TMJ/TMD

Facial, Ear, Head, and Jaw Pain

A Discussion of Temporomandibular Joint Disorder/Dysfunction (TMD)

The temporomandibular joints are the hinge joints located on either side of the face in front of the ears which connect the lower jaw to the skull. The upper bone of the TMJ is the temporal bone and the lower bone of the TMJ is the mandible. Each temporomandibular joint has two sections that permit the hinge and gliding actions needed to open the mouth widely. Treating TMJ problems successfully must involve treatment of both the upper and lower bones of the TMJs.

The joints work in concert with the facial bones and four 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 the cycle characteristic of TMJ disorders: muscles and joints not working together correctly causing muscle spasms, which can produce far-reaching pain, muscle tenderness, and tissue damage. Temporomandibular joint (TMJ) disorder (TMD) affects a vast majority of Americans and it can mimic many other diseases and conditions. Therefore, it is often misdiagnosed or overlooked.

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Common Symptoms

Dull, aching pain around the ear, often radiating into the face, neck, back of the head, and shoulders
Ringing in the ears (tinnitus), hearing loss, “plugged” ears, and ear pain
Certain types of headaches, sometimes of migraine proportions
Tenderness of the jaw muscles
Clicking or popping noises when opening or closing the mouth
Difficulty opening the mouth or chewing and locking of jaws open or closed

Causes of TMJ Disorder/Dysfunction (TMD)

TMD can be caused by many things. Some of the more common things are malocclusions 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, chewing gum, recent dental work, accidents that damage facial bones or the jaw, extraction of teeth or missing back teeth, birth trauma due to delivery complications, and traction involving the head, jaws, and neck.

The most common TMJ disorder (TMD) originates in the jaw muscles and is called myofascial pain dysfunction (MPD). MPD strikes three times as many women as men-usually those between 20 and 40 years old-and results from a tendency to deal with physiological and/or emotional tension and stress by clenching or grinding the teeth. These “habits” can tire the muscles and trigger spasms, producing pain, more spasms and, eventually, a TMJ disorder. MPD sufferers may or may not have problems with their dental bite. Often, these patients do have an airway problem with accompanying habitual mouth-breathing, snoring, or sleep apnea.

Because TMJ disorder (TMD) mimics so many other conditions, diagnosis is complicated. Many people spend a great deal of time and money searching for the source of their symptoms. If your physician can not find any underlying conditions, he/she may consider the possibility of a TMJ problem and recommend that you consult a dentist that focuses on the diagnosis and treatment of TMJ disorders. Since there is no board-recognized actual specialty for TMJ/TMD treatment, be wary of doctors referring to themselves as “TMJ specialists”. This self-designation is deceptive and insinuates to the consumer that the practitioner has completed special and extensive training in the area of TMD. Demand credentials and proof of experience, since some have simply completed weekend training courses about TMJ treatment and then call themselves “specialists”.

TMJ Disorder/ Dysfunction (TMD) Mimics Other Diseases

Chronic recurrent headaches as well as facial and neck pain are a common occurrence in millions of Americans. In addition, people frequently suffer from ear symptoms including pain, ringing, buzzing, and loss of hearing, or clicking/locking of the jaw which can make chewing, speaking or moving the jaw painful or difficult. These symptoms, appearing unrelated, are frequently undiagnosed or misdiagnosed as migraine, tension headache, neuritis, neuralgia, or stress. When standard treatment remedies for these types of disorders proved unsuccessful, patients were frequently labeled as hypochondriacs, “it’s all in your head”, or neurotic.

It is well recognized today by certain health care practitioners that these often unexplained, undiagnosed and therefore untreated symptoms are related to a group of problems called Temporomandibular Disorder/Dysfunction (TMD). Practitioners with proper training and diagnostic skills are able to isolate and treat the causes of these symptoms and eliminate symptoms that may have been present for years.

A Closer Look at Temporomandibular Disorder/Dysfunction (TMD)

A question frequently asked is what exactly is TMD? TMD or Temporomandibular Disorder/Dysfunction is a group of maladies that can affect the temporomandibular joints (TMJs) as well as associated muscles of the jaw, face, neck, and related neurological and vascular structures.

Problems within the TMJs can produce a myriad of symptoms which might appear to be totally unrelated to the jaw complex. These symptoms can include headaches over the eye, in the temples, behind the eyes, and at the base of the skull; generalized facial pain as well as more specific pain directly in front of the ears; and ear symptoms including ringing, buzzing, congestion, and pain. In addition, neck and shoulder pain, clicking or grating noises of the jaw joint with movement, and locking of the jaw or pain in the jaw with function are frequently encountered. Sufferers may not possess all of these symptoms. However, it is certainly possible that they may.

Millions of the American population possess one or more of the symptoms of a temporomandibular joint (TMJ) disorder (TMD). Many of these individuals may not have conditions severe enough to warrant treatment. However, many have developed such debilitating pain that the quality of their lives is degraded to the point where making family, social, and business interrelationships is difficult, if not impossible.

Craniomandibular Dysfunction (CMD)

Craniomandibular Dysfunction (CMD) describes a collection of symptoms which result when the chewing muscles and jaw joints do not work together correctly. TMJ is a popular term commonly used to describe the same group of symptoms. TMJ is an abbreviation for temporomandibular Joints. These are the two joints that connect your jaw to your skull. When these joints are out of place, they can cause many problems, such as:

Clicking or popping of the jaw joints
Pain in or around the jaw joints
Locking or limited opening of your mouth

TMJ symptoms, or TMD, are only a part of CMD.

