Banner Shape
Back

Dentistry/Orthodontics

The Dental Perspective to the Multiverse of Temporomandibular Joint Disorder

Dr William Lim
Share:

The term Temporomandibular Joint disorder (TMJD) may be a mouthful to enunciate but the management shouldn’t be so daunting. Individuals can suffer from the myriads of symptoms and have difficulty pinpointing the cause of their ailment. We hope to provide some clarity to this medical condition.

Definition

The Temporomandibular joints (TMJ) are the two points of connection between the lower jaw and the skull. They are one of the most complex joints in the body and are pushed and pulled by many sets of muscles for our daily activities such as talking, eating and yawning.

Temporomandibular joint disorder (TMJD or TMD) arises when one or more of these interlinking systems fail to run smoothly. It is considered a multi factorial condition and is broadly divided into three areas

Myofascial pain – These includes the muscles and their connective tissue covering around the mouth region but can extend to the temple region (headaches) and shoulders (neckaches).

Internal Derangement of the joints – The jaw might be stuck or have difficulty opening or closing when the soft tissue cushion of the joint is affected. The joint itself might be damaged due to increased  pressure on it.

Degenerative joint disease – If you have a history of osteoarthritis or rheumatoid arthritis your TMJ could be affected.

Do I have it?

This list is of signs and symptoms are not diagnostic for TMJD

(Please consult your physician or dentist for a proper diagnosis and management)

  • Waking up to a sore jaw
  • Stiffness in the muscles of the jaw, temple, neck and shoulder
  • Frequent headaches
  • Pain in the neck, shoulder, face
  • Clicking or popping of the jaw joints
  • Locked or difficulty in motion of the jaw
  • Ringing in the ear not caused by infection
  • Notable clenching or grinding of jaw
  • Severe wear of teeth

Shift in the way the jaw closes (teeth don’t feel align)

What causes TMJD/TMD?

Dietary habits with respect to chewing hard food can lead to TMD. Diets involving heavy chewing like nuts, meat or chewy vegetables might lead to repeated usage of the TMJ system causing fatigue.

Stress can be a major influence in the development of TMD. Exam stress, work stress or relationship stress can result in excessive clenching or grinding which will overload the system.

Nighttime grinding (Nocturnal Bruxism) is another habit that will cause TMD as the jaw is working overtime when you are asleep. The biting force during sleep can exceed that of daily chewing forces by more than 2 times and this severely damages the joints and teeth.

Maligned teeth (malocclusion) lead to unstable contact during chewing or closing of the teeth together. This situation puts stress on the TMJ system.

Sleep Apnoea is a medical condition which might potentiate TMD due to your sleeping position and jaw posture. Please discuss with your sleep Physician if you have symptoms of TMJD.

Traumatic injury to the TMJs can result in TMD. A fall or a knock might cause damage to the joint and soft tissue structures. The joints are vulnerable in this situation and any persistent pain after a trauma should be investigated.

 

Treatment can be divided into home based or physician based

Simple home-based remedies include

  • Eating soft food
  • Ice to reduce swelling
  • Limit jaw movements and mouth opening
  • Resting the TMJ
  • Relaxation techniques and stress management
  • Consciously not clenching the teeth
  • Posture training


If the above did not improve your condition, please reach out for a discussion on Medicine or pain relievers such as

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Muscle relaxers
  • Antidepressants

An oral appliance called a mouthguard to be worn in the mouth (to reduce teeth grinding)

Injections to affected muscles (eg local anaesthetic, Botulinum toxin) to eradicate pain of reduce the stress on the TMJ complex.

Joint arthrocentesis (Joint wash out) for treatment of the joint and internal soft tissue components.

This article is written by Dr William Lim.

He’s an Oral Maxillofacial Surgeon, and currently practices at Smileworks Surgical Suite at #09-18/19.

Previous ArticleNext Article