What is TMJD

TMJ pain and discomfort are often overlooked as a serious contributor to other ailments like tension headaches and jaw pain. Most people don’t even realize that they are experiencing mild symptoms of TMJD which can make diagnosis difficult in less severe to mild cases. Even though most instances of TMJ problems are short lived and can be resolved with conservative treatment options, there are times when TMJ dysfunction can cause serious pain and discomfort that will require more intensive treatment options.

It is important when treating TMJDs that specialized care is used to ensure that the proper diagnosis is received. If you or a loved one have been experiencing tension headaches, jaw pains, or other TMJ related pain, contact a Los Angeles TMJ specialist who can help find the best treatment option for you. Dr. Katayoun Omrani is the leading TMJ Pain specialist in Southern California and has helped thousands of patients overcome temporomandibular joint disorders. If you or a loved one is suffering from TMJ pain, contact Headache TMJ Los Angeles Pain Clinic today to schedule your consultation.

What is TMJ?

TMJDs (temporomandibular joint disorders) exist when there is temporomandibular joint dysfunction ^[1] caused by structural, muscular, or lifestyle issues. The TMJ acts as a hinge that connects the temporal bone to the lower mandible or jawbone. There’s a TMJ on each side of the head which sits right in front of the ear. Each joint is connected by muscles that help control the movement of the jaw. When they work together, they help chew, talk, and open and close our mouths.

Both of these joints can become dysfunctional which can lead to disorders of the TMJ which causes discomfort and pain in the moving parts of joints and muscles.

TMJ Treatment

TMDs are usually transient and self-limiting; therefore, there is no need for complicated and irreversible procedures. The main objectives in TMD treatment are pain reduction or elimination and resumption of normal mandibular activity. By addressing the physical disorder and perpetuating factors through a structured and time limited program, these goals could be simply met. The five basic general principles of TMD managements include:

Patient Education & Self Care

The primary objective for satisfactory management of TMD is explanation and reassurance for the patient. Most often persistent noise in the TMJ is interpreted as a sign of disease and it may be difficult for the patient to accept that joint noise is very prevalent and may occur in otherwise healthy joints. The home care program should include instructions like avoiding chewy foods, performing jaw stretching exercises, applying moist heat or ice, and not clenching teeth during the day. These simple modifications may be sufficient to alter symptom intensity.

TMJD Medications

Medications are employed to control the TMD symptoms by promoting patient comfort and healing. These include:

• Non-steroidal anti-inflammatory drugs (NSAIDs): Drugs like Aleve, Advil and Ibuprofen are over the counter and be taken to relive pain. There are stronger dosages that would require a prescription.
• Muscle relaxers: These drugs are effective for people suffering from TMJ pain that is caused by muscle spasm and clenching and grinding teeth too hard. Flexeril, Zanaflex, Baclofen, Skelaxin and Robin are a few of the used muscle relaxants.
• Tricyclic anti-depressants: Drugs like Nortriptyline or Amitriptyline in low doses can also help reduce and control pain.
• Corticosteroids – They can be used orally, or they can be injected to help relieve tmj pain.

TMJD Therapies

• Counseling: Gaining a deeper understanding of the different contributing factors and behaviors that can contribute to TMJ can help people avoid them. Actions that can be avoided include grinding teeth, biting fingernails, or clenching your jaw.
• Cognitive Behavioral Interventions: The primary objective for satisfactory management of TMD is explanation and reassurance for the patient. Most often persistent noise in the TMJ is interpreted as a sign of disease and it may be difficult for the patient to accept that joint noise is very prevalent and may occur in otherwise healthy joints. The home care program should include instructions like avoiding chewy foods, performing jaw stretching exercises, applying moist heat or ice, and not clenching teeth during the day. These simple modifications may be sufficient to alter symptom intensity.
• Physical Therapy: Physical therapy ^[2] includes posture, stretching and strengthening exercises, joint mobilization and the use of modalities like vapocoolant spray and stretch, trigger point injections, hot packs, ice, ultrasound or other stimulating techniques. Treatment goal is to decrease pain and improve joint movement by altering nociceptive sensory input, reducing inflammation, coordinating and strengthening muscle activity and promoting tissue regeneration. 