Muscle spasms go hand-in-hand with displaced jaw joints. Nerves and muscles are complex in the TMJ area and when the muscles spasm the symptoms can be far-reaching. People suffer from symptoms they would never think to associate with their bites, such as:

Headaches
Pain behind the eyes (retro-orbital pain)
Dizziness, disequilibrium, nausea
Earaches, hearing loss, ringing of the ears (tinnitus)
Clenching or grinding of the teeth
Neck, shoulder, or back pain
Numbness or tingling of the fingers

These symptoms may relate to your bite and they can be treated successfully by a dentist who has had advanced education and expertise in managing these disorders.

The cause of the symptoms can be in the temporomandibular joints (TMJs) themselves, the muscles of the face and jaws, or a combination of these. The symptoms masquerade as other conditions and many people travel from doctor to doctor in search of a cure. Many Americans suffer from one or more of these symptoms and never think to seek out a dentist for help.

Causes of Craniomandibular Dysfunction (CMD)

The structures that make it possible to open and close your mouth properly include the bones, TMJs, teeth, muscles, and nerves. These are very specialized and must work together like a well-tuned symphony whenever you chew, speak, or swallow. The upper bones of the TMJs are the temporal bones and are part of the cranium (skull). The alignment of the temporal bones dictates part of the paths of opening and closing of the lower bone of the TMJs, the mandible. The temporomandibular joints (TMJs) attach your lower jaw (mandible) to your cranium within the temporal bones. Your teeth are in your jaw bones and their alignment is dictated partly by the sizes and shapes of the upper and lower jaw bones and the teeth themselves. The alignment of the teeth dictates part of the path of mouth closure. Muscles attach to the jaw bones and allow the joints to move via input from the nerves. Any issue that prevents this complex system of bones, joints, teeth, muscles, and nerves from working together in harmony may result in Craniomandibular Dysfunction (CMD).

Bone Alignment

The temporal bones are on the sides of your cranium and contain the ear bones and the TMJs. Their alignment to each other and the rest of the cranial bones is crucial for optimal function of the TMJs. Think of them like the front end of your car. If the car’s front end alignment is off, there will be wear on the tires. If the alignment of the temporal bones is off, there will be wear in the form of arthritic degeneration in the TMJs. If the temporal bones are not aligned, then the upper jaw (maxillae) bones will also be off and both of these factors can cause TMJ Disorder/Dysfunction (TMD) and Craniomandibular Dysfunction (CMD) because the mandible can not close properly within the existing confines of the temporal bones and maxillae.

TMJ Displacement

Each TMJ is a ball (head of the mandible) and socket (temporal bone) joint that works like a sliding hinge. The ball and socket do not touch when functioning properly because a disc of tissue is interposed between them like a cushion, allowing the joint to move smoothly and without noise. Each disc is held in place and guided by muscle anteriorly and ligaments posteriorly.

The TMJ disc can be pulled out of alignment and displaced if your bite is not correct, the muscle connected to it goes into spasm, or if a traumatic dislocation occurs. Typically the displaced disc is pulled forward by the muscle attached to it. Since it no longer serves as a cushion, the head of the mandible itself now rubs against the bony socket in the temporal bone and presses on pain fibers. Mild and acute TMJ disc displacement causes a clicking or popping sound in the jaw joint. More severe and chronic TMJ disc displacement can be very painful, causes grinding noises, and can cause permanent damage to the TMJ via degenerative arthritis.

A “Bad Bite” (Dental Malocclusion)

There are various ways this system can be disrupted, such as accidents involving a blow to the face or a whiplash. Yet the most common cause of Craniomandibular Dysfunction (CMD) relates to your teeth and your bite. If your bite isn’t right, it can affect both the muscles and the TMJs. A “bad bite” means that your upper and lower teeth do not come together in a way that provides the proper bracing support for your jaw against your skull. This could result from a missing tooth, misaligned teeth and jaw bones, or back teeth that are too short. A “bad bite” is called a malocclusion and usually needs orthodontic braces to be fixed. Braces, or orthodontics, should be performed only after the TMJs have been treated if necessary and have been determined to be fully functional.

An unstable bite can cause jaw joint disc displacement, muscle strains, and pain. Conversely, a jaw joint disc displacement will always cause an unstable bite. Many seemingly unrelated symptoms result which are collectively known as Craniomandibular Dysfunction (CMD). When this condition is prolonged, the body begins to compensate and adapt by causing spasms in the muscles in the neck, back, shoulders and even sometimes those of the arms, fingers, and legs. The unstable bite will also cause tooth clenching/grinding, wear patterns on the teeth, gum recession and bone loss around the most stressed teeth, cracks in teeth, darkened teeth, and ridging on the insides of the cheeks and sides of the tongue.

Muscle Spasms

Your upper and lower teeth must come together firmly each time you swallow. This happens over 2000 times each day and night. Your muscles must work extra hard when your bite is unstable. This extra work makes them shortened, stiff, and strained. Eventually this strain makes them feel painful. A vicious cycle begins of tissue damage, muscle tenderness, and pain. The pain makes you feel tense and uptight. This worsens the muscle spasm, which in turn increases the pain.

Nerve Entrapments

Nerves run in, around, and through bones and muscles. When bony alignments are off or muscles are in spasm, nerves can become entrapped, pressures are placed upon them, and pain or other symptoms result from the irritation. The symptoms resulting may be far away from the source. That is why proper diagnosis and treatment by a practitioner properly schooled in the treatment of CMD and TMD is so important.

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