Chew on This
Getting the jaw and teeth in sync can help TMJ disorders.
Let's say you're at the movies and get something from the concession stand. Do you worry that your munching might distract or annoy the moviegoers around you? Maybe not, but if you have a TMJ disorder, you might be a little self-conscious, since TMJ trouble often causes each bite and chew to be accompanied by audible clicking or popping noises. At its worst a TMJ disorder can cause discomfort and pain so intense that you'd have to kiss your popcorn and Milk Duds goodbye and embrace a soft foods-only diet.
TMJ stands for "temporomandibular joint," which is the joint on each side of your head in front of your ears, where your lower jaw connects to your skull. The TM joints are among the most complex joints in the body, according to the American Dental Association, and enable the jaw to move in a variety of ways, so that the jaw can act as a hinge, and also glide and rotate when a person chews or speaks.
The clicking and popping or pain that often go hand in hand with TMJ dysfunction can be a sign that there is a discrepancy between the way a person's teeth want to come together and the way the joint wants the teeth to come together, says Robert N. Marshall, D.M.D., M.A.G.D., of Aesthetic Dental Center in Concord. For healthy functioning, "the position of the jaw joint needs to be harmonious with the way our teeth want to open and close," he says.
TMJ disorders can occur at any age, but most often occur in women of childbearing age, says Bernard W. Ang, D.M.D., of Amherst Village Dental and Dental Arts of Bedford. "Men usually grind their teeth down to little nubs. That's how the body deals with [the misalignment]," he says. Estimates suggest that more than 10 million Americans suffer from TMJ disorders, according to the National Institutes of Health.
A mystery of the mouthThere are often no outward signs of TMJ disorders; a gorgeous set of pearly whites can mask pain and discomfort. Also, a TMJ problem does not always show up on x-rays but is often "self-diagnosed" with patients arriving at the dentist's office with complaints of pain in the jaw, Marshall says.
Truly, TMJ dysfunction remains a bit of a gray area in dentistry. Its precise causes are not always clear, but are often thought to include clenching or grinding the teeth, jaw injury and arthritis, with the most common trigger for TMJ trouble being misalignment between the teeth and the jaw joint. Like bickering young siblings arguing over a toy, the teeth try to go in one direction while the jaw joint wants to go in another and, orally speaking, no one wins. Instead the jaw joint becomes out of sync with the bite, possibly causing wear and tear on the teeth, grinding and unbalanced muscles in the jaw.
If there is a mismatch between the TM joint and the teeth, clicking and popping sounds might be the only resulting symptom, Ang says. Some people remain in that phase, perhaps bothered by the popping and clicking but pain-free, he says. In other cases misalignment leads to more serious problems.
In fact, symptoms can run along a continuum from jaw noises to pain so severe and debilitating that it interferes with basic functioning. Patients can also experience earaches, headaches and pain that radiates down the neck and into the back, Marshall says. Symptoms often occur in cycles, waxing and waning with no clear reason as to why.
"TMJ dysfunction can mean a lot of different things to a lot of different people," says Ang. "For women, usually it's associated with a lot of pain - muscle pain, migraine headaches, ringing in the ears, even teeth sensitivity," he says. The incongruity between teeth and jaw can make it difficult to open and close the mouth, and some patients experience vertigo, Ang says. "All of those could be symptoms of problems with the TM joint," he says.
Creating oral harmonyOpinions vary on how best to treat TMJ disorders. "There are all kinds of things being done," Marshall says. But typically, patients who only experience clicking and popping - and many do - do not necessarily require treatment, and in general, conservative, nonsurgical treatments will alleviate symptoms for most TMJ dysfunction patients. Rarely, in severe cases, TMJ disorders can require surgery.
But doctors typically advise starting with less-invasive treatments. Some patients find relief through pain medication or muscle relaxants, Marshall says, but if symptoms persist, intervention that addresses the bite may be in order. Many dentists prescribe use of a nightguard, Marshall says. Some patients also try stress-reduction techniques and biofeedback with electrodes that help the patients become aware of when they move their jaw in a certain way, he says. For instance, a lot of people claim that they don't grind or clench their teeth during the day, Marshall says, but they do without realizing it, and people who clench or grind their teeth are often "the ones that have problems with pain in that joint," he says.
Chiropractic treatments or physical therapy can also help with symptoms, but do not always resolve the causes that lurk behind TMJ-related symptoms, Ang says. Following these forms of treatment, "Some people will be fine, but a subset will not be fine," he says. "The problem is there's no clear way of telling who is going to continue to have a problem and who is not."
At their core TMJ disorders are a structural issue, Ang says. Their root problem must be addressed or the symptoms most likely will never go away. But TMJ dysfunction "is a very controversial issue," he says. "It's a four-letter word in the dental medical world, because there's a lot of confusion about it," he says, and not everyone agrees on what the recommended treatment should be. NH