Joshua Hong, DDS Blog

Although temporomandibular joint pain is common among adults aged 25 years and older, it is bound to develop sooner especially amongst teenagers. A majority of the cases develop during childhood due to injuries as well as constant breathing through the mouth which is associated with allergies. Thus, most teenagers live with TMJ as it remains undiagnosed, disrupting their lives without them realizing it. For this reason, it is advisable that TMJ evaluations be conducted regularly in order to detect the problem early on before it becomes obtrusive.

What Causes Temporomandibular Disorders in Teenagers?

A number of factors are responsible for the development of TMJ disorders in teenagers. They include the following:

• Adding or removing braces – In most cases, braces are given between the age of 12 and 16 years, a time when the mouth is still developing.They are able to correct any existing alignment issues. Consequently, orthodontic work tends to change your bite while the re-alignment of your teeth continues. The change in the bite may result in TMJ. Unconscious clenching of teeth, following an orthodontic visit, especially when the teeth are sore can also result in a TMJ. You are advised to pay attention to your jaw joint during your orthodontic work to be able to identify any problems that may arise.
• Childhood mouth breathing – This is common if you suffer from allergies that make it impossible for you to breath using your nose, so you end up breathing through your mouth for long periods. Breathing through the mouth constantly when the jaw is yet to fully develop can result in the formation of a bad bite.
• Tooth grinding – This is another cause of TMD in teenagers that is triggered by exposure to stressors like exams, school projects as well as extracurricular activities. In fact, teens who are faced by projects and exams at the end of the year are more likely to experience TMJ pain compared to other times. Frequent grinding of teeth can cause the temporomandibular joint to be fatigued in addition to the development of a bad bite.
• Injuries suffered during sports are also likely to result in the development of TMJ in teens. That is, whether they are participating in cheerleading or contact sports, such as football players are always faced at the risk of developing TMJ.

Factors that Contribute to TMJ

Certain factors are known to trigger the development of TMJ. One such factor is impact injury especially if it directly affects your chin owing to the many tumbles and falls you may experience. Various dental conditions that affect the alignment of your teeth like extended overjet, open bite, missing back teeth and cross bite are linked with the development of TMDs.

There are also habits that contribute to the occurrence of TMD like tooth clenching, grinding (bruxing), hypertension as well as other habitual behaviors that are repetitive. Certain resting and postural positions may also contribute to the occurrence of TMJ.

Signs and Symptoms

Many signs and symptoms characterize TMD. However, it is difficult to tell if you are suffering from TMD because these signs are also present in other problems. Thus, you can trust your dentist to help you make the right diagnosis. Some common symptoms of TMJ include:

• Headaches that mimic migraines, earaches as well as pressure and pain behind the eyes
• Pain in the jaw, ear area, or face
• The presence of a popping or clicking sound when you open or close the mouth
• Tenderness of the muscles of the jaw
• A swollen face
• A jaw that gets locked/stuck or gets out of place

Treatment Options for TMJ

With the right diagnosis, TMJ can be treated. In most cases, non-surgical TMJ treatment is recommended to offer TMJ pain relief. If you are experiencing nighttime tooth grinding, bite splints (also known as neuromuscular orthotics) may be created to not only protect your teeth but also realign your jaw while you sleep. Minor changes may also be made to your teeth to change your bite. Other TMJ treatment options may be recommended depending on the nature of your disorder. These include TMJ exercises that target specific pain.

Generally, you are advised to embrace regular dental care at a dental clinic that practices neuromuscular dentistry, which includes TMJ evaluations to be able to detect TMJ at the earliest opportunity before it advances.

Image source: deloiz.com

The temporomandibular joint, or the ‘jaw point’, is a hinge that connects your jaw to your temporal skull bones.  It assists in the opening and closing of your jaw, and plays an important role in letting you speak, chew, smile and yawn.

Because of the frequent and constant use of the jaw point, it is a common target for recurring pain and the jaw pain associated with it is called TMJ pain.

What is TMJ Dysfunction?

TMJ dysfunction is an umbrella term covering a large number of painful jaw ailments like: pain in the jaw joint, jaw clicking and popping, ear pain, popping sounds in ears, throbbing headaches, sore jaw muscles and locking of the jaw joint.

Before treating a TMJ dysfunction, it is important to diagnose it properly to pinpoint the exact underlying problem.

