TMJ (Temporomandibular Joint)
TMJ is formed by the connection of the lower jaw with the upper jaw. Between the two bones is a disc. This disc is primarily made of cartilage and in the TMJ acts like a third bone, because it is attached to a muscle.
The nerve to the TMJ is a branch of the trigeminal nerve.
The two bones of the TMJ are held together by a series of ligaments, which can be damaged. A damaged ligament results in a dislocation of the disc, the lower jaw or both. The bones are connected by two main muscles: the temporalis and the masseter. Either of these muscles may be painful and produce pain in the TMJ or abnormal movement of the lower jaw.
SYMPTOMS:
1. Frequent headaches
2. Popping, clicking, or cracking sounds when you chew
3. Stuffiness, pressure or blockage in your ears
4. Ringing or buzzing
5. Dizziness
6. Jaws feel tight
7. Do you separate your teeth with your tongue
8. Teeth ache, or sensitive to temperature change
9. Sore facial muscles
10. Clench or grind your teeth
11. Pain in ears or in front of ears
12. Pain when jaw is moved from side to side
13. Pain in neck, back of head or shoulders
14. Injury to jaw, during surgery or whiplash
TREATMENT
Rest - the joint, and give the body time to heal. If you have splint to separate the teeth and relax the muscle is helpful.
Soft Diet - When inflammation or injury to the joints occurs you must reduce the forces generated during chewing.
Limit your opening
Avoid prolong opening - do not have wisdom teeth removed unless absolutely necessary. extractions produce tremendous pressures on the joints and jaws.
Ice and Heat - with any joint injury apply ice immediately to reduce swelling and pain for the first 12 to 24 hrs. Apply for 20 to 25 minutes then remove for 5 to 10 minutes. Moist heat is used after 24 hrs. to increase the circulation and remove toxins from damaged tissues.
Good Nutrition - When connective tissue is injured in a joint or ligament injury, the protein collagen framework must be repaired.
Posture - affects head position which affects the mandibular position (jaw). Try to keep your head erect, and over your shoulders, not in front of your body which would stress the closing muscles, and create pain.
Jaw Exercises:
Opening and closing with 2 toothpicks placed between the two front teeth of the upper and lower jaw. Try to keep these in a straight line when opening and closing.
Open against resistance of fist should include side to side and forward .
Neck Exercises:
DISORDERS THAT MIMIC TMJ
TEMPORAL TENDINITIS:
Symptoms: TMJ pain, Ear pain & pressure, tooth sensitivity, cheek pain, eye pain, temporal headache, neck shoulder pain.
Stuffiness and or clogged feeling in the ear.
Diagnosis confirmed by injection into the temporal tendon with anesthetic.
Treatment- medication cortisone or Sarapin=antiinflammatory, and moist heat several times per day.
ERNEST SYNDROME:
Mandibular ligament that connects the base of the skull with the mandibular.
Symptoms: pain in the temple, TMJ, ear, cheek, and eye. The throat when swallowing and the lower back teeth and jaw bone
Treatment same as above.
EAGLE'S SYNDROME:
Elongated styloid process or calcified stylohyoid ligament.
Symptoms: a foreign body lodged in the throat, or neck pain along the distribution of the carotid artery, therefore a constant dull throat ache, ear pain, difficulty with swallowing,and headache.
The stylohyoid ligament originates from the tip of the styloid process of the temporal bone and ends by attaching to the hyoid Treatment is surgical resection of the styloid process and ossified stylohyoid ligament.
HYOID BONE SYNDROME:
Only bone in body that does not articulate with any other bone. cause is trauma.
Symptoms: chronic constant pain in the lateral side of the throat that radiates to the ear, throat, temple, cheek and TMJ. Pain in the lower molar teeth. upper chest pain. Dizziness or fainting when turning the head towards the injured side. Pain when swallowing. Chronic sore throat, difficult or tightens when swallowing Treatment is surgery.
OCCIPITAL NEURALGIA:
Pain located in the cervical and posterior regions of the head. Cause whiplash injury or blow to the back of the head or twisting of the head.
Symptoms; occipital pain on both sides of the back of head. Pain or pressure behind the eyes. Light sensitivity. Pain radiating to the ear, shoulder, and arm.
TRIGEMINAL NEURALGIA:
Fifth Cranial nerve.
Symptoms; Sharp electrical pain last for seconds. Pain is triggered by touching specific area of the skin.
