By: Stephen David Smith, D.M.D.
The Temporomandibular (TMJ) jaw joints are in front of the ear and are the hinges between the jawbone and head. Neck movement, breathing, talking, chewing, swallowing, smiling, all require jaw movement. As the lower jaw moves, it requires both TMJ’s to move and slide freely.
When there is an abnormality with the joints and associated muscles of the jaw, pain can develop. Symptoms of TMJ Disorders include the following:
- • Clicking, popping joints
- • Locking, inability to open, dislocation
- • Headache, neck pain, face pain
- • Teeth soreness/aching, with no dental cause
- • Chewing pain, difficulty swallowing
- • Dizziness, tinnitus/ear ringing
- • Ear pain, blocked Eustachian tubes
- • Muscle soreness in temple region, side of face, neck
- • Pain behind eye
- • Awakening with sore clenched jaws
- • Throat pain
Headache and Orofacial pain are often complex, involving both local areas and other regions of the musculoskeletal system of the body. Thus, a thorough history and comprehensive clinical examination are generally done at the first visit. At chair side, clinical evaluation and charting involves the structures inside the mouth and outside. Palpation of the Temporomandibular joints, muscles of mastication, and entire head/ neck region is critical in assessing Orofacial/TMJ related pain and headache.
Range of Motion of the jaw in all dimensions is measured, correlated to stethescopic sounds. The movement of opening and closing should be smooth without jarring or deflection. Lateral side to side and forward motion should be unstrained. When there is restriction and locking/popping of the joint, the existing closed position of the mandible and the fit of the teeth are manually compared to other potential jaw positions. This is done to test for differences in TMJ disk/joint function improvement. The normal jaw opening is 50 mm, without deviation to the side or joint noise.
Diagnostic procedures should be recommended such as impressions of the teeth/jaws, from which dental study models are made. Radiographic/X-Ray imaging is done to view jaw structures and abnormalities of the teeth, TMJ, head and neck region.
A complete orthodontic/orthopedic facial skeletal analysis with anatomic tracings is often used to help correlate teeth positions and jaw posture to boney growth.
Besides palpation assessment, other procedures may involve measurement of muscle dysfunction and contraction/spasm via an EMG, or electromyogram, to the head, neck and jaw region. Tightness produces contraction and muscle referred pain. After a thorough diagnostic workup, and case assessment/plan discussion, a conservative course of treatment is usually recommended. This may typically involve an initial pharmacologic approach to acute pain and physical medicine modalities, such as moist heat/ hydro collator pack , cold/vapocoolant spray & stretch, EGS electrogalvanic stimulation, TENS transcutaneous electrical stimulation and ultrasound or the use of light wave monochromatic Infrared energy.
There has been recent development for Orofacial region/TMJ pain, with new infrared treatment modality delivery. Manipulation/mobilization procedures to jaw and neck region, trigger point injections, home care exercises and postural stress/tension reduction are also utilized to help with long-range stabilization.
Splint Appliances: A hard laboratory processed splint is usually prescribed for longer term use, 24 hours a day in acute situations. The goal is to reduce pressure on the joint to get it to settle down (decompression). For night time only, a “pull forward ramp” may be added, with breathing holes. Arch bar and clasping provide for additional retention; a flat-planed design for primary muscle/clenching type pain may be elected. Return visits require further bite/appliance adjustments, coupled with therapy. Long-range plans may call for other dental rehabilitation, orthodontic, and prosthodontics considerations.
Referral may be made for an MRI or magnetic resonance image of the joint, where potential surgery is anticipated for dislocation or chronic displacement. Maintenance/return visits with continued therapy and splint/niteguard use help prevent relapses
For a further discussion, including photographs and video, visit Dr. Smith in PRO’s WELLNESS VILLAGE under TMJ Dentists and look under Pennsylvania, or go directly and just click ParkinsonsResource.org/tmj/dr-stephen-smith-dmd/.