Diagnosis

You might have to take a radiograph of your jaw point, which will show a detailed picture of your TMJ anatomy and pinpoint any visible anomalies. Your dentist might also recommend you to wear jaw repositioners (splint appliance), which is an appliance that helps eliminate bite pain. Once the appliance is refined in a way that it has eliminated your bite pain, a long-term treatment is prescribed to duplicate the effects of the appliance.

The Splint Appliance

The jaw repositioners that we were talking about are also used to remedy bite disharmony and the resulting pain. This is done by positioning the splint in a way that it adjusts the jaw point in a stable position.

These jaw repostioners or splints as they are called, are used to eliminate jaw point pain with a procedure called occlusal splint therapy, where the repositioner is adjusted in tandem with the jaw point to alleviate pain. There are many types of splints used in this therapy:

Stabilization splints

These are used to prevent or alleviate the wearer from clenching and bruxism (involuntary habitual grinding of the teeth). These can be made out of hard materials or soft (more flexible) materials and mostly have to be worn at night.

Repositioning splints:

Repositioning splints are to be worn 24*7 and are used to pull the lower jaw forward. Here are some specific splints:

• MORA (mandibular repositioning appliance)
• Anterior bite planes
• Anterior repositioning splint

These splints help the wearer lessen jaw pain because they allow the muscles & ligaments to relax by taking a firm grip on the jaw. This helps in getting rid of the tension that bruxism and teeth clenching causes.

Also the splints help protect the patient’s teeth from wear and tear caused due to grinding.

The splints also help in correcting a patients’ bite (correcting the way the patient’s teeth fit together). An off bite may not be right for the patients jaw points and can lead to extreme pain.

Most of the times, splint therapy works perfectly. Other times the splint might worsen the pain. In these rare cases, there are many alternatives:

• Physical Therapy
• Trigger Point Injections
• Massage Therapy
• Lastly: Surgery

TMJ can make your life very uncomfortable. There is a way you can avoid cringing in pain every few minutes and start smiling instead. Contact Dr. Joshua Hong at Joshua Hong DDS to help you keep smiling.

When it comes to TMJ treatment, it is better to go with non-invasive or conservative treatment as much as possible.  Surgical options, which tend to be more invasive, should only be considered as a last resort.  Chiropractic techniques have been found to work very well in relieving problems with body joints.  With a good chiropractor, you can find effective TMJ pain treatment as he or she realigns your jaw joint.  This treatment can be used by itself or alongside other treatment that you may be receiving.

It has been found that chiropractic treatment relaxes the muscles that surround the joint and also adjusts the joint.  This can alleviate pain temporarily and in some cases even permanently.  The idea is to relieve the joint of tension, leaving it relaxed and re-aligned.

Interestingly, if you have poor posture or are suffering from a back problem, you may find yourself suffering from TMJ syndrome as well.  The condition can be caused by a misaligned upper back or neck and as the chiropractor works on aligning the spine, you may find your TMJ gone as well. You will find that the symptoms that accompany TMJ, the ear pain, neck pain, headaches and jaw locking, disappear with chiropractic treatment.

Why Should Chiropractic Treatment Be Part Of Your TMJ Treatment Options?

Studies have shown that chiropractic treatment can indeed improve TMJ disease.  A study carried out in 2003 with 15 participants resulted in improved pain relief and the participants could open their jaws wider.  This shows that there is promise in this area of treatment.

This treatment can be used by itself or with other treatment options.  Medicine can also be prescribed as needed.  Some of the medications used are anti-inflammatory drugs, pain killers, corticosteroid injections and muscle relaxants.  One may also need to use a cold or hot compress which does a good job in reducing inflammation.  For those who clench and grind their teeth at night, a mouth guard is also recommended to prevent that.

Other options for TMJ disorder treatment include a bite plate that is used to correct any misalignment, relaxation techniques, modified chewing habits, stress reduction and jaw stretching exercises.  All of these have been shown to be effective approaches to the treatment of TMJ. Combining these with chiropractic treatment can help.

