Article by Dr Manasa S, B.A.M.S
Introduction to TMJ Disorders
Temporomandibular Joint (TMJ) Disorders, also known as TMD, refer to a group of over 30 conditions that affect the jaw joint and surrounding muscles and ligaments. These disorders can cause pain, tenderness, and discomfort in the jaw, leading to symptoms like headaches, jaw pain, and difficulty in opening or closing the mouth. Common causes of TMD include teeth grinding, jaw injuries, arthritis, and general wear and tear.
TMD can vary widely from person to person, both in severity and treatment needs. Treatment options may include medications, physical therapy, custom mouthguards, and in severe cases, jaw surgery. Between 5% and 12% of adults experience some form of TMJ disorder, with the condition being more common in women and those aged 20 to 40.
What is the Temporomandibular Joint?
The temporomandibular joint (TMJ) is a highly complex joint that allows both horizontal and vertical movement, enabling essential functions such as chewing and speaking. Located at the base of the skull, it connects the lower jaw (mandible) to the temporal bone on the side of the skull.
Due to its ability to move up and down, as well as side to side, the TMJ is one of the most intricate joints in the body. This complexity can make severe TMJ disorders more challenging to diagnose and treat effectively.
Types of Temporomandibular Joint Dysfunction (TMD)
Healthcare providers categorize TMD into three primary types:
Jaw Joint Disorders – These involve issues with the temporomandibular joints themselves, such as inflammation, misalignment, or damage to the joint structures.
Muscle Disorders – These occur when the muscles used for chewing become painful or dysfunctional, leading to difficulty in jaw movement.
TMD-related Headaches – Headaches caused by TMD result from tension or strain in the jaw muscles and joints, often radiating pain to the head and neck areas.
Each type may require different approaches to diagnosis and treatment.
TMJ Disorder Symptoms
Temporomandibular Joint Disorder (TMD) can lead to significant pain and discomfort, affecting daily activities like chewing and speaking. The condition can be temporary or persist for many years, often impacting one or both sides of the face. It is most common among individuals between the ages of 20 and 40.
Here are some common symptoms of TMD:
Pain and Tenderness – Discomfort may be felt in the jaw joint, face, neck, shoulders, and around the ears, especially during activities such as chewing, speaking, or opening the mouth wide.
Jaw Mobility Issues – You may experience difficulty when trying to open your mouth wide, or the jaw might get “stuck” or “locked” in an open or closed position.
Clicking or Popping Sounds – The jaw joint might produce clicking, popping, or grating sounds when opening or closing the mouth or chewing. This can occur with or without accompanying pain.
Facial Fatigue – A tired or fatigued feeling may be present in the facial muscles.
Biting Difficulties – You may encounter trouble chewing or feel as if the upper and lower teeth are misaligned. For those with more severe misalignment, considering teeth alignment surgery has pros and cons to weigh carefully.
Facial Swelling – Swelling on one or both sides of the face is another potential symptom.
Related Symptoms
Additional symptoms can include toothaches, earaches, hearing issues (such as tinnitus), headaches or migraines, dizziness, and numbness or tingling in the fingers.
Neck and Shoulder Pain – Pain may radiate into the neck and upper shoulders, adding to the discomfort associated with TMD.
Causes of TMJ Dysfunction
Temporomandibular Joint Disorder (TMD) does not have a singular cause. It typically results from multiple or combined factors, including:
– Jaw Injury: Trauma such as a broken or dislocated jaw can lead to TMD.
– Teeth Grinding or Clenching (Bruxism): Constant pressure from grinding or clenching can strain the jaw joint.
– Arthritis: Conditions like osteoarthritis or rheumatoid arthritis can affect the jaw joint.
– Malocclusion: When the teeth don’t align properly, it can create stress on the jaw joint.
– Stress: Emotional or physical stress may lead to jaw clenching or tension, exacerbating TMD.
Factors That Worsen TMJ Dysfunction
While some causes of TMD are uncontrollable, certain habits can worsen the condition, including:
– Using Teeth as Tools: Avoid using your teeth to tear off tags or open packaging.
– Poor Posture: Bad posture can strain your neck, shoulder, and facial muscles, worsening TMD.
