Painful Problem – TMD Causes Discomfort, Dysfunction in Jaw, Mouth

Dr. Matthew Haluch recently had a patient come to his office who could only open her mouth the width of her index finger.
“Her muscles were in spasm,” said the co-owner of Baystate Dental, adding that she was diagnosed with TMD, or temporomandibular joint disorder.
TMJ and TMD are umbrella terms used to cover pain and dysfunction of the muscles that move the jaw and the temporomandibular joints that connect the jawbone to the skull. The disorder affects approximately 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the U.S. population, twice as many women as men, and can cause a multitude of symptoms.
However, Dr. Michael Kelliher of Flagship Dental Group in Longmeadow says many people who come to his office in pain and tell him they have TMJ have never been diagnosed with the problem.
“The vast majority have a muscular issue that results from clenching and grinding their teeth, which is more common and easier to treat than true TMJ,” he said, explaining that the latter is caused by trauma, genetics, or arthritis in the joint or disc that sits between the jawbone and the skull and can cause debilitating pain.
The temporomandibular joints and jaw muscles on each side of the head make it possible to open and close the mouth. They work together whenever a person chews, speaks, or swallows; include ligaments and the jawbone; and control the lower jaw and allow it to move forward, backward, and side to side.
Each joint also contains a disc that acts as a cushion between the ball and socket and permits the jaw to open wide, rotate, and glide. They usually work in harmony, but when an imbalance occurs and causes the bite to get out of line, it can be painful.
“TMD can cause headaches on one side that feel like migraines and cause fatigue in the jaw from chewing, ringing in the ears, worn or broken teeth, clicking or popping of the jaw, and tingling in the fingers due to nerve involvement,” Haluch said, adding that the headaches are sometimes misdiagnosed as migraines. The disorder, which is also known as myofascial pain dysfunction, can also cause aching in or around the ear, tenderness in the jaw, or difficulty opening and closing the mouth.
In many instances, the discomfort people feel is temporary, and the pain goes away without any treatment. But in others, it can be chronic and lead to significant problems, so it is critical for people to visit their dentists to determine the actual cause and prevent further episodes.
Kelliher said the first thing he does is ask the person where their pain is. If it is near the ear and if he can feel crunching when he palpitates the joint near the ear and the person opens and closes their mouth, it indicates the person may have a problem with the joint itself.

Cause and Effect
The Mayo Clinic says the cause of TMJ can be difficult to determine, but it can result from genetics, arthritis, an accident that causes injury to the teeth or jaw, biting or chewing something the wrong way, poor posture, and stress that causes the person to tighten their facial and jaw muscles or clench their teeth. When that happens, it can set up a cycle of pain and muscle spasms. In addition, a bite that is off can cause people to clench and grind their teeth and, over time, can lead to cracked teeth, tooth loss or TMJ.
Extensive dental work that requires the person to have their mouth open wide long periods of time can also cause myofascial pain, and orthodontic work that moves the teeth in a way that is not in alignment with the joints and connecting structures can be problematic.
The National Institute of Dental and Craniofacial Research recommends a number of things people can do to try to alleviate TMD pain. They include eating soft foods; applying ice packs; avoiding extreme jaw movements such as wide yawning, loud singing, and gum chewing; and learning relaxation and stress-reduction techniques.
But if these measures fail, it’s important to see a dentist. “There could be a very simple fix for the problem,” Kelliher told HCN.
In most cases, Haluch said, the key to pain relief is to get the muscles to relax — and muscle relaxants may be needed. He also uses neuromuscular dentistry to correct TMJ problems, produce a balanced bite, and establish a “physiologic rest position” for the jaw.
The process can include using a TENS (transcutaneous electrical nerve stimulation) machine that serves as an alternative to painkilling medication. A treatment takes about an hour and sends stimulating pulses across the skin and along the nerve strands that help prevent pain signals from reaching the brain, and also help the body produce higher levels of its own natural painkillers, or endorphins.
Kelliher and Haluch also treat pain by creating a stabilization splint or bite guard, which is a plastic guard that fits over the upper or lower teeth and is worn while the person sleeps. It provides a cushion between the upper and lower teeth and prevents grinding. “It is the first line of defense,” Kelliher said.
Other treatments to relieve pain include massage, Botox treatments that paralyze and relax the muscles, and physical therapy. Gentle jaw stretching and specific exercises taught during physical therapy sessions can also help to increase jaw movement.
But if a bad bite has led to the problem, it is critical to fix it, Haluch said. “A bad bite can do a lot of harm. If it is not corrected, it can damage the teeth and the jawbone, and result in chronic pain.”
That may involve replacing missing teeth and crowns or veneers. Orthodontic work may be needed, as it corrects the relationship between the upper and lower teeth and eliminates the tension that occurs in the muscles as a result of teeth hitting together incorrectly.

Bottom Line
An advanced form of technology called tomography can measure the function of the jaw muscles and movement of the jaw bone, and there are special clinics that treat TMJ, such as the Tufts University School of Dental Medicine Geld Center, which is devoted to the diagnosis and management of temporomandibular disorders and chronic head, neck, and facial pain.
Kelliher has sent patients there, but both he and Haluch urge people to visit their own dentist when they have a problem.
TMD pain can almost always be resolved, but it takes a dentist to determine the best way to treat it and prevent it from reoccurring.