TMJ Disorders

TMJ (temporomandibular joint) disorders are a family of problems related to your complex jaw joint. If you have had symptoms like pain or a “clicking” sound, know that these problems are more easily diagnosed and treated than they were in the past. These symptoms occur when the joints of the jaw and the chewing muscles (muscles of mastication) do not work together correctly. TMJ stands for temporomandibular joint, which is the name for each joint (right and left) that connects your jaw to your skull. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.

No one treatment can resolve TMJ disorders completely, and treatment takes time to become effective. Dr. Hecht can help you have a healthier and more comfortable jaw.

Trouble With Your Jaw?

TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. You may have a damaged jaw joint due to injury or disease. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. Thus, the disk which is made of cartilage and functions as the “cushion” of the jaw joint, can slip out of position. Whatever the cause, the results may include a misaligned bite, pain, clicking or grating noise when you open your mouth or trouble opening your mouth wide.

Do You Have A TMJ Disorder?

Here are some questions to ask yourself to help determine if you could have a TMJ disorder:

  • Are you aware of grinding or clenching your teeth?
  • Do you wake up with sore, stiff muscles around your jaws?
  • Do you have frequent headaches or neck aches?
  • Does the pain get worse when you clench your teeth?
  • Does stress make your clenching and pain worse?
  • Does your jaw click, pop, grate, catch or lock when you open your mouth?
  • Is it difficult or painful to open your mouth, eat or yawn?
  • Have you ever injured your neck, head or jaws?
  • Have you had problems (such as arthritis) with other joints?
  • Do you have teeth that no longer touch when you bite?
  • Do your teeth meet differently from time to time?
  • Is it hard to use your front teeth to bite or tear food?
  • Are your teeth sensitive, loose, broken or worn?

The more times you answered “yes”, the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they are treated.

Treatment

There are various treatment options that Dr. Hecht can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, Dr. Hecht will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care joined with professional care.

The initial goals are to relieve the muscle spasm and joint pain. This is usually accomplished with a pain reliever, anti-inflammatory or muscle relaxant. Steroids can be injected directly into the joints to reduce pain and inflammation. Self-care treatments can often be effective as well and include:

  • Resting your jaw
  • Keeping your teeth apart when you are not swallowing or eating
  • Eating soft foods
  • Applying ice and heat
  • Exercising your jaw
  • Practicing good posture

Stress management techniques such as biofeedback or physical therapy may also be recommended, as well as a temporary, clear plastic appliance known as an orthotic. An orthotic fits over your top or bottom teeth and helps keep your teeth apart. There are different types of appliances used for different purposes. A night-guard helps you stop clenching or grinding your teeth and reduces muscle tension at night, helping to protect the cartilage and joint surfaces. An anterior positioning appliance moves your jaw forward, relieves pressure on parts of your jaw and aids in disk repositioning. It may be worn 24 hours a day to help your jaw heal. An orthotic stabilization appliance is worn 24 hours a day or just at night to move your jaw into proper position. Appliances also help to protect from tooth wear.

TMJ treatment with Orthotics (Splints)

The use of orthotics is a non-invasive approach to treat many jaw and facial pain disorders. There are at least five therapeutic modalities inherent in using the orthotics for the basis of non-invasive treatment.

The orthotic:

  1. Opens the joint space by opening the bite. This allows the head of the jaw joint to drop out of the fossa preventing the bone from crushing or impinging the disc that rides with the condyle thus relieving muscle pull responsible for inflammation inside the joint.
  2. Places the condylar head is in the inferior position increasing lubrication to the disc. This allows the disc to move more freely with the condyle helping to relieve locking due to adherence of the disc to boney walls.
  3. Changes the muscle resting length, which decreases muscle spasm around the head and neck area.
  4. Allows the mandible with musculature to obtain a comfortable position.
  5. Reduces the effect of any dental habits that may trigger pain.

The orthotic is worn 24/7 for approximately three months except when eating. Thereafter, night use only may be sufficient. Often, the orthotic is used in conjunction with muscle relaxants and/or physical therapy.

It should be noted that sleep apnea is a condition that causes or aggravates TMJ. In these cases, a diagnosis of sleep apnea should be made and the patient treated to decrease the symptoms in the jaw joint.

What About Bite Correction or Surgery?

If your TMJ disorder has caused problems with how your teeth fit together, you may need treatment such as bite adjustment (equilibration), orthodontics with or without jaw reconstruction, or restorative dental work. Surgical options such as arthroscopy and open joint repair restructuring are sometimes needed, but are reserved for severe cases. Dr. Hecht does not consider TMJ surgery unless the jaw can’t open, is dislocated and non-reducible, has severe degeneration or if the patient has undergone appliance treatment unsuccessfully.