– Chewing Non-food Items: Pens, pencils, and other objects should not be chewed, as it can aggravate the jaw.
– Chewing Ice or Gum: Excessive chewing can overwork the jaw muscles.
– Taking Large Bites: Avoid large bites of food, which can strain the jaw.
– Daytime Clenching or Grinding: Pay attention to clenching during the day to reduce jaw stress.
– Sleeping on Your Stomach: This sleep position can exacerbate jaw discomfort.
Complications of TMJ Dysfunction
Untreated TMJ dysfunction can lead to several complications, including:
– Chronic Pain: Persistent pain in the jaw, face, or neck.
– Limited Chewing Function: Difficulty chewing or a restricted range of jaw movement.
– Bruxism-related Wear: Excessive grinding or clenching can cause tooth wear and damage.
Diagnosis and Tests for Temporomandibular Joint Dysfunction (TMD)
Healthcare providers can diagnose TMD through a combination of physical examinations and imaging tests. Here’s what you can expect during the diagnostic process:
Physical Examination
During a dental checkup or physical exam, the healthcare provider will:
– Observe your range of motion while you open and close your mouth.
– Press on specific areas of your face and jaw to identify discomfort.
– Feel the jaw joints while you open and close your mouth to detect any abnormalities.
Imaging Tests
If further investigation is needed, your healthcare provider may recommend imaging tests to assess the jaw joints and surrounding structures. These may include:
– Dental X-rays: To check the health of your teeth and jaw bones.
– CT scans: To provide detailed images of the bones and tissues in your jaw area.
– MRI Scans: To examine soft tissues, including the discs in your jaw joint.
– TMJ Arthroscopy: A procedure that allows your provider to directly view the joint using a small camera.
Home Treatments for TMD
If you suffer from Temporomandibular Joint Disorder (TMD), there are several self-care measures that can help alleviate symptoms. Your doctor may recommend trying these remedies in combination to find the most effective relief.
Over-the-Counter Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen, can help reduce muscle pain and swelling associated with TMD.
Moist Heat or Cold Packs
Apply an ice pack to the side of your face and temple for about 10 minutes. Afterward, perform gentle jaw stretches (as recommended by your dentist or physical therapist). Follow this with a warm towel or washcloth applied to the same area for about 5 minutes. Repeat this routine several times a day for relief.
Soft Foods Diet
Eat softer foods like yogurt, mashed potatoes, scrambled eggs, fish, soups, cooked fruits and vegetables, beans, and grains. Cut food into smaller portions to reduce the need for extensive chewing. Avoid hard, crunchy, or chewy foods such as pretzels, raw carrots, caramels, and taffy, as well as large bites that require wide jaw movements.
Avoid Extreme Jaw Movements
Limit activities that require you to open your mouth wide, such as yawning, singing, yelling, or chewing gum. Reducing these movements can prevent further strain on the jaw.
Maintain Good Posture
Practice proper posture to help reduce neck and facial pain. Avoid resting your chin on your hand or holding your phone between your shoulder and ear, as these habits can exacerbate symptoms.
Relax Your Jaw
Keep your teeth slightly apart as much as possible to relieve pressure on the jaw. You can place your tongue between your teeth to help prevent clenching or grinding during the day.
Relaxation Techniques
Learn and practice relaxation techniques to ease tension in your jaw muscles. Your dentist may recommend physical therapy, massage, stress reduction therapy, or biofeedback to help manage stress and reduce jaw tension.
Avoid Chewing on Objects
Stop chewing on non-food items like pens, pencils, or ice, and avoid chewing gum, which can put added stress on the jaw.
Adjust Your Sleep Position
Sleeping on your stomach can worsen TMD symptoms. Try changing your sleep position to alleviate pressure on your jaw.
Avoid Using Teeth as Tools
Avoid using your teeth to open packaging or rip off tags, as this can strain the jaw and worsen TMD symptoms.
TMJ Disorder Treatments
If you have Temporomandibular Joint Disorder (TMD), your dentist may recommend the following treatments:
Medications
Your dentist may prescribe higher doses of NSAIDs for pain and swelling, muscle relaxants to stop clenching or grinding, or antianxiety medications to reduce stress. These medications can help control TMD symptoms and are available by prescription.