How Can You Take Care Of Yourself

As the sufferer, there are certain things that you can do to help you feel better when you are experiencing TMJ symptoms and treatment.  Here are a few suggestions:

• Go on a soft diet as this will give your jaw temporary rest. Avoid foods that may be chewy, crunchy or hard and do not open your mouth wide to accommodate whole fruits, apples and corn on the cob.
• When you yawn, be sure to offer your jaw support by placing your fist on your chin to ensure that your jaw does not lock open.
• Use a hot water bottle or heat pack to provide moist heat which goes a long way to reduce pain and improve jaw function.
• Consciously relax the muscles in your face. Relax the lips and be sure to keep your teeth apart.
• Do some slow and gentle exercises for your jaw to increase mobility.
• When you go to bed at night, lie on your side and support yourself with a pillow between the neck and shoulder.
• Use an ice pack to reduce inflammation, promote healing and numb pain.
• Use relaxation techniques to your advantage such as slow, deep breathing, mediation, massage or yoga to help deal with pain.

It is also important that you avoid the following things:

• Chewing gum
• Clenching your jaw
• Cradling the phone with your neck
• Dental appointments that will require you to keep your mouth open for over 30 minutes
• Anesthesia, as it can affect your ability to open your mouth and may even damage the joint

If you have been suffering from TMJ disease, it is important that you have the problem dealt with as soon as possible.  The earlier the better because you can use minimally invasive treatments to provide the relief you need.  Contact us for more information on TMJ and the treatment options available for you including chiropractic therapy.

The joint that attaches the lower part of your jaw to your skull is known as the temporomandibular joint (TMJ). It really is a hinge and it enables the opening and closing of your mouth.  It also allows your mouth to move from one side to the other when you chew.  The joint is surrounded by muscles to control the position of the jaw.  There are people who suffer disorders that may affect the TMJ, the muscles surrounding it or both.

TMJ syndrome is a painful condition that also restricts the function of the jaw.  Even though most people experience the symptoms temporarily and they naturally disappear on their own, for others the issue may require surgical intervention.

Treatment options, both surgical and non-surgical, are available as follows:

1. Non-Surgical Treatment Options for TMJ
   When it comes to the TMJ treatment, the key is being conservative.  Usually, the treatment can be done in the comfort of your home and without any surgical intervention.  If the issue is very severe, there may be need for mouth guards, splints and therapy.
   • Physiotherapy for the JawThis works well to reduce stiffness and pain while improving the muscles range of motion and strength.  It includes mobilization, stretching the muscle gently, acupuncture and exercise.  If you are experiencing muscle spasms that are related to TMJ, this is going to be the first line of treatment for you.
   • Managing StressStress can cause one to grind and clench the teeth, and this can make TMJ worse.  It is therefore important that you learn some relaxation techniques such as altering your breathing patterns and even learning how to breathe correctly.  You may want to go a step further and identify your stressors and then make whatever lifestyle changes are necessary.
   • Helpful MedicationIf you have been going through TMJ symptoms and treatment for a long while, you may have some medications prescribed to help.  These include anti-inflammatory pills, sedatives, anti-depressants, anti-anxiety and muscle relaxants.
   • Occlusal Appliance Therapy for TMJWhen you go to bed at night, you may be required to wear splints or bite plates which are effective in taking pressure off your teeth and jaw joints causing your muscles need to relax.

   Surgical Treatment Options for TMJ
   Surgery will not be considered unless it is absolutely necessary.  This will likely only happen if the cartilage found in the joint has been displaced severely.  This can result in pain and can limit your jaw function.  Surgery will only be considered if the jaw cannot be repositioned some other way and if other TMJ disorder treatments have failed.  Eminectomy is the most common surgery.  Here, part of your jaw joint, the part obstructing forward movement, is removed.  It is usually carried out under general anesthesia and considered a minor surgery.

