TMJ
Many people suffer from dizziness, earaches, face, head, neck shoulder, and back pain. They may also suffer chronic fatigue, irritability, blocked or ringing ears, difficulty in swallowing, temporary loss of memory and arthritis-like joint pains or numbness in parts of the body that seem to have no relation to the teeth.
The case is frequently unrecognized by physicians whose standard training has not equipped them to understand the relationship between the teeth and jawbone and the alignment of the jaws and rest of the body. Many dentists are also unaware of how closely their work is linked to a patient's general health.
Consequently, thousands of chronic sufferers go from one medical specialist to another, taking potent drugs which fail to bring relief, even having needless surgery when the pain becomes unbearable or being referred to psychiatrists who cannot help them because these experts are concentrating on the symptoms without recognizing the cause.
TMJ Anatomy & Function
The temporomandibular joint, or TMJ, is the articulation between the condyle of the mandible and the squamous portion of the temporal bone.
The condyle is elliptically shaped with its long axis oriented mediolaterally.
The articular surface of the temporal bone is composed of the concave articular fossa and the convex articular eminence.
The MENISCUS is a fibrous, saddle shaped structure that separates the condyle and the temporal bone. The meniscus varies in thickness: the thinner, central intermediate zone separates thicker portions called the anterior band and the posterior band. Posteriorly, the meniscus is contiguous with the posterior attachment tissues called the bilaminar zone. The bilaminar zone is a vascular, innervated tissue that plays an important role in allowing the condyle to move foreward. The meniscus and its attachments divide the joint into superior and inferior spaces. The superior joint space is bounded above by the articular fossa and the articular eminence. The inferior joint space is bounded below by the condyle. Both joint spaces have small capacities, generally 1cc or less.
Normal TMJ Function
When the mouth opens, two distinct motions occur at the joint. The first motion is rotation around a horizontal axis through the condylar heads. The second motion is translation. The condyle and meniscus move together anteriorly beneath the articular eminence. In the closed mouth position, the thick posterior band of the meniscus lies immediately above the condyle. As the condyle translates forward, the thinner intermediate zone of the meniscus becomes the articulating surface between the condyle and the articular eminence. When the mouth is fully open, the condyle may lie beneath the anterior band of the meniscus.
TMJ Dysfunction
Internal derangement of the TMJ is present when the posterior band of the meniscus is anteriorly displaced in front of the condyle. As the meniscus translates anteriorly, the posterior band remains in front of the condyle and the bilaminar zone becomes abnormally stretched and attenuated. Often the displaced posterior band will return to its normal position when the condyle reaches a certain point. This is termed anterior displacement with reduction.
When the meniscus reduces the patient often feels a pop or click in the joint. In some patients the meniscus remains anteriorly displaced at full mouth opening. This is termed anterior displacement without reduction. Patients with anterior displacement without reduction often cannot fully open their mouths'. Sometimes there is a tear or perforation of the meniscus. Grinding noises in the joint are often present.
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Your jaw joint which holds your lower jaw in place is suspended beneath your skull by an intricate system of muscles and tendons.
The jaw joints also known as the temporomandibular joints (TMJ) are some of the most complex in the body. The jaw joint, surrounding muscles, and the fit of your teeth are closely interrelated, each affecting the other as you make every day jaw movements such speaking and chewing.
The way your teeth fit together is called occlusion. When your teeth are not in proper relation to each other and to your jaw joints, the jaw automatically shifts to a new position in an attempt to compensate for the misalignment of your teeth known as malocclusion.
It can be seen from the diagram how a misaligned TMJ can affect blood vessels, nerves and muscles, causing severe headache or ear pain. Now also imagine what can happen to the rest of the body. If the jaw is out of alignment, other skeletal structures (such as the neck and spine) can become involved, which can result in other joints, nerves, muscles and blood vessels being affected. As nature tries to compensate for one difficulty, others are likely to arise.
Structural stress from a misaligned TMJ is the worst kind of physical stress because there is no way the body can find relief for it. An injured limb can be rested, but it is impossible to leave the TMJ inactive. Without realizing it, we swallow hundreds of times a day, and at night we may clench or grind our teeth. Every time those teeth meet in incorrect occlusion, there is stress. To compensate for it, the jaw muscles begin to hold a tense unnatural position; and before long, the tension travels by chain reaction throughout the body.