Occlusal Appliances for TMJD

Occlusal appliance therapy has been the mainstay of TMD therapy. Occlusal appliance used in TMD are controversial but the use of stabilization appliances are reported to be the most effective with the least adverse effects.

• Stabilization appliances are made of hard cured acrylic and should cover the entire maxillary or mandibular teeth. The potential benefits of the appliance use are protecting teeth, providing joint stabilization, redistributing forces on the joint surface, relaxation of masticatory muscles and reducing par functional habits.
• Anterior repositioning devices holds the lower jaw in a forward position. When compared to stabilization appliances, they are equally or effective in managing TMJ clicking and locking. The long-term use (more than 3 months) of these appliances may lead to occlusal changes; therefore, they are to be used with caution.
• Nociceptive Trigeminal Inhibition Reflex (NTI) devices are another appliance that is popular. However, potential side effects like swallowing, possible aspiration, tooth movement, and bite changes make this appliance unattractive.

Botox for TMJ

Botox has been used to treat bruxism (teeth clenching/grinding) and jaw pain since the 1990s. Botox use for TMJD is off label but has been one of the most effective treatment modalities. Typically, the effect of Botox lasts for 12-16 weeks. The medication is usually injected into the masseter and temporalis muscles using 20+ units.

Plasma Rich Platelet (PRP) Injections

Plasma Rich Platelets (PRP) therapy is a revolutionary treatment gaining widespread recognition for its effectiveness in treating conditions like TMJ (temporomandibular joint disorder). This innovative approach utilizes the patient’s own blood to accelerate healing and reduce pain. In PRP therapy, a small sample of the patient’s blood is processed to concentrate platelets, which are crucial for blood clotting and tissue healing. The resulting plasma-rich platelets contain a high concentration of growth factors and healing agents. When injected into the affected area, these platelets stimulate the body’s natural healing processes which often leads to significant improvements in conditions that were previously unresponsive to conventional treatments.

Surgical Treatments for TMJD

Since TMD is self-limiting, invasive surgical interventions are rarely warranted. However, after all other less invasive treatment options fail, surgery may be the last possibility to get relief.

• Injections: Corticosteroid injections can relieve pain in the jaw associated with TMJ disorders. Most patients respond to a simple joint injection with corticosteroid. However, with repeated corticosteroid injections condylar damage is reported.
• Arthrocentesis: The surgery is minimally invasive and injects fluids into the TMJ that wash out debris that may be causing inflammation. Intraarticular irrigation of the joint with lactated Ringer’s solution or normal saline is very helpful in reducing TMJ pain and improving range of motion.
• TMJ Arthroscopy: Arthroscopic surgery can be an effective treatment option for TMJ disorders. This generally results in a small thin tube that is inserted into the joint, where surgical instruments can be used for surgery. This option is less invasive with less complications than open joint surgery.
• Modified Condylotomy: This surgery works on the mandible instead of the actual joint itself. It may help relieve pain and reduce the chance of locked jaw.
• Open Joint Surgery: When all other treatments fail, open joint surgery can replace or repair the joint to address any structural problems. This does come with its own set of limitations as should be considered after hearing the potential risks involved. The open joint surgery is performed less frequently and is indicated for more complex disease or traumatic conditions.

If surgery becomes the necessary treatment option to finally treat your TMJDs, be sure to discuss the potential benefits to risks. It is important that you truly understand each of the options before making a decision.

Home Remedies for TMJD

• Apply hot / cold packs: Using a strategy of cooling the TMJ with a cold pack for 10 minutes followed by stretching and then applying a warm pack for 5 minutes should help reduce inflammation and improve blood flow which can help reduce pain.
• Eat soft foods: Eating foods that don’t require a lot of chewing can help prevent the jaw from being overworked. Lots of chewing can lead to muscle soreness and can aggravate muscle trigger points.
• Stretching your jaw: Explore stretches ^[3] that can help your TMJD with your doctor or dentist and practice those movements to strengthen your jaw muscles.
• Massage the TMJ: Gently massaging your jaw muscles can relieve tension and pain.

Alternative Medicine for TMJD

• Acupuncture: An acupuncturist can help relieve pressure and pain by inserting thin needles into trigger points around your body called meridians.
• Relaxation techniques: Slowing your breathing ^[4] and meditating to relax can help reduce muscle tension that causes pain.
• Biofeedback: Using biofeedback tools can help pinpoint what areas of the body are causing pain. This is particularly important when dealing with referral pain.