   • Botox as TMJ Treatment Botox is generally known for the reduction of frown lines and wrinkles.  Today however, it is being used in dental offices to treat TMJ.  Botox is generally injected in the medial pterygoid, masseter and temporalis, which are the muscles that work together to move the jaw.  Those who have experienced this treatment have reported significant improvement in function, pain, amount of tenderness and mouth-opening ability.Botox works by relaxing the muscles that move uncontrollably because it blocks the nerve signals. It takes ten to fifteen minutes to take effect and remains effective between 2 and 6 months.
     • ArthrocentesisIn this procedure, fluid is extracted from the joint with a needle.  The area is then irrigated in order to remove any inflammatory derivatives and fragments that may be causing the problem.  Once that is done, a lubricant is then injected back to ensure that the joint moves again normally.  This procedure works for some but not others, and recovery takes about two days.
     • ArthroscopyThis procedure is somewhat similar to the one above albeit more invasive.  Here, an intra-oral camera is used to examine the inner part of the jaw joint.  The dental surgeon will then determine the best course of action depending on his findings.  These may include removing scar tissue that may be loose, stitching the discs and the like.  It is an outpatient procedure and it takes about a week to recover.  The required incision is quite small.
     • ArthroplastyThis term refers to open joint surgery.  It is only done if the less invasive surgical procedures cannot resolve your problem.  If there is need to do surgery on the bone, or to replace, remove or repair the articular disc, then this is the preferred treatment.  You will be under either general or local anesthesia and a small cut will be made right in front of your ear.
     • Osseous SurgeryIn the event that your bones are shaped badly, then this is the ideal treatment to re-structure and re-shape the disc.  It is a surgical procedure that attempts to remodel your bone.
     • MenictomyThis procedure includes a partial or complete removal of the disc.  The cartilage may be damaged beyond repair and may need to be replaced with an implant that carries out the same functions.
   • Alternative Treatments for TMJThese include radio wave therapy, TENS (transcutaneous electrical nerve stimulation), trigger-point injections and ultrasound.  These options are known to provide temporary relief but do not completely treat the problem. They are a good option for TMJ pain treatment but not TMJ cure.TMJ disease can be painful, making life very uncomfortable.  It is treatable however, and should be looked into as soon as possible in order to avoid the more invasive treatments.  Contact us and let Joshua Hong DDS in Goodyear AZ help you find the relief you are looking for.

Causes of TMJ

Temporomandibular Joint Disorder is a disorder that causes pain in your temporomandibular joint most commonly known as your jaw. For some time, specialists thought that it results from malocclusion, but after a lot of research was carried out, it has led them to believe this may not be the only cause.

If you suffer from TMJ, it is common for you to have some trouble when opening your mouth. In many cases when you try to open your mouth widely, your joint pops or clicks. If you suffer from TMJ, you will also be prone to having toothache or neck pain. You may also experience dizziness or you could have tinnitus. Some other causes of Temporomandibular Joint Disorder include:

• HPA Axis Dysregulation
• Inflammation
• Hormone balance
• Child birth
• Pinched nerves
• Obstructed airways

TMJ and how HPA Axis Dysregulation affects you;

If this disease affects you, you should understand that the more stress you are under, the more pain you are likely to experience. Adrenal Fatigue or HPA Axis Dysregulation is a common symptom of those that have TMJ. This is because you will have higher levels of cortisol in the morning and when you are stressed out you will release large amounts of it. TMJ sufferers have showed that they have cortisol rhythms that are not the norm, which would indicate that they would suffer from adrenal fatigue.

TMD and Inflammation

If you suffer from TMJ, stress causes your body to become resistant to the effect of cortisol. With your body being immune, the normal process to keep inflammation at bay doesn’t function as well as it should. It is believed that the stress that you undergo could also be associated with the pain that you feel when suffering from TMJ.

How does your hormone balance affect your condition with TMJ?

It seems that women are more prone to suffering from TMJ because disorders that cause pain such as Fibromyalgia are more common among women and it is believed that the balance of your hormones can play a major role. When you suffer from TMJ whether you are male or female, your estrogen levels would be a lot higher than a non-sufferer would. Estrogen compared to testosterone causes a lot more damage to TMJ. Female patients that are on an oral contraceptive or receiving hormone replacements are more likely to develop the disorder. There are ways to balance your hormones and in turn, it is effective for TMJ Disorder Treatment and they include:

• Make sure that you are at a healthy weight
• Avoid compounds that could expose you to more estrogen
• Try keep your stress levels as low as possible
• Eat an adequate amount of fiber to keep your constitution healthy

Does Child Birth affect TMJ?

It is believed that the process of a baby travelling down the birth canal and the pressure on the skull can cause TMJ Disorder. Although most babies might not suffer any effectsfrom this pressure, there are cases where children will suffer at a later stage in life.

What are TMJ Symptoms and Treatment?

Here are many different TMJ Symptoms and Treatments for sufferers. The symptoms of TMJ are painful and many struggle to live with it. Symptoms can include any of the following:

• Headaches
• Neck, back and shoulder pains
• Difficulty in opening the jaw widely and experiencing a popping of the jaws

Although it is often adults that suffer from TMJ, children can also be sufferers. Even though treatment of TMJ Symptoms can alleviate pain for the young and old, the treatment isn’t something that can work overnight. It takes time for TMJ Treatment to alleviate the pain that accompanies it. For TMJ Treatment, you can consider the following:

• If you are a teeth grinder, you can use a mouth guard
• For young children, a trip to the orthodontist to balance the jaw or to fix skewed teeth is necessary
• Adults and children need to get enough sleep

How does pinched nerves and obstructed airways affect a TMJ sufferer?

