the initial consult has taken place and treatment has been started we will take further specialized x-rays for the TM joints along with models or “cast” of your teeth to see how your bite fits together. From the models a custom fabricated orthotic is created especially for you.
The orthotics’ purpose is to help eliminate muscle spasms, TMJ swelling and dislocation and generally reduce any type of pain. It is worn over the teeth to maintain the neuromuscularly derived bite position. You typically wear the orthotic for a prescribe period of time to verify that this new jaw position reduces or even solves the problem. The therapy also includes periodic adjustments of the orthotic.
The treatment we offer is non-invasive, conservative and non-surgical. Nothing we do is irreversible. The use of an oral orthotic and lifestyle changes are very effective in treating most truly TMJ problems. Other disorders that mimic TMJ (Fibromyalgia, Atypical face pain, temporal tendinitis, etc.) are often treated with oral orthotic therapy also.
Adjustments of the occlusion, orthodontic treatment, restoration with crowns, and surgery of all types all produce changes that can not be reversed, and should be considered only after a correct diagnosis and/or treatment with the orthotic aren’t producing results. Jaw joint surgery may be an option however it is usually reserved for advanced cases when no other treatment plan has worked and the patient still experiences pain.
If a TMJ sufferer is experiencing severe emotional and/or psychological problems, not addressing these important issues will almost guarantee a surgical failure. Psychological and physical problems are sources of unresolved pain complaints involving the TMJ or associated areas.
- Do you have frequent headaches?
- Do you suffer form earaches, tenderness of the jaw muscles, or dull, aching facial pain?
- Do you hear popping, clicking or cracking sounds when you chew?
- Does your jaw lock or stray to one side when you open your mouth?
- Do you suffer from dizziness, ringing in the ears, difficulty swallowing, loose teeth, sensitive teeth, neck pain, postural problems, or nervousness?
- Does your jaw feel like they catch?
- Does your jaw feel tight, or difficult to open?
- Can you not open your mouth as wide as you used to?
- Do you wake with sore facial muscles?
- Do you clench or grind you teeth during movements of frustration or concentration? Or at night?
- Do your teeth ache?
- Does it hurt to move your jaw sideways?
- Does your neck, back of your head, or shoulders hurt?
- Have you had an injury to your head, neck, face, jaw or teeth?
- Have you experienced whiplash?
- Have you seen a neurologist, psychologist, E.N.T., for unexplained head, neck or ear pain?
- Are you currently under unusual stress?
- Have you had a recent change in lifestyle or change in work pattern?
- Have you been told that you might have TMJ?
TMJ QUICK NOTES
The National Institute of Dental and Craniofacial Research of the National Institutes of Health indicates 10.8 million people in the United States suffer from TMJ problems at any given time.
Men, women and children suffer TMJ problems.
Medical research has not yet defined all the causes of the various TMJ disorders. Many people reported having TMJ symptoms following dental procedures, the insertion of a breathing tube, trauma to the head, neck, or face, clenching and grinding the teeth. Conditions that occur in other parts of the body, such as arthritis, can also aggravate TMJ pain and dysfunction.
There is no standard for insurance coverage; it varies from state to state, and plan to plan. Many insurance companies do not or only partially cover TMJ related treatment.
Many symptoms may be associated with TMJ. Often, pain will be felt in the shoulders and back due to muscle contraction, a condition called myofacial pain dysfunction syndrome. Dizziness, disorientation and even confusion are also seen in patients who suffer from TMJ.
PAIN DISORDERS CONFUSED WITH TMJ
Temporal Tendinitis- Symptoms are TMJ pain, ear pain and pressure, tooth sensitivity, cheek pain, eye pain, temporal headache, neck & shoulder pain. Temporal Tendinitis has been called “The Migraine Mimic” because many of the symptoms are similar to migraine headache pain.
Ernest Syndrome- This problem involves a ligament that connects the base of the skull with the lower jaw. If injured, this structure can produce pain in regions of the face, head and neck: the temple, the TMJ, the ear, the cheek, the eye; the throat, especially when swallowing, and the lower back teeth and jaw bone.
Trigeminal Neuralgia- This is a disorder of the trigeminal, or fifth cranial nerve. It is a painful twitch, sharp electrical pain which lasts for seconds. This pain is triggered by touching a specific area of the skin with makeup, shaving, or even the wind.
Atypical Face Pain- This disorder also affects the trigeminal nerve. The symptoms are not clearly defined as they are in typical and atypical trigeminal neuralgia. Atypical facial pain seems to affect people who are under a lot of stress and may have a history of psychiatric problems.
FREQUENTLY ASKED QUESTIONS ABOUT TMJ
What are the most important symptoms I should be concerned about?
Pain in the jaw or teeth, pain when eating/chewing, lockingWhat is a locking?
When a patient locks during opening or closing movement, there is an interruption of jaw movement. It can catch or stop, and in order to complete the movement the patient has to jiggle or somehow self manipulate the jaw.Why does it happen?
When the disk rides on top of the condyle head, the joint is getting stuck in the wrong place and is preventing the Condyle from moving.If I can unlock or reduce the dislocation myself, why should I seek out treatment?
Each time it happens there is more and more damage occurring to the tissues in the joint, and the tissues controlling that disk. As a consequence there is a risk that if the problem is not addressed one day you will be unable to unlock or reduce the dislocation yourself and you’ll end up in the emergency room or at an oral surgeon’s office. In those cases most of the time reduction can only occur under general anesthesia.There are a lot of noises in my TM joints when I move my jaws. What is going on?
Joint noises during jaw movements are a sign that the functional elements are not working properly. Crunching and grinding noises are associated with hard tissue contact during movement. Again the Condyle head and the disk are not working together. The head is passing over the outside ridge of the disk and you’re getting a click noise as they rub against each other.What is a limited range of opening?
A range of opening is how wide you can open your mouth. A normal range of motion is between 42-52mm. A limited range would be anything under 42mm. An equivalent for normal would be approximately 3 finger opening, or wide enough to eat a Big Mac!Why are ear symptoms associated with TMJ disorders?
The ear is in very close proximity of the TM joint. Sometimes the Condyle head of the joint is improperly positioned in the joint space that it is in actual contact with the Tympanic bone of the ear. The consequence is that there is often ear pain without an infection, a sense of fullness or stuffiness. Sometimes in one ear, sometimes in both. Sometimes there is also a ringing in the ears. A panoramic x-ray and sometimes tomographic x-rays are all valuable in seeing the location of the joint.