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TMJ at All Smiles

Temporomandibular joint (TMJ) syndrome is a disorder of the jaw muscles and nerves caused by injury to the temporomandibular joint. The temporomandibular joint is the connection between the jawbone and the skull. The injured temporomandibular joint leads to pain with chewing, clicking, crackling, and popping of the jaw, swelling on the sides of the face, nerve inflammation, headachesmigraines, tooth grinding (bruxism), Eustachian tube dysfunction, and sometimes dislocation of the temporomandibular joint. Temporomandibular joint syndrome is also known as temporomandibular joint disorder.

What are the signs and symptoms of TMJ syndrome?

The main symptom of TMJ syndrome is pain in the jaw joint. This joint is located just in front of the ear, and pain associated with TMJ syndrome may involve the face, eye, forehead, ear, or neck. Signs and symptoms of TMJ syndrome include the following:

• Pain or tenderness in the jaw, especially at the area of the joint
• Popping/clicking of the jaw
• Pain that feels like a toothache
• Ear pain or sounds of cracking in the ears
• Ringing or popping sounds in the ears (tinnitus) or a sense of fullness in the ears
• Headaches, including migraines
• Blurred vision
• Tight, stiff, or sore jaw or neck muscles

• Muscle spasms in the jaw
• Facial pain, mouth pain, jaw pain, cheek pain, or chin numbness or tingling
• Pain at the base of the tongue
• Pain, swelling, or a lump in the temple area
• Difficulty chewing
• Shoulder pain
• Locking or dislocation of the jaw (usually after widely yawning), referred to as lockjaw
• Dizziness or vertigo

What is the treatment for TMJ syndrome?

Many symptoms of TMJ syndrome can respond well to home remedies for stress reduction and relaxation techniques. The following home remedies may provide some relief:
•Ice or cold packs to the area of the joint
•Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve), and other pain relievers, including aspirin (Ecotrin) and acetaminophen(Tylenol)
•Eating soft foods and avoiding chewing gum
•Massage or gentle self-stretching of the jaw and neck muscles (A doctor or physical therapist can recommend appropriate stretches.)
•Relaxation techniques and stress management and reduction.

Home Remedies

When home remedies are not effective, medical treatment options may be necessary. Most of these types of treatments and remedies will not cure TMJ, but they can provide temporary and even long-term relief from the pain symptoms. These include the following:
•Dental splint (occlusal splint or stabilization splint or bite guard), which is a dental appliance placed in the mouth that keeps the teeth in alignment and prevents tooth grinding. This resembles a mouth guard and is usually prescribed and fitted by a jaw specialist.
•Botox may be used to relax the muscles of the jaw. However, this is not currently an FDA-approved treatment for TMJ syndrome.
•Physical therapy with jaw exercises can strengthen muscles, improve flexibility, and range of motion.
•Biobehavioral management (biofeedback, cognitive behavioral therapy [CBT]) may help diminish pain intensity.
•Trigger point acupuncture can sometimes be helpful.

In severe cases, surgery on the jaw or dental surgery may be necessary.
•TMJ arthroscopy or arthrocentesis is a minimally invasive procedure usually done in an outpatient setting. Recovery time for this procedure is about a week.
•Sometimes a total joint replacement is needed. This generally requires a stay in the hospital for several days, and surgery recovery time is four to six weeks.
•The following prescription-strength medicines may be used to treat TMJ:
•Muscle relaxers: metaxalone (Skelaxin), cyclobenzaprine (Flexeril)
•Anti-inflammatory medications: nabumetone (Relafen), meloxicam (Mobic), celecoxib (Celebrex)
•Steroid injections: beclomethasone (Qvar)
•Tricyclic antidepressants: nortriptyline (Pamelor), amitriptyline (Elavil, Endep), and desipramine (Norpramin), imipramine (Norfranil, Tipramine, Tofranil)
•Benzodiazapines: diazepam (Valium), clonazepam (Klonopin), alprazolam (Xanax)
•Sleep medications: doxepin (Silenor)
•Nerve pain medications: gabapentin (Neurontin), topiramate (Topamax), levetiracetam (Keppra), pregabalin (Lyrica)

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