Treatment Baclofen, or Neurontin
REF: TMJ has many faces by Wesley Shankland. DDS M.S. PhD.
The nerve to the TMJ is a branch of the trigeminal nerve.
The two bones of the TMJ are held together by a series of ligaments, which can be damaged. A damaged ligament results in a dislocation of the disc, the lower jaw or both. The bones are connected by two main muscles: the temporalis and the masseter. Either of these muscles may be painful and produce pain in the TMJ or abnormal movement of the lower jaw.
SYMPTOMS:
1. Frequent headaches
2. Popping, clicking, or cracking sounds when you chew
3. Stuffiness, pressure or blockage in your ears
4. Ringing or buzzing
5. Dizziness
6. Jaws feel tight
7. Do you separate your teeth with your tongue
8. Teeth ache, or sensitive to temperature change
9. Sore facial muscles
10. Clench or grind your teeth
11. Pain in ears or in front of ears
12. Pain when jaw is moved from side to side
13. Pain in neck, back of head or shoulders
14. Injury to jaw, during surgery or whiplash
TREATMENT
Rest - the joint, and give the body time to heal. If you have splint to separate the teeth and relax the muscle is helpful.
Soft Diet - When inflammation or injury to the joints occurs you must reduce the forces generated during chewing.
Limit your opening
Avoid prolong opening - do not have wisdom teeth removed unless absolutely necessary. extractions produce tremendous pressures on the joints and jaws.
Ice and Heat - with any joint injury apply ice immediately to reduce swelling and pain for the first 12 to 24 hrs. Apply for 20 to 25 minutes then remove for 5 to 10 minutes. Moist heat is used after 24 hrs. to increase the circulation and remove toxins from damaged tissues.
Good Nutrition - When connective tissue is injured in a joint or ligament injury, the protein collagen framework must be repaired.
Posture - affects head position which affects the mandibular position (jaw). Try to keep your head erect, and over your shoulders, not in front of your body which would stress the closing muscles, and create pain.
Jaw Exercises:
Opening and closing with 2 toothpicks placed between the two front teeth of the upper and lower jaw. Try to keep these in a straight line when opening and closing.
Open against resistance of fist should include side to side and forward .
Neck Exercises:
- Side bending of the head
- Head Rotation
- Head flexion
- Chin to chest
- Shoulder stretching
DISORDERS THAT MIMIC TMJ
TEMPORAL TENDINITIS:
Symptoms: TMJ pain, Ear pain & pressure, tooth sensitivity, cheek pain, eye pain, temporal headache, neck shoulder pain.
Stuffiness and or clogged feeling in the ear.
Diagnosis confirmed by injection into the temporal tendon with anesthetic.
Treatment- medication cortisone or Sarapin=antiinflammatory, and moist heat several times per day.
ERNEST SYNDROME:
Mandibular ligament that connects the base of the skull with the mandibular.
Symptoms: pain in the temple, TMJ, ear, cheek, and eye. The throat when swallowing and the lower back teeth and jaw bone
Treatment same as above.
EAGLE'S SYNDROME:
Elongated styloid process or calcified stylohyoid ligament.
Symptoms: a foreign body lodged in the throat, or neck pain along the distribution of the carotid artery, therefore a constant dull throat ache, ear pain, difficulty with swallowing,and headache.
The stylohyoid ligament originates from the tip of the styloid process of the temporal bone and ends by attaching to the hyoid Treatment is surgical resection of the styloid process and ossified stylohyoid ligament.
HYOID BONE SYNDROME:
Only bone in body that does not articulate with any other bone. cause is trauma.
Symptoms: chronic constant pain in the lateral side of the throat that radiates to the ear, throat, temple, cheek and TMJ. Pain in the lower molar teeth. upper chest pain. Dizziness or fainting when turning the head towards the injured side. Pain when swallowing. Chronic sore throat, difficult or tightens when swallowing Treatment is surgery.
OCCIPITAL NEURALGIA:
Pain located in the cervical and posterior regions of the head. Cause whiplash injury or blow to the back of the head or twisting of the head.
Symptoms; occipital pain on both sides of the back of head. Pain or pressure behind the eyes. Light sensitivity. Pain radiating to the ear, shoulder, and arm.
TRIGEMINAL NEURALGIA:
Fifth Cranial nerve.
Symptoms; Sharp electrical pain last for seconds. Pain is triggered by touching specific area of the skin.
Treatment Baclofen, or Neurontin
REF: TMJ has many faces by Wesley Shankland. DDS M.S. PhD.