Splints or Night Guards
These plastic devices prevent your teeth from touching, reducing the effects of grinding and improving your bite. Splints are worn all the time, while night guards are used only while sleeping.
Dental Work
If needed, your dentist may replace missing teeth or use crowns, bridges, or braces to correct bite problems and balance your teeth.
Advanced Treatments
If basic treatments don’t help, your dentist may suggest:
– TENS Therapy: Low-level electrical currents relax the jaw and relieve pain.
– Ultrasound: Deep heat applied to the joint to relieve soreness.
– Trigger-point Injections: Pain relief by injecting tender muscles.
– Radio Wave Therapy: Stimulates the joint to increase blood flow and ease pain.
– Low-level Laser Therapy: Reduces pain and inflammation.
Surgery for TMD
Surgery is only considered if other treatments fail. Options include:
– Arthrocentesis: A minor procedure to unlock the jaw and remove damaged tissue.
– Arthroscopy: Minimally invasive surgery to examine and treat the joint.
– Open-joint Surgery: For more severe issues, like bone damage or tumors.
– Modified Condylotomy: Surgery on the lower jaw to relieve pain and jaw locking.
Preventing TMJ Dysfunction
While some risk factors for Temporomandibular Joint Dysfunction (TMD) are unavoidable, there are several steps you can take to reduce your risk:
– Wear a Night Guard: If you clench or grind your teeth, using a night guard can help protect your jaw and teeth.
– Use a Mouth Guard for Sports: Wearing a mouth guard during contact sports can prevent jaw injuries.
– Maintain Good Posture: Proper posture can reduce strain on your neck, shoulders, and jaw muscles.
– Manage Stress: Incorporate stress-reduction techniques like meditation, mindfulness, or relaxation exercises to avoid clenching or tension in the jaw.
Findings of some studies –
Most patients had a hard diet (56%) which could be a contributing factor in causing the disorders. Long term consumption of a hard diet has a direct impact on TMJ. Therefore, the patients should be educated and motivated to discontinue the habit.
The gravest cause was habits (32%). Most patients had associated habits that resulted in this disorder. Habits like chewing gum (75%), nail or lip biting (18%) and bruxism (7%). Most patients were unaware of the habits.
The second most common cause was dental treatments (29%).
About 17% of patients had a history of trauma and 10% of patients had rheumatoid arthritis.
TMJ is a complex symptom. It is caused by multiple factors that are poorly understood. It affects people between 20 and 40 years old. About 20-40% of the adult population is affected to some degree.
The main etiology of TMD is abnormal functions of TMJ due to incorrect habits and practices. Therefore, more importance should be given towards educating the patient on how to avoid behaviours that are abusive to TMJ. Patient education is also a key to successful TMJ rehabilitation.
Beneficial Yoga Poses
– Balasana – Child’s Pose
– Paschimottanasana – Seated Forward Bend
– Simhasana – Lion’s Pose
– Supta Matsyendrasana – Supine Twist
– Adhomukha Svanasana – Downward facing dog pose
– Salamba Sarvangasana – Shoulder Stand Pose
– Viparita Karani – Legs up the wall pose
– Salamba Sirsasana – Headstand Pose
Ayurveda Understanding of TMJ Disorders
TMJ Disorders can be closely correlated with a condition called ‘Hanugraha’ or ‘Hanustambha’ explained in the context of Vata Vyadhi. The symptoms of TMJ resemble those of Hanugraha. Involvement of Vata in the causation of TMJ Disorders can be observed by seeing their symptoms. Vata aggravating etiological factors are responsible for causation of TMJ disorders.
Treatment of TMJ Disorders shall be done on the lines of treating Vata Vyadhi. Abhyanga, Swedana, Lepa, Upanaha, Nasya and Vasti form the mainstay of treating TMJ disorders through Ayurveda.
TMJ disordes may also be treated on the lines of treating Ardita, Ekanga Vata and Sandhigata Vata.
Related Reading – ‘Hanugraha’
Related Reading – ‘TMJ Disorders – Ayurveda Management’
