Adult TMJ Disorder
Do you suffer from temporomandibular joint (TMJ) disorder?
If you have the following symptoms, it is likely that you do:
Ear pain symptoms
Headaches: sometimes of migraine proportions.
Ear pain symptoms: ringing in the ears, hearing loss, “plugged” ears, ear pain, a feeling of “underwater”
Clicking/Popping: There is a pad or disc which ideally sits between the temporal bone and mandible in the TM Joint. This cushion, like a magic carpet, can slip out of place causing clicking when opening and closing. Clicking can lead to locking and grating or crepitus.
Locking: When a disc is chronically displaced, it does not always click back into place. This leads to locking of the jaw joint with deflection of the jaw and limited range of motion.
Jaw Pain: Although it can originate from many sources, the most common reason for jaw pain is dental, then musculoskeletal. Most dentists can rule out dental decay, periodontal disease or root canal as the offending dental pathology. Muscles, tendons, ligaments and the temporomandibular joint can all cause jaw pain. Jaw pain can radiate from the neck.
It’s estimated that tens of millions of men, women, and children suffer from TMJ and TMD, many of whom have no knowledge of their condition or how to seek TMJ treatments from a qualified TMJ Doctor or Dentist. Headaches and pain are the most common complaints from those afflicted with TMJ. Around 80% of patients with a TMJ disorder complain of a debilitating headache, and over 40% report some kind of facial pain. Your TMJ condition may unfortunately only worsen with time if you do not seek treatment from a TMJ specialist doctor or dentist. Without proper TMJ treatment you will experience increasing joint damage or inflammation, and further wear and breakdown of your teeth, which typically leads to increases in muscle contraction and consequently increased head, neck and facial pain. If your jaw is not correctly aligned, you’ll add wear and tear every time you speak, chew, swallow, and yawn: even while you sleep.
TMJ Diagnostics: Joint Vibrational Analysis
Your TMJ’s or jaw joints are the skeletal foundation of your mouth. All dentists are required to assess the health and function of your TMJ’s. Our office uses Joint Vibration Analysis (JVA) which records the vibrations created by joint fluid, cartilage and bone as you open and close your mouth. This test allows us to objectively measure and document the health of your Jaw Joint in just 10 seconds of opening and closing. It can be used to help diagnose problems with the joint that can be the cause of breakdown or pain, and can help us make sure we are aware of any underlying issues before performing any treatment that could damage or strain your jaw joints.
Fortunately, there are treatment options, many non-surgical, offered by our TMJ specialist doctors and dentist offer. We customize all TMJ treatments to your specific needs to ensure you receive optimal treatment for your TMJ symptoms.
TMJ Oral Appliances
Sved appliance, Garcia splint- TMJ appliances all reposition the jaw to decrease clicking and decompress the auriculotemporal nerve. Stabilization appliances are also used for myofascial pain and cognitive behavioral habit control. Orthodontic appliances can also be used in the course of treatment.
Sleep Appliances for TMJ
Breathing related sleep disorders are often diagnosed in conjunction with TMJ disorders. Oral sleep appliances can be prescribed in these cases.
Trigger Point Injections
Trigger point injection therapy involves the injection of a local anesthetic into tender points to eliminate pain and re-educate the muscles.
Physical Therapy for TMJ
Manual physical therapy can be used in myofascial release, mobilization of the TMJs, and deep muscle therapy.
Causes of TMJ Disorder
There are many reasons you may suffer from TMD, including:
Bruxism: A stereotyped movement disorder which occurs during sleep can overload the TMJ as a repetitive strain type injury and also exacerbate muscle pain.
Estrogen: Adolescent girls can experience idiopathic or internal condylar resorption. Perimenopausal women also frequently complain of TMJ sensitivity and bite changes secondary to the presence of estrogen receptors in the TMJ.
Autoimmune: Rheumatoid arthritis, psoriatic arthritis, Lupus, Sjogrens, Reiters syndrome, and seronegative arthritis can be responsible for jaw pain and bite changes.
Joint laxity: Elongated ligaments allow the disc to easily slip out of position.
Trauma: Macrotrauma, bad falls, blows to the chin, intubation and wisdom tooth extraction can all lead to joint strain or sprain.
Sleep: Lack of stage 3 and 4 NREM sleep can lead to overall or widespread pain and fatigue. Healing occurs with 7-8 hours of deep restorative sleep.
Arthritis: Arthritis can be localized as an osteo or traumatic arthritis, or systemic as an auto immune disease. With this, you can also experience inflammation. Inflammation may be localized.
TMJ and your Ears
DID YOU KNOW there is an intimate connection between the jaw and the ear through the first branchial arch? The temporomandibular joint (TMJ joint) and the petrotympanic suture connect the TMJ to the malleus and incus via Pinto’s ligament. While that may seem technical, it matters because Ear Pain may be located around the TMJ, but may be referred to the head, neck and ear. Ear pain that is located immediately in front of the tragus of the ear, projecting to the ear, temple, cheek and along the mandible, is highly diagnostic for TMJ due to trauma or compression and a sign of inflammatory arthritis. TMJ pain and dysfunction is often associated with neck and shoulder pain as well.