Exercises for TMJ Pain Relief

Doing some simple exercises can have a large impact on range of movement which can help alleviate TMJ pain. Strengthening and stretching jaw muscles will help increase jaw mobility and reduce jaw clicking. That being said, exercises should be done with the support and guidance from your primary care physician to ensure that exercises and stretches are at a level that won’t aggravate any TMJDs.

Types of TMJ Disorders

TMJ disorders can typically be segmented into one of 3 different disorders:

• Myofascial Pain: This is categorized by muscle pain which is aggravated by trigger points and muscle tension. This is generally felt in the upper torso and head and can involve localized and referred pain. This is often times triggered by muscle strain which can lead to TMJ headaches
• Internal Derangement of TMJ: This is a more severe injury which occurs when the jaw gets dislocated and involves disc displacement.
• Arthritis: This disease results in joint inflammation and can affect many other parts of the body. There are several varieties of arthritis that can impact the TMJ, including rheumatoid arthritis, osteoarthritis, traumatic arthritis, synovitis, and infection arthritis.

TMJ Causes

Your temporomandibular joint (TMJ) is the hinge that connects your jawbone to your skull. TMJ pain is usually caused by dysfunction in the muscles and bone structure but pinpointing the cause of a TMJ disorder ^[5] can be difficult to identify. Your pain can be the result of everything from injury to arthritis and even poor genetics. Jaw pain in the temporomandibular joint can also be triggered by severe grinding of the teeth (bruxism) or clenching of the jaw. The following can all trigger or exacerbate TMJ disorder symptoms:

• Poor teeth health resulting in damaged or lost teeth
• Lost teeth that have led to mandibular damage or poor alignment
• Severe overbite / underbite
• Teeth grinding / jaw clenching
• Strenuous chewing
• Damaged or injured joint
• Arthritis
• Myofascial pain syndrome
• Infections
• Tumors / growths
• Worn down cartilage in the TMJ

TMJ Symptoms

TMJD symptoms ^[6] are generally mild and temporary but still include:

• Pain around either of the temporomandibular joints
• Tenderness around the jaw when opening and closing your mouth
• Throbbing pain in your ears
• Chewing becomes difficult to do without minor discomfort or pain
• Facial muscles ache
• Lock jaw which can impede chewing, talking, and opening or closing your mouth
• Clicking or grinding sound that can be felt when your mouth is opened
• Pain that can feel much like a toothache in the rear molars
• Ringing or popping of the ears
• Mild to severe tension headaches
• Blurry vision or blind spots
• Tight, sore neck or upper back muscles
• Muscle spasms in the jaw
• Numbness in the face or jaw area
• Pain or swelling around the temple
• Dizziness or vertigo

Some of these symptoms exist without pain or discomfort which could still indicate a TMJD. That being said, TMJD do not always require treatment if quality of life is not impacted.

TMJ Risk Factors

There are several groups of people who either by lifestyle or demographic are more likely to have TMJDs.

• People with poor posture are more likely to have neck muscle strain which may lead to dysfunctional jaw motions.
• People who live high stress lives may have increased muscle tension, nail biting, and jaw clenching.
• Women 18 – 44 have a higher tendency to develop TMJDs.
• People with previous injuries to their jaw or badly malformed teeth that require extensive orthodontics may also be prone to TMJDs.
• People with higher sensitivities to pain and stress may also be more susceptible to different TMJD triggers.

TMJ Diagnosis

Temporomandibular joint dysfunction is usually found and diagnosed during standard medical / dental exams. During these exams, your primary care physician or dentist will:

• Feel your TMJ as you perform normal functions like imitate chewing, talking, and opening and closing your mouth.
• Physically examine the muscular structures of your face to find tenderness and pain points.
• Monitor and observe the range of movement and motion when the mouth is opened and closed.