Diagnosing the problem
Before prescribing the proper treatment for your particular problem, a variety of diagnostic procedures may be necessary. A detailed head and neck physical examination is usually necessary and is so detailed as to require one or more hours time. Sophisticated radiographs may be taken of your jaw joints. These radiographs are used as a means of detecting disease and position of the jaw joint. A medical, and head and neck history is also carefully reviewed. Other electronic, computer aided studies may also be used such as sonographic joint vibration analysis, EMG recording and MRIof TMJ.
Treatment and Care
I. Activities
Do NOT chew gum.
During the initial phase of treatment, particularly if symptoms are acute, stay on a definite soft diet (baby food, soups, milkshakes, eggs, hamburger, etc.)
For the next few months, be sure to cut all foods into small, bite sized pieces and try to avoid opening your mouth any wider than the thickness of your thumb. (1-2 inch).
Do not eat hard crusts of bread, rough meat, raw vegetables, or any other food that will require prolonged chewing.
Do not chew peanuts, ice cubes or any other substance that is repeatedly milled between your back teeth.
Do not chew gum, bite your lips, clench your teeth or habitually chew the insides of your cheeks.
Do not thrust your lower jaw forward, as when biting off a piece of thread, applying lipstick, smoking, or through force of habit.
Do not bite any food with your front teeth.
If you must yawn, limit the distance your mouth opens by pulling your lower lip up over the edges of your lower teeth.
Make every effort not to strain your jaw joints unnecessarily by such activities as talking excessively, deliberately popping your jaw joint as one would pop the knuckles of his hand, leaning on the palm of your hand while reading or watching TV, etc.
Try to sleep on your back. Avoid sleeping on the side of your face or on your fist.
During all times of occupational, marital or academic stress, and also while waiting to fall asleep at night, say to yourself "lips together, teeth apart" over and over again.
Try not to do strenuous work or lift items weight more than 10 pounds above your waist because when your jaw muscles and jaw joints are out of balance, your body is out of balance and your pains will probably increase due to this imbalance.
A low fat diet should be maintained due to the fact that fats produce adds and are hard to digest. Therefore, milk, cream and eggs should be avoided because of their high fat content. IT IS IMPORTANT TO STAY ON A HIGH PROTEIN DIET. It may be advisable to take a multiple vitamin preparation to insure adequate vitamin intake.
PREPARE FOODS BY: BOILING, BAKING OR PRESSURE COOKING. DO NOT FRY.
II. Aspirin, Motrin or Advil
Since aspirin is the drug of choice for inflammation of any joint, you should initially take two 5 grain aspirin tablets every four hours. As symptoms improve you may reduce the amount of aspirin you are taking. Please take medication with food to prevent stomach upset.
If you cannot take aspirin for any reason, you may take any of the aspirin substitutes.
If you need a stronger drug for pain, we can prescribe a different type of medication.
Motrin or Advil can also be effective for jaw pain. Take 200-400 mg every 4 to 6 hours as directed.
III. Moist Heat/Ice
Moist heat applied to the area around a painful joint provides more relief from pain than dry heat.
Fill a basin with water as hot as the skin can stand and soak two large wash cloths in it. Take one out,wring it out, and apply it to the painful area. When the first towel cools off apply the second towel. Repeat with hot towels for a total of 20 minutes.
Follow moist heat with ice cubes. Rub on painful area for 30 seconds/wait 30 seconds and repeat for 5 minutes.
This procedure should be carried out for 25 minutes 3 times a day allowing for at least a 20 minute interval between applications.
IV. Disengagement
One of the most important steps in breaking the habit of clenching and grinding your teeth is to learn to keep the lips together and teeth apart. You must make a conscious effort to separate the teeth at the same time you keep the lips closed. Repeat to yourself several times a day, "Lips together and teeth apart."
This simple step will relax the very muscles that become tense and taut, besides permitting a more normal positioning of the jaw joints. Remember, the only time your teeth should normally touch is during swallowing and chewing.
If you clench or grind your teeth, you will continue to injure your chewing system and thus delay healing and the results of our treatment.
These few simple rules can easily allow you to avoid such jaw movements that might re-injure your joints, muscles or ligaments.
