Jaw Problems (TMJ)
The way your teeth meet when your top and bottom jaws close down on top of each other is known as your 'bite'. If your teeth don't fit together properly, you could have malocclusion or 'bad bite', which can cause problems with your teeth, gums, the temporo-mandibular joint (TMJ) and the muscles in your face.
This misalignment, often referred to as TMJ disorder, can also cause some people to clench the jaw and grind their teeth at night. This can lead to facial pain, headaches, discomfort and clicking when biting or chewing, migraines as well as neck and shoulder pain, even back pain.
If you recognise any of these symptoms or suffer with these on a daily basis, you will need to see a dentist to treat your problems or refer you to a specialist if necessary.
In some cases, the treatment includes wearing a hard plastic appliance at night. This is made to measure and fitted onto your bite accurately, so that when you bite on it, your teeth are in a position where your muscles are relaxed. This also stops your teeth from becoming worn down by grinding and protects them. Depending on the origin and severity of your problem, you may need orthodontic treatment or maxillofacial surgery. Other solutions may include replacing missing teeth or adjusting any ill-fitting bridgework that you may have.
The important thing to do is see your dentist as soon as possible so your problem does not become worse over time and require more drastic measures to correct.
Headaches & Facial Pain
Not tonight I have a headache!
- Do you suffer from chronic headache, neckache or backache?
- Do you wake up with tightness in your jaw or face muscles?
- Do you get clicking in your jaw joint?
- Does your partner complain that you grind your teeth noisily at night?
If you have answered yes to any of the above, then it may be the way your teeth bite together that is the cause of your problems, and a simple treatment such as a tiny removable device can alleviate chronic or severe pains. Unfortunately, very few doctors and even fewer patients are aware of this non-drug, non-invasive, tremendously successful treatment.
Many people clench their jaw and/or grind their teeth. Some people do it while they are asleep and aren't even aware of it. These tiny acrylic mouth pieces fit on to your teeth and can help alleviate headaches, and also reduce the force of grinding and thus limit wear and damage to your teeth.
The Temporo-Mandibular Joint
The temporomandibular joint connects the lower jaw (mandible) to the temporal bone of the skull. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of your head. As these joints are flexible, the mandible can move smoothly up and down and from side to side, enabling us to talk, chew and yawn. Muscles attached to and surrounding the mandible control its position and movement.
When we open our mouths, the rounded ends of the mandible, at the opposite end from the chin, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft fibrocartilaginous disc lies between the condyle and the temporal bone. The disc absorbs shocks to the TMJ from mastication and minor trauma.
Temporomandibular Disorders
There are three main categories:
- Myofascial pain: the most common form of TMD being discomfort or pain in the muscles that control joint function and the muscles of the head and neck;
- Internal derangement of the joint: being either a dislocated mandible, displaced disc, injured condyle or some combination;
- Degenerative joint disease: osteoarthritis or rheumatoid arthritis of the TMJ.
A person may have one or more of these conditions at the same time.
Temporo-mandibular Joint Dysfunction Syndrome
TMD is a progressive and painful condition stemming from the joint, involving the muscles of mastication and the facial musculature. The pain may be localised to the joint capsule or radiate to the head and neck. It can be unilateral or bilateral.
The aetiology may be developmental, a history of traumatic injury, relapsed orthodontics, poor or inadequate dentistry or self-induced. Acute or chronic stress can lead to parafunctional activity of the muscles of mastication causing clenching or grinding of the teeth known as bruxing. This continuous grinding causes damage to the teeth and restorations in the mouth. It also causes inflammation of the delicate tissues of the temporo-mandibular joint. The disc or the ligaments attached to the disc can become perforated, stretched or torn. Muscles of the joint fatigue. Pain ensues and with it an altered chewing pattern. This causes other muscles to fatigue. Pain radiates to various parts of the head and neck, the chewing pattern become further altered and there is the potential for more teeth or restorations to break.
Signs and symptoms
A variety of symptoms may be linked to TMD. Pain, in the chewing muscles or in and around the jaw joint, is the most common symptom. Other likely symptoms include:
- limited movement or locking of the jaw,
- radiating pain in the face, neck or shoulders,
- painful clicking, popping or grating sounds in the joint when opening or closing the mouth,
- a sudden, major change in the way the upper and lower teeth fit together.
- Symptoms such as headaches, earaches, dizziness and hearing problems may be related to TMD.
It is important to keep in mind, however, that occasional discomfort in the jaw joint or chewing muscles is not uncommon and is generally not a cause for concern. Researchers are working to clarify TMD symptoms, with the goal of developing better methods of diagnosis with improved treatment.
It is essential to make a clear diagnosis of the type of condition before embarking on treatment even splint therapy. All historical medical and dental records can be useful in coming up with a diagnosis.
Diagnosis
Since the exact causes and symptoms of TMD are not clear, diagnosing these disorders can be confusing. At present, there is no widely accepted, standard test to correctly identify TMD. In about 90% of these cases, however, the patient's description of symptoms, combined with a simple physical examination of the face and jaws, provides information useful for diagnosing these disorders.
The examination includes feeling the jaw joints and chewing muscles for pain or tenderness; listening for clicking, popping or grating sounds during jaw movement; and examining for limited motion or locking of the jaw while opening or closing the mouth. Checking the patient's dental and medical history is very important. In most cases this evaluation provides enough information to locate the pain or jaw problem, to make a diagnosis, and to start treatment to relieve pain or jaw locking.
TMD Treatment
Minor acute TMJ problems often will resolve themselves within 5 to10 days if the patient rests the joints, limits the extent of opening and sticks to soft foods. A dislocated joint is alarming and urgent attention is required.
Some TMJ problems respond well to restorative or prosthetic dental treatment, some require surgery, for others, currently there is no treatment other than palliative relief from prescription medication. We only treat TMJ patients when we feel that there will predictably successful results. Severe cases requiring complex surgery or long-term prescription medication are referred to the oral-facial pain clinic of a dental hospital.
TMJ Splints
The majority of TMJ splints made are of questionable therapeutic value and many potentially harmful. If your splint does not feel comfortable and your pain or headaches continue discuss this with your treating dentist.
Multi-disciplinary Treatment
TMD treatment is not the sole domain of any one of the medical or dental specialties. There is an overlap in training in all specialities with a philosophy slanted according to the mode of therapy delivered by same. In blunt terms "to a hammer everything looks like a nail". Normally, it is the role of the prosthodontist to diagnose or co-diagnose the case, formulate a treatment plan and coordinate this with the other specialists. In situations, where the problem can be resolved orthodontically, then the role of the prosthodontist becomes redundant. More frequently, there is a malocclusion, missing or damaged teeth, oro-facial pain and a "capsular" defect. Prior to embarking upon treatment it is essential that all the treating specialists have a common goal in sight. To do otherwise is tempting fate and possibly courting disaster. Working with an experienced team is a wise precaution.
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