Multitude of symptoms falls under the category of TMD ( jaw joint disorder ). Dr. Kundel has gone through the gamut of feelings, sensations, and treatments himself. There was anxiety, anger, pain, fatigue, clenching, grinding, exhaustion, teeth sensitivity. Various appliances were used to alleviate discomfort. Several worked.
Treatment always begins with diagnosis. Consultation, evaluation, X rays, and even photos are needed. Conservative approach is always preferred.
Dr. Kundel possesses the needed expertise and experience to deliver proper diagnosis and treatment which is crucial in alleviating the pain and discomfort caused by the disorder.
Facts – TMJ Disorder
What are TMJ Disorder Symptoms?
It should be considered that there are many symptoms of TMJ disorder and everyone is different; therefore, the disorder can and does manifest itself in a variety of ways.
- Headaches are very common with TMJ/TMD
- Pain around the jaw joint as well as radiating pain in the face, shoulders, back, and arms
- Problems chewing – a feeling that your upper and lower teeth are not meeting as they should
- Jaws locking when you yawn or open your mouth wide
- Limited mouth opening ability
- Tooth pain
- Noise like clicking, popping or grating while chewing or moving your jaw
- Swelling around the temporomandibular joint
- Tinnitus or ringing in the ears
What is TMJ Disorder and the Temporomandibular Joint?
TMJs (The Temporomandibular Joints) in humans are complex sliding ball joints that attach the mandible (lower jaw) to the skull (specifically the temporal bone). These joints are located just in front of the ears, and you can feel them if you press your fingers to the area just in front of your ears and open and close your mouth. The TMJs enable the jaw to open and close, move forwards and backwards, left and right, and various combinations of these movements. The American Academy of Facial Pain has a helpful site on TMJ anatomy, available on their TMJ AnatomyLink
What causes temporomandibular joint disorder?
- Bruxism (grinding or clenching of the teeth) (coming soon: an article on bruxism)
- Arthritis (rheumatoid arthritis or osteoarthritis) and other degenerative conditions
- Trauma or injury
- Congenital abnormalities
- Dental work (orthodontia, wisdom teeth, dental prosthesis, malocclusion)
- Postural factors (disorders of the support structures and musculature of the head and neck)
Many patients do not have one clear event that caused their problems. It is usually a combination of several, which may include, but are not limited, to the above list.
How is TMJ Disorder Diagnosed?
TMJ disorder has many symptoms, some of which can mimic other disorders. It has been called “The Great Imposter” by many physicians, and, because of this, diagnosis should be done by a knowledgeable professional. The most common method of diagnosing TMJ disorder is by visiting a dentist. The dentist will examine your face and jaw for pain and tenderness, listen to your joint for noises, check your bite, and measure your opening. He or she will most likely take x-rays of your joints which will enable the bones and surrounding teeth to be seen and make sure that no other problems affecting these structures are causing your symptoms. Sometimes, other tests are ordered, such as CT scans, which are used to view the bony detail of the joint. MRI’s can also be ordered to view the soft tissues of the joint, including the disc.
What is the treatment for TMJ Disorder?
Treatment can vary from simple, self-care to complicated surgical procedures. It is very important when seeking TMJ treatment for the patient to exhaust all conservative options before moving to invasive treatments. When you first believe that you may have a temporomandibular joint problem, there are things you can do at home to relieve your pain, such as:
- Eating soft foods such as yogurt, eggs, cereal, oatmeal, and similar to give your joints a rest
- Avoid hard, crunchy foods (raw vegetables, chips, nuts), chewy foods (hard rolls, gum), and large foods that force you to open your mouth wide (hamburgers, big sandwiches, hot dogs, etc)
- Moist heat or cold packs if both are used, apply ice first, then do gentle stretching as directed by your physician, and apply heat. You can make your own heating pack by either wetting a washcloth or towel and microwaving it, or putting rice in a tube sock and microwaving it.
