IT'S ONE OF THE MOST elegant mechanisms in the body. The temporomandibular joint – which connects your lower jaw (mandible) to the (temporal) bone at the side of your head – incorporates hinge and sliding motions, plus powerful shock absorption, to support a remarkable range of functions we mostly take for granted, from chewing to opening and closing our mouths. But because it's so complex and delicate, this jaw joint and its supporting muscles are a common source of chronic pain.
More than 10 million Americans suffer a temporomandibular joint or TMJ disorder. Arthritis, muscle pain, injury (or all of the above) can cause ear pain or pain that radiates to your face or down your neck. It can cause your jaw to pop or click or, in severe cases, even lock when you open it.
I see many cases of TMJ arthralgia in my practice as an otolaryngologist. The good news is that the great majority can be very effectively treated with a gentle program of rest, non-steroidal anti-inflammatory medications and, if necessary, therapy to change any habits (like chronic teeth grinding or nail biting) that might be contributing to the problem.
How Do You Know You Have TMJ?
Many patients who come to me are a little scared because they're suffering increasingly debilitating symptoms that they can't explain. Ear pain is often the most common. But they may also have radiating pain in other areas of the face and head, or jaw pain or stiffness that makes it difficult to eat. The pain is usually sharp and intermittent, but it can also be steady and dull. It may feel as if something is persistently irritating the joint. And it's usually worse on one side, and worse when you're using your jaw a lot, either to talk or to chew.
We start with a medical history and a thorough physical exam to rule out ear and sinus infections and other problems. We evaluate how your teeth come together and palpate your jaw, looking for popping, pain or swelling. And we ask a lot of questions, including but not limited to: Where exactly is the pain and what makes it worse? Do you grind your teeth at night? Do you bite your nails or chew gum? Do you lean on your chin when you sit at your desk? Are you under a lot of stress?
Your responses help us tailor a therapeutic program for your specific case.
Rest works! The first thing we always recommend for TMJ is to rest everything. You should not chew at all for at least two weeks – which means a soft or liquid diet. And you should try to avoid yawning, singing, playing a musical instrument or even doing a lot of talking. I usually recommend warm compresses to loosen up the jaw joint and muscles and reduce inflammation, along with a non-steroidal anti-inflammatory medication as necessary.
If you grind your teeth at night, we might send you to a dentist to fit you with a mouth guard to reduce some of that pressure. And, at Mid-Atlantic Permanente Medical Group, we might refer you to our physical therapists to help with gentle stretching and other exercises to help you relax your jaw muscles throughout the day, or to our counselors to help with behavioral issues such as teeth grinding and nail biting.
Mindfulness meditation and yoga can be very helpful for reducing stress in the jaw muscles, and researchers have found that acupuncture can be effective in treating TMJ.
Some patients, if they've exhausted these remedies and are still in a lot of pain or are continuing to have difficulty opening and closing their mouths, do consider muscle relaxants, steroids or botox injections, and even a range of surgeries – options that are available through our dental colleagues.
I have found that for many patients, just being aware of the tension they hold in the jaw area, and taking steps to rest and relax it, makes a world of difference. The less invasive treatments we prescribe – from rest and awareness to therapy and mind/body practices – are very effective for TMJ and have a high rate of success in helping most patients feel better over time.
Nitinkumar J. Patel, M.D., Contributor