• The way your teeth meet when your top and bottom jaws close down on top of each other is known as your “bite”. If your teeth don’t fit together properly, you could have malocclusion or “bad bite”, which can cause problems with your teeth, gums, the temopromandibular joint (TMJ) and the muscles in your face.
  • This misalignment, often referred to as TMJ disorder, can also cause some people to clench the jaw and grind their teeth at night. This can lead to facial pain, head-aches, discomfort and clicking when biting or chewing, migraines as well as neck and shoulder pain, even back pain.
  • If you recognize any of these symptoms or suffer with these on a daily basis, you will need to see a dentist to treat your problems or refer you to a specialist if necessary.
  • In some cases, the treatment includes wearing a hard plastic appliance at night. This is made to measure and fitted onto your bite accurately, so that when you bite on it, your teeth are in a position where your muscles are relaxed. This also stops your teeth from becoming worn down by grinding and protects them. Depending on the origin and severity of your problems, you may need orthodontic treatment or maxillofacial surgery. Other solutions may include replacing missing teeth or adjusting any ill-fitting bridge work that you may have.
  • The important thing to do is see your dentist as soon as possible so your problem does not become worse over time and require more drastic measures to correct.


What is the temporomandibular joint?

The temporomandibular joint is the joint that connects the lower jaw (mandible) to the skull, and is located immediately in front of the ear on each side of the head.The joints are flexible,allowing up and down as well as side to side movements to be performed and enabling you to talk, chew and yawn. Muscles attached to and surrounding the jaw joint and lower jaw control the position and movement of the jaw.

What cause TMD?

Temporomandibular disorders (TMD) occurs as a result of problem associated with the jaw joint and surrounding facial muscles that control chewing and movement of the jaw. Injury to the jaw, temporomandibular joint, or muscles of the head and neck – such as from a heavy blow or whiplash – can cause TMD. Other possibilities include:
. Grinding or clenching the teeth, which overload the TMJ.
. Dislocation of the soft cushion or disc between the 2 bones.
. Osteoarthritis or rheumatoid arthritis in the TMJ.
. Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth.


What are the Symptoms of TMD?

People with TMD can experience severe pain and discomfort that can be temporary or last for many years. More women than men experience TMD and TMD is seen most commonly in people between the ages of 20 & 40.

Common symptoms of TMD include:
. Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak or open your mouth wide.
. Inability to open the mouth very wide.
. Jaws that “lock” in the open – or closed – mouth position.
. Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain)
. A tired feeling in the face.
. Difficulty chewing or a sudden uncomfortable bite – as if the upper and lower teeth are not fitting together properly.
. Swelling on the side of the face. Other common symptoms include toothaches, headaches, neckaches, dizziness, and earaches and hearing problems.

How is TMD Diagnosed?

A careful patient history and clinical examination to exclude similar symptoms resulting from toothache, sinusitis, arthritis or gum disease will be done.
The surgeon will examine your temporomandibular joints and associated muscles for pain or tenderness; listen for clicking, popping or grating sounds during jaw movement; look for limited motion or locking of the jaw while opening or closing the mouth; and examine bite and facial muscle function. Sometimes panoramic X-rays will be taken. These full face X-rays allow your surgeon to view the entire jaws, TMJ, and teeth to make sure other problems aren’t causing the symptoms. Sometimes other imaging tests, such as magnetic resonance imaging (MRI) or a computer tomography (CT) are needed. The MRI views the soft tissue such as the TMJ disc to see if it is in the proper position as the jaw moves. A CT scan helps view the bony detail on the joint.

What Treatment Are Available for TMD?

Treatments range from simple self-care practices and conservative treatments to injections and surgery. Treatment should begin with conservative, non-surgery therapies first, with surgery left as the last resort. Surgery does not guarantee resolution of symptoms.

Basic Treatment

. Apply moist heat or cold packs.
. Eat soft foods.
. Take the medications.
. Wear a splint or night guard.

Other Treatments

When the basic treatments listed above prove unsuccessful, your dentist may suggest one or more of the following:
Transcutaneous electrical nerve stimulation (TENS): this therapy uses low-level electrical currents to provide pain relief by relaxing the jaw joint and facial muscles. This treatment can be done at the dentist’s office or at home.
Ultrasound: Ultrasound treatment is deep heat that is applies to the TMJ to relieve soreness or improve mobility.
Trigger-point injections: Pain medication or anesthesia is injected into tender facial muscles called “Trigger points” to relieve pain.
Radio Wave Therapy: Radio waves create a low level electrical stimulation to the joint, which increases blood flow. The patient experiences relief of pain in the joint.
Surgery: Surgery should only be considered after all other treatment options have been tried and you are still experiencing severe, persistent pain.
Arthrocentesis: patients undergoing arthroscopic surgery first are given general anesthesia. The surgeon then makes a small incision in front of the ear and inserts a small, thin instrument that contains a lens and light. This instrument is hooked up to a video screen, allowing the surgeon to examine the TMJ and surrounding area. Depending on the cause of the TMD, the surgeon may remove inflamed tissue or realign the disc or condyle.
Open-joint Surgery: patients undergoing open-joint surgery also are first given a general anesthesia. Unlike arthroscopy, the entire area around the TMJ is opened so that the surgeon can get a full view and better access. There are many types of open-joint surgeries.

This treatment may necessary if:
. The bony structures that comprise the jaw joint are deteriorating.
. There are tumors in or around your TMJ.
. There is severe scarring or chips of bone in the joint. Compared with arthroscopy, open-joint surgery results in a longer healing time and there is a greated chance of scarring and nerve injury.