- Try over-the-counter medications such as Ibuprofen or Naproxen. Your physician may prescribe other medications such as anti-anxiety medications, muscle relaxants, narcotics, nonsteroidal anti-inflammatories, and antidepressants. (PLEASE NOTE: Most, if not all medications have the potential to produce side-effects. Please ensure you exercise caution when taking any medication and if you experience any side effects, you should stop taking the medication immediately and seek professional help. Always read the label and use medication only as directed.)
- Avoid yawning widely, resting your chin on your hand, resting the phone on your shoulder, or excessive talking
- Try and practice good posture
- Be aware of clenching and grinding: try to keep your lips together and teeth apart
- Try and avoid situations which are known to cause you to feel stressed or emotionally traumatized because this can cause an exacerbation of symptoms (many people clench or grind their teeth when stressed).
Some people go through stressful situations prior to developing TMJ disorder, but there is definitely a physiological factor involved as well. This point has been debated by patients and physicians for many years. Some patients do not believe that emotional factors play a large part in their disorder, while others do. More research needs to be completed regarding issue.
What if Self-Care Treatments Fail?
If self-care fails and self-care techniques mentioned above, do not relieve your pain, your dentist might recommend moving forward with treatment that can include:
MRI, CT, X-Rays (Panorex, Tomogram), and other imaging can be used to determine the state of the joints and surrounding tissues as well as determine what treatment may be the most appropriate. MRI’s are primarily used for visualizing soft tissue such as discs and muscles. CT scans show bone in great detail. X-Rays give a basic look at the joints and their relationship with your occlusion (the way your teeth fit together).
Splints, night guards, biteplates and NTI’s (all words for similar devices) are the most common treatment for jaw-related pain and muscle disorders.
Trigger point injections are injections to address knots in muscles that cause pain. These can be done with anesthetic only (no epinephrine and no anti-inflammatory). After having these injections, your physician will direct you to use some sort of coolant such as spray or ice, and do stretching exercises to avoid discomfort. Some physicians may choose to do a type of injections called “dry needling” which involves no anesthetic or steroid. Anti-inflammatory injections are given with anesthetic followed by either a steroid or serapin (a type of anti-inflammatory derived from a natural plant source). The amount of steroid injections is limited because the structure of muscles can be compromised if excess is administered.
Some doctors will send you to physical therapy, others will perform it in their offices, or will have you do it at home. The most common modalities performed in physical therapy are TENS, ultrasound, infrared, iontophoresis, stretching exercises, hot and cold packs, massage, and evaluation of posture, ergonomics, and sleeping positions.
Some doctors will refer you to chiropractors, massage therapists, acupuncturists, biofeedback therapists or nutritionists. An osteopath is trained to perform all of these functions. An osteopath is a doctor who has different medical training than an MD. As with any medical procedure, one must do research and be comfortable both with the modality and the practitioner for it to be successful.
Variety of medications are available to treat TMJ disorders depending upon symptoms. These include muscles relaxants to relax muscles around the joint, pain medications to help with daily function, anti-depressants such as SSRI’s and tri-cyclics for pain and depression, non-steroidal anti-inflammatory drugs (NSAIDs) to assist with pain relief and inflammation, sleeping medication to assist with sleep disruption that often accompanies pain, anti-seizure medication used for nerve pain and sometimes headaches, headache abortives as many TMJ patients respond positively to migraine or headache medications for headache. Sometimes medication management gets complicated and patients are referred to pain clinics or specialists such as neurologists. These physicians will ensure that there are not interactions between medications and the medications and side effects of these medications are not exacerbating symptoms.
Referral to Specialists
Many of the symptoms of TMJ disorder can be complicated and require referral to specialists. These specialists will work with your general physician or dentist to form a team. This can include neurologists for migraines, headaches, and nerve pain, pain specialists for pain management, medication management, and neck and back pain, rheumatologist for arthritis, fibromyalgia or other related diseases and disorders, or ear nose and throat doctor for ear and hearing related symptoms. Depending on who is originally treating you, you might be referred to a “TMJ specialist” or oral surgeon.
More Advanced Treatment
If conservative treatments fail after a period of time, TMJ surgery may be considered depending on your situation. An invasive treatment should only be considered after exhausting extensive conservative, non-invasive therapies and receiving multiple opinions from independent specialists.