If a problem is identified, additional X-rays can be used to examine the TMJ and see if there is any other damage being caused that could explain the pain and discomfort. The different scans include:

• MRI scans: Magnetic Resonance Imaging can see the soft tissues around skeletal systems. These MRIs will show any inflammation, jaw dysfunction while moving, and the positioning of the muscular and skeletal systems. This will generally show the condition of the TMJ and if it is functioning as expected.
• Panoramic X-rays: This is the type of X-ray that you will find in most dentists’ offices with an overview of the top and bottom rows of teeth, your mandibular, and the TMJs.
• CBCT scans: Cone bean computed tomography will take thousands of cross section snapshots of your face including your teeth, facial structures, sinuses, and jaws. These images are assembled to create a 3-D image that can provide an extremely detailed view of any problematic areas.

Preparing For Your TMJD Appointment

When speaking to a doctor or dentist about TMJ pain, there are a few things you can do to prepare prior to your appointment to ensure that you are properly informed and takeaway the information that you need to successfully treat your TMJD.

Be Prepared with Responses to General Questions About TMJ

• When did TMJD symptoms begin?
• Has this been a recurring problem or is this a new problem?
• Have there been any lifestyle triggers like increased stress or anxiety?
• Are frequent headaches, neck aches, and toothaches normal?
• What medications, both pharmaceuticals and over the counter, are taken regularly?
• Is TMJ pain persistent or come and go?
• Are there any specific activities that seem to trigger TMJ pain or discomfort?
• Does the jaw function without clicking or locking when opened and closed?
• Is normal jaw function difficult or strained?

Having responses prepared for these types of questions will help your doctor or dentist with their diagnosis. Based on the responses to the question above, there may be additional questions asked that will help determine what may be causing the TMJ problems and how to best provide relief.

TMJD Prevention Tips

TMJD symptoms can be regulated with some prevention tactics that have proven successful in mitigating TMJ pain and discomfort. Symptoms are also episodic which can be exacerbated by stress, anxiety, and poor lifestyle choices. Following some simple tips can greatly reduce the chances that TMJD will be aggravated to the point of discomfort.

• Choosing softer food options will help reduce strain on the TMJ which can relieve TMJ tension. This includes avoiding things like chewing gum and hard or crunchy foods.
• Take smaller bites that requires a smaller range of movement and less chewing overall.
• Taking steps to improve posture will reduce strain on connective muscle tissues that connect shoulder, back, and neck muscles to the muscular structures of the face and TMJ.
• Practice relaxation techniques designed to reduce stress and anxiety like meditation, going on walks, breathwork, or aromatherapy.
• Using dental guards to help support proper TMJ alignment and reduce teeth grinding and jaw clenching.
• Using mouth guards when doing activities that could result in jaw injuries like during exercise or sports.

Contact an Experienced TMJD Doctor to Schedule an Appointment

If you or a loved one have experienced TMJ pain or discomfort call Dr. Kathy Omrani to schedule an appointment today. Dr Omrani has specialized in orofacial pain so she can help diagnose TMJDs and create a custom treatment plan that is designed to effectively reduce and eliminate TMJ pain and discomfort.

Sources

[1] https://www.nidcr.nih.gov/health-info/tmd

[2] https://www.nm.org/conditions-and-care-areas/rehabilitation-services/temporomandibular-joint-tmj-therapy

[3] [4] https://www.medicalnewstoday.com/articles/317871

[5] [6] https://www.cedars-sinai.org/health-library/diseases-and-conditions/t/temporomandibular-joint-disorder.html

Temporomandibular Joint Disorder FAQ’S

What is the best way to get rid of TMJ?

Since TMJ pain is usually episodic, using home remedies is the first thing that should be attempted to alleviate TMJ pain or discomfort. These strategies include alternating between hot and cold packs to reduce inflammation and soreness, taking over the counter pain killers, adjusting diet and activities, and using a mouth guard for additional support.

Can TMJ go away on its own?

TMJD can be problematic but can also go undiagnosed for a long time because symptoms may not be severe enough to affect quality of life. In those instances, minor TMJ discomfort often goes away without treatment as long as the TMJ isn’t constantly being aggravated.

What is the most common treatment for TMJ?

The most common treatment options for TMJ are generally the options that are the least invasive. After home remedies and over the counter medicines are applied, the most common treatment is most likely using occlusal appliances like bite guards to help support proper TMJ alignment and prevent actions that trigger TMJ discomfort.

What causes TMJ to flare up?

There are several factors that can trigger TMJ pain and discomfort. The most common triggers include stress responses like jaw clenching or teeth grinding, hormonal changes, strenuous activity that causes TMJ muscle tension.