Having an imbalance of your spine could cause the pain associated with TMJ because your muscles have to work harder to rectify the body’s balance and could ultimately cause tingling sensations and numbness in your limbs. When the lower jaw isn’t aligned properly, your tongue will end up further back in your mouth than it should, which will in turn cause obstructed breathing. This causes the body to once again work harder and the extra stress on the body will cause more pain in the neck and jaw for sufferers. Since there are so many small details that could make a difference in your TMJ Disorder Treatment, it is best to do as much reading as you possibly can to get all the relevant information needed to understand the disease.

Risk Factors for TMJ Disorder : A risk factor is anything that predisposes you to catching a disease or condition. Therefore, you will need to be exposed to one or more risk factors to get a disease. The more the risk factors you are exposed to, the more the likelihood of being affected.

Temporomandibular joint (TJM) syndrome is a group of conditions that affect temporomandibular joint areas. TMJ syndrome is usually a self-limiting and a very common disorder. TMJ patients usually experience chronic pains and discomforts such as lower back pain, fibromyalgia, and headaches which is the main focus during TJM treatment. In some cases, the patients suffer jaw malfunctions which are associated with teeth clenching and grinding.

Below are some of the risk factors that can predispose an individual to TMJ. However, you can develop TMJ syndrome without being predisposed to various risk factors listed below.

If you are exposed to many of these risk factors, it is important to ask your health care provider on possible ways to reduce your risk.

TMJ syndrome risk factors

1. Stress

Stress is one of the major predisposing factors that increase the risk of catching TMJ syndrome. Some of the stressing habits likely to increase an individual’s risk of getting TMJ syndrome include:

• Grinding your teeth at night during sleep or during the day
• Regularly or constantly chewing things such as gum for a long period of time
• Constantly clenching and unclenching your jaw

2. Medical conditions

The following are some of the medical conditions that are likely to increase your risk of catching TMJ syndrome:

• Facial and jaw deformities
• Arthritic conditions such as osteoarthritis, and rheumatoid arthritis
• Misaligned bite and teeth
• History of facial or jaw injuries such as dislocations or fractures of the mandibles

3. Age

Most cases of TMJ syndrome symptoms have been reported among people aged 30 to 50 years of age. Therefore, people within this age group are more susceptible to suffering from TMJ syndrome.

4. Gender

Studies reveal that women are three times more susceptible to catching TMJ syndrome as compared to men. The risk of chronic TMJ among women increases significantly between the ages 18 to 44 years.

Studies have found that TMJ syndrome risk is high during childbearing years but decreases thereafter.

5. Ill-fitting dentures

Improperly fitted dentures after a jaw injury may be a risk factor that predisposes one to TMJ syndrome.

Other risk factors

It has been suggested that women who take hormone replacement therapy have a high likelihood of developing TMJ syndrome symptoms. Several studies that have been done on the TMJ syndrome suggest a link between TMJ syndrome and mitral valve prolapse.

Variability in genetics has also been shown to be a risk factor. People who have alterations in several genes are likely to suffer from TMJ syndrome. Some of these altered genes are known to influence stress response, inflammation, and psychological well-being. Therefore, the understanding of these phenomena has aided the research for drugs to be used in TMJ treatment.

It is also important to note that TMJ syndrome susceptibility is not related to low socio-economic status of an individual. This is unlike other chronic conditions. For example, socioeconomic status has been found to have a profound effect on sciatica, musculoskeletal pain, neuropathic pain, and ulcer.

Final word

The above-discussed factors are the major predisposing factors to TMJ. However, you should note that TMJ syndrome can be caused with or without exposure to the above factors. Women are the most susceptible to catching the TMJ syndrome as compared to men especially during their child bearing age. If you are more exposed to the above factors, you need to consider visiting your doctor or healthcare provider to give you tips on how to reduce the risks. Prevention is always better than TMJ treatment.

These risk factors can be broadly be classified into psychological distress, genetics, pain amplification, and history of physical and psychological trauma.