Ear Pain Symptoms Indicative of TMJ: Do you believe you are suffering from some kind of ear pain that is related to TMJ? Below is a list of symptoms
Tinnitus: Tinnitus is usually described as a ringing noise in the ears or head. It has been described as a high pitched whining, electric, buzzing, hissing, screaming, humming or whistling sound. Tinnitus can come and go or it can be continuous. It is often the cause of great distress, but the intensity of tinnitus can be moderated by adjusting the position of the shoulder, head, tongue and jaw. Our TMJ specialists can discuss specific treatment for tinnitus with you during your consultation.
Once your primary care physician has ruled out ear pathology or infection, the head and neck muscles – as well as the temporomandibular joint itself – can be evaluated for referral to the ear. The auricuotemporal nerve is often compressed sending pain into the ear.
Vertigo (spinning sensation)
Floating or swimming sensation
Loss of balance or feeling of unsteadiness
Ear Sensitivity: Sensitivity can occur when the ear is overly sensitive to certain frequency ranges of sound. Thus people suffering from hyperacusis find it very difficult to adapt to seemingly-loud, everyday sounds.
TMD is painful but does not have to be debilitating. There are plenty of treatments available to consider.
Frequently Asked TMJ Questions:
What does TMJ mean?
TMJ stands for Temporomandibular Joint, the joint which connects the mandible to the temporal bone. The mandible is the moving component.
What is TMD?
TMD refers to Temporomandibular Disorders which are joint, muscle, tendon and ligament disorders of the jaws. Pain and inflammation as well as limited opening, clicking and locking are included in this broad category. TMD is in the same medical class as TMJ.
How do I use my TMJ appliances?
Daytime symptoms typically call for daytime appliance therapy for at least 6-8 weeks along with cognitive behavioral attention. Nighttime treatment depends on the diagnosis. Breathing related sleep disorders may call for an appliance which maintains an open airway. There are a variety of appliances for sleep bruxism and clenching and grinding.
How do I clean my appliances?
What caused TMJ?
Interesting fact: 80% of TMJ patients are women so estrogen plays a big role in setting the stage for the effects of micro and macro trauma. There are estrogen receptors in the TMJ so women of child bearing age are sensitized to feel increased pain in the TMJ. Clenching, Grinding and Bruxism produce micro trauma and repetitive strain injury which can cause degenerative changes and inflammation in the joint. 4 Bicuspid extractions in orthodontic therapy with over retraction of the maxilla are a very common contributing factor in our practice. Any headgear which retracts the maxilla can also contribute to TMJ disorders. Systemic joint laxity or hypermobility syndromein women make the TMJ more susceptible to injury, clicking, popping and locking. TMJ has many causative factors the more common of which are malocclusion or problems in the way the teeth fit together, a blow to the jaw or head, clenching or grinding of the teeth, arthritis of the jaw, poorly fitting dentures, yawning for prolonged periods with the mouth open too wide, recent dental work, accidents that damage facial bones or the jaw, extraction of teeth or missing back teeth, and traction involving the head, jaws, and neck. Because this dysfunction mimics so many other conditions, diagnosis may be complicated. Many people may spend a great deal of time and money searching for the source of their symptoms. If your physician cannot find any underlying conditions, he could consider the possibility of TMJ dysfunction and recommend that you consult a dentist with a special interest in the diagnosis and treatment of TMJ dysfunctions.
What is TMJ exactly?
The temporomandibular joints (TMJ Joints) are the hinges located on either side of the face that connect the lower jaw to the skull. Each temporomandibular joint has two sections that permit the hinge and gliding actions needed to open the mouth widely. The joints work together with the facial bones and five pairs of muscles to allow opening and closing of the mouth and forward, backward, and side-to-side movements of the lower jaw. Any disturbance of this facial symphony can trigger TMJ dysfunctions: muscles and joints not working together correctly, causing muscle spasm, resulting in pain, muscle tenderness, and tissue damage. With these disturbances, arthritic changes can accelerate, muscles can tighten and the bite can feel off. Simply having a dentist adjust the teeth usually makes TMJ symptoms worse and can throw the jaw further off line and create even more pain; this is why it is imperative to see a TMJ specialist like Dr Jill Ombrello and Dr Michael Rosellini.
Do I get my teeth fixed before I see you for TMJ and Sleep Disorders?
We only recommend emergency dental treatment prior to TMJ therapy and Oral appliance therapy for snoring and sleep apnea. One of the goals of TMD treatment is to find a jaw position where all chief complaints have been alleviated. Oral appliance therapy for sleep apnea can change the bite. We want to alleviate all airway complaints and achieve a bite which is harmonious with an open airway.