Temporo-Mandibular Joint Disorder (TMJ)
The jaw meets the upper skull in front of the ear at a joint called the temporomandibular joint (TMJ). The initials refer to the joint itself and does not refer to a diagnosis. You may hear the term TMD, which stands for temporomandibular disorders, which represents a group of TMJ disease states, often painful, that affect the TMJ and the muscles that control chewing.
Noises due to the TMJ are extremely common and often confused as coming from the ear. Such noises include popping, clicking, tinnitus (ringing in the ears), and pulsations. However, sometimes pain or difficulty in opening or closing the mouth accompanies the noises and is the main reason which triggers a physician visit. A strain or injury to the TMJ or increased tightness/stiffness of the jaw muscles can cause these problems. The injury can be the result of a specific trauma to the jaw area or can result from prolonged microtrauma from oral habits. Once a joint is strained, it can be easily re-injured (like a sprained ankle which is subsequently more prone to injury). Because we use the jaw for so many activities (talking, eating, yawning, laughing, etc), the joint is constantly being moved. Therefore, TOTAL relaxation of the TMJ and surrounding muscles is difficult. Holding the jaw muscles and joints in a relaxed position is, however, very manageable with practice. Regular attempts to relax the jaw muscles and avoidance of activities that would overwork the area will be helpful to reduce the pain and prevent additional strain to the area. The following suggestions will help you diminish your pain.
1. Apply moist heat for 20 minutes 2-4 times each day to the painful area (microwave a wet towel for about 1 minute or until towel is very warm… you can also wrap this moist towel around a hot water bottle to keep it warm longer). Also, you may spend some extra time in the shower letting the hot water flow over your painful areas. If moist heat is not helpful, you can try using ice wrapped in a thin washcloth for 10 minutes 2-4 times each day. Keep ice on the painful area only until you first feel some numbness. Heat or ice can reduce joint or muscle pain and relax the muscles.
2. Eat a soft diet. Avoid hard foods such as French bread or bagels. Avoid chewing foods, such as steak and candy. Cut fruits and steam vegetables and cut them into small pieces. Chew with your back teeth rather than biting with your front teeth. DO NOT CHEW GUM!
3. Chew your food on both sides at the same time to reduce strain on one side.
4. TONGUE UP AND TEETH APART – The teeth should never be touching (except occasionally they touch lightly with swallowing). We suggest that you closely monitor your jaw position during the day (waking hours) so that you maintain your jaw in a relaxed, comfortable position. This involves placing the tongue lightly on the top of your mouth behind your upper front teeth, allowing the teeth to come apart and relaxing the jaw muscles. An easy way to accomplish this is to say the letter “N” to yourself. This puts the tongue in the position we described. You may even consider putting the letter “N” on a post-it note in your visual field at work or in the car to help you become aware of your jaw position and to remind you not to clench your jaws together (IE: your computer monitor or car dashboard).
5. Avoid caffeine. Caffeine is a muscle contracture drug and can make your muscles tighter. Caffeine or caffeine-like drugs are in coffee, tea, soda, and chocolate.
6. Avoid oral habits that put strain on the jaw muscles and joints. These include teeth clenching, teeth grinding (bruxism), teeth touching or resting together, biting cheeks, tongue pushing against teeth, and jaw tensing. These also include biting fingernails, pens, or pencils, or your lips.
7. Avoid resting your jaw on your hand.
8. Avoid activities which involve wide opening of the jaw (yawning, prolonged dental treatments, etc) for a period of time until the pain as been reduced. If you must have dental work, tell your dentist you are having TMJ pain and ask for breaks in which you can close your mouth and rest the muscles and joints.
9. Avoid stomach sleeping since this puts adverse forces on the jaw and neck muscles. Also, avoid sleeping solely on one side. The best sleeping position to reduce facial pain is on your back. You are not as likely to clench or grind when sleeping on your back.
10. Use non-steroidal anti-inflammatory and pain reducing medications such as ibuprofen or Motrin to reduce joint and muscle pain.
11. Some patients with muscle pain and tightness may also benefit from specific exercises. Your doctor will let you know if you should try these exercises. The exercises we recommend are described below. If these exercises cause an increase in your pain, stop doing them and let us know at your next appointment.
Finger/knuckle exercise: This is an exercise to help stretch the masseter muscles that open and close your jaw. These muscles are located in your cheeks and you can feel them when you bite down. Open your mouth as wide as you are comfortable and insert two to three fingers or knuckles. Rest them on your upper teeth but do not allow your lower teeth to touch them. Hold your mouth open in this position for 5-10 seconds. Then close and relax. Repeat this 4-5 times. Try to do this stretch at least 4 times per day. If you are able to open wider with time, then insert another finger or knuckle. If you are also using moist heat on your muscles, do this stretch after applying the moist heat.
Neck stretches: To do this stretch, lean your head to one side, as if you are trying to touch your ear to your shoulder. The muscles in the opposite side of your neck are stretched. Hold for about 5 seconds. Then lean your neck to the other side. Finally, lean your head forward and stretch the muscles in the back of your neck. You may want to support your head with your hand. Repeat in each directions a few times. Try to do this 2-4 times per day. This stretch may help your facial pain because tight neck muscles contribute to tightness in facial muscles.
Please recognize that this is not a life-threatening situation, even though it can be very uncomfortable. Injury to the TMJ and jaw muscles is common. Joint noises (clicks, pops) and locking of the jaw is also not uncommon. Most often these symptoms will improve over