Pain and the TMJ (Jaw Joint)

What is the TMJ ?

You may not have every heard of it, but you use it hundreds of times every day. It is the temporomandibular joint, the joint where the mandible (lower jaw) joins the temporal bone of the skull, immediately in front of the ear on each side of the head. Each time you chew, you move it. But you also move it every time you talk and every time you swallow (every three minutes or so). It is, therefore, one of the most frequently used of all the joints in your body.

You can locate that joint by putting your little finger into the ear canal with your fingernail facing backward and pressing forward as you open and close your jaw. The motion you feel is the TMJ.

How Does the TMJ Work?

When you bite down forcefully, you not only put force on the object between your teeth, but also on the joint. In terms of physics, the jaw is the lever and the TMJ is the fulcrum. Actually, more force is applied (per square inch) to the joint surface than to whatever is between your teeth. To accomodate for such forces, and to prevent too much wear and tear from occurring in one spot within the joint space, the joint was designed to be a sliding joint, rather than the usual ball-and-socket type joint (such as the hip or shoulder). Joints are lined with cartilage, which is a rubber, slippery material that allows for smooth motion.

Therefore, the forces of chewing can be distributed over a wider surface in the joint space, which dissipates the wear and tear and allows healing to rapidly occur between chewing times.

How Can Things Go Wrong with the TMJ ?

If you habitually clench, grit or grind your teeth, you increase the wear on the cartilage lining of the joint. If your dentures are not properly aligned, increased wear and tear also occurs. Many people grind their teeth and they do not know it unless an observant roommate tells them so. If you chew gum frequently, you increase the wear and tear on the joint and you give it little opportunity to recover between meals as it ought to have. If you chew habitually only on one side of your mouth, or if your dentures are misaligned, you concentrate all the pressure on one side rather than equally on both sides and too much wear occurs on the joint of that side. This often occurs if there is a tooth problem on one side, or recent dental work that causes you to favor one side over the other.

Teeth that do not fit together properly are often at fault. This is called improper “bite.” Imagine how much extra pressure the TMJ must endure during each chew when teeth on one side come together before those on the opposite side.

In each of the above circumstances, a faulty chewing pattern takes place that creates one focus of wear in the cartilage lining of the joint space. When that spot wears down to nerve endings, pain occurs. A form of arthritis occurs (traumatic type) which is called TMJ dysfunction (dysfunction means faulty or painful function).

How Does TMJ Dysfunction Feel?

The pain may be sharp and searing, occurring each time you swallow, yawn, talk or chew; or it may be dull, constant and boring. The usual focus of pain is over the joint, immediately in front of the ear; however, pain can also radiate elsewhere. The pain often causes spasm in the adjacent muscles which are attached to the bones of the skull, face and jaws. Therefore, pain can be felt at the side of the head (the temple), the cheek, the lower jaw, the teeth, behind the ear, and even the neck. Some people have attributed sinus disease, migraine and backaches to the TMJ, but that would be difficult to explain with our present-day knowledge of anatomy and physiology.

A very common focus of pain is the ear. Many patients come to an ear specialist quite convinced that their pain is from an ear infection. When an earache is not associated with a hearing loss, and the ear drum looks normal, the doctor will consider the possibility that the pain comes from TMJ dysfunction.

There are a few other symptoms besides pain that TMJ dysfunction can cause. In some patients the TMJs make popping, clicking or grinding sounds when the jaws are opened widely. They can lock wide open (dislocate), or at the other extreme, they can prevent the jaws from fully opening up. Some people get ringing in their ears from TMJ trouble, which is an exaggeration of the ear-ringing that people can normally produce by clenching their teeth hard.

What Can be Done for T M J Dysfunction?

If yours is a mild case, or one that has been detected fairly early, it will probably respond to these simple remedies:

  1. Chew evenly, left vs. right.
  2. Try to stop clenching, gritting or grinding your teeth.
  3. Stop chewing gum.
  4. Avoid hard chewy foods.
  5. Apply heating pad for ½ hour at least twice daily.
  6. Take aspirin (or buffered aspirin), or Ibuprofen (or Tylenol® if you cannot take either of the first two) three to four times daily for one week, then as needed for pain.

Items 1 to 4 are intended to reduce the amount of wear and injury that the joint suffers. Items 5 and 6 are to encourage the healing process. Aspirin and other anti-inflammatory medicines such as Ibuprofen are very effective for reducing inflammation in the joints, which is why patients use them for arthritis. They are very effective for TMJ dysfunction as well. Checking for dental problems and re-adjusting your bite can help.

Stubborn cases of TMJ dysfunction may require further consultation with an oral surgeon or dentist. Your dentist can fit you with a splint to open your bite and decrease bruxism (grinding your teeth while sleeping).

TMJ dysfunction is frequently a chronic condition which will come and go with time; however, by incorporating these recommendations into your lifestyle you will ensure that your symptoms are kept to a minimum.

If you have any questions or problems, please contact our office at (937) 325-8796 or toll-free at 1-800-325-8796