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TMJ

The temporomandibular joints (TMJ) connect the lower jaw or mandible to the temporal bones at the sides of the head. These joints are flexible allowing the jaw to move smoothly up and down and side to side and enabling us to talk chew and yawn. TMJ dysfunction involves face pain clicking sounds in the TMJ and limited movement of the jaw. About 33 percent of the population has TMJ dysfunction and as many as 75 percent have some symptoms.

Signs and Symptoms

TMJ dysfunction is often accompanied by the following signs and symptoms.

bulletPain particularly in the chewing muscles and/or jaw joint
bulletLimited movement or locking of the jaw
bulletRadiating pain in the face neck or shoulders
bulletPainful clicking popping or grating sounds in the jaw joint when opening or closing the mouth
bulletA sudden major change in the way the upper and lower teeth fit together
bulletAlso sometimes headaches earaches dizziness and hearing problems

What Causes It?

The only definitive cause of TMJ dysfunction is a severe injury such as a heavy blow to the jaw or temporomandibular joint. Other possible causes include the following.

bulletA bad bite (malocclusion)
bulletOrthodontic treatment such as braces and the use of headgear
bulletJaw clicking which is more likely the sign of a displaced disk
bulletStress which may cause or aggravate TMJ dysfunction. People with TMJ dysfunction often clench or grind their teeth at night which can tire the jaw muscles and lead to pain.

Who's Most At Risk?

The following risk factors are associated with TMJ dysfunction.

bulletGender—women seek treatment two times more than men
bulletAge—people 30 to 50 years of age are most often affected
bulletNutritional or metabolic disorders
bulletGrinding teeth clenching jaw
bulletMalocclusion (bad bite)
bulletHigh stress levels

What to Expect at Your Provider's Office

If you are experiencing symptoms associated with TMJ dysfunction you should see your health care provider. He or she can help make a diagnosis and guide you in determining which treatment or combination of therapies will work best for you.

Your provider will check muscles in the area of the TMJ look for asymmetry or inflammation in your face listen for joint clicking or scraping sounds test your mandibular range of motion and look for evidence of jaw clenching or teeth grinding. If you're experiencing any neurological symptoms such as numbness your provider will give you a neurological examination. Imaging techniques may be used if there is evidence of degenerative disease or disk problems.

Treatment Options

Prevention

Reducing stress and keeping yourself from grinding your teeth or clenching your jaw may help prevent TMJ dysfunction or lessen the symptoms.

Treatment Plan

Some health care providers consider TMJ dysfunction a medical condition while others consider it a dental problem.

Drug Therapies

Your provider may prescribe the following medications.

bulletAnalgesics—aspirin or nonsteroidal anti-inflammatory drugs
bulletMinor tranquilizers or muscle relaxants at bedtime to reduce spasms and pain
bulletInjections of a local anesthetic
bulletAntidepressants—for pain that persists
bulletCortisone injections in cases where no other treatment works

Surgical and Other Procedures

When all other measures have failed surgery may be necessary.

Complementary and Alternative Therapies

A comprehensive treatment plan for TMJ dysfunction may include a range of complementary and alternative therapies.

Nutrition

The following nutritional tips may help prevent or reduce symptoms of TMJ dysfunction.

bulletEat soft foods high in flavonoids to provide antioxidants to decrease joint pain.
bulletAvoid saturated fats fried foods and caffeine all of which increase inflammation.
bulletAvoid chewing gum.

Potentially beneficial nutrient supplements include the following.

bulletEssential fatty acids (omega-3 and omega-6) to decrease inflammation

Herbs

bulletSt. John's wort (Hypericum perforatum) may improve serotonin levels affected in TMJ dysfunction. Oil may be applied to the skin over the joint. Oral dose is 250 mg three times a day.
bulletCramp bark (Viburnum opulus) and lobelia (Lobelia inflata) are antispasmodic. Rub 5 drops tincture of each herb into joint. Do not apply to broken skin.

Homeopathy

An experienced homeopath could prescribe a regimen for treating TMJ dysfunction that is designed especially for you. Some of the most common acute remedies are listed below.

bulletCausticum for burning pains
bulletHypericum perforatum for sharp shooting pains
bulletIgnatia for tension in the jaw
bulletKalmia for face pain especially with other joint pains or arthritis
bulletMagnesia phosphorica for muscle cramps
bulletRhus toxicodendron for pains that feel better in the morning and in dry weather and worse after movement or in wet weather
bulletRuta graveolens for pains from overuse or injury

Acute dose is three to five pellets of 12X to 30C every one to four hours until symptoms are relieved.

Physical Medicine

Contrast hydrotherapy—alternating hot and cold water applications—may decrease inflammation provide pain relief and enhance healing. Use hot packs and ice wrapped in a wash cloth and apply to area. Alternate three minutes hot with one minute cold and repeat three times for one set. Do two to five sets per day.

Acupuncture

Acupuncture may help decrease spasm and reduce the frequency and intensity of symptoms.

Massage

Certain types of massage techniques and chiropractic manipulation may help decrease muscle spasms provide pain relief and prevent recurrence of symptoms.

Prognosis/Possible Complications

TMJ dysfunction is treated successfully in 75 percent of patients who follow a multifaceted treatment plan. In rare cases prolonged teeth clenching or grinding trauma infection or connective tissue disease may result in degenerative joint disease or arthritis. If you experience severe grinding you may benefit from nighttime use of a bite guard worn inside your mouth.

Following Up

You may need to see your provider regularly to ensure the prescribed therapies are working for you.

Supporting Research

Challem J. TMJ pain may be aggravated by free radicals relieved partly by anti-oxidants. The Nutr Reporter. 1998.

Crider AB Glaros AG. A meta-analysis of EMG biofeedback treatment of temporomandibular disorders. J of Orofacial Pain. 1999;13(1):29-37.

Dambro MR. Griffith's 5-Minute Clinical Consult. 1999 ed. Baltimore Md: Lippincott Williams & Wilkins Inc.; 1999.

Ernberg M Hedenberg-Magnusson B et al. Pai allodynia and serum serotonin level in orofacial pain of muscular origin. J Orofacial Pain. 1999; Winter 13(1):56-62.

Goroll A ed. Primary Care Medicine. 3rd ed. Philadelphia Pa: Lippincott-Raven Publishers; 1995.

Jagger RG Bates JF Kopp S. Temporomandibular Joint Dysfunction. Oxford England: Wright; 1994.

Koopman WJ ed. Arthritis and Allied Conditions. 13th ed. Baltimore Md: Williams & Wilkins Inc.; 1997.

Marbach JJ. Temporomandibular Pain and Dysfunction Syndrome. Rheum Dis Clin North Am. 1996;22(3).

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany Calif: Hahnemann Clinic Publishing; 1993:111-114 185-186 187-189 208-209 237 324-325 329-330.

Roberts J Hedges J ed. Clinical Procedures in Emergency Medicine. 3rd ed. Philadelphia Pa: W.B. Saunders; 1998.

Rosen P ed. Emergency Medicine: Concepts and Clinical Management. 4th ed. St. Louis Mo: Mosby-Year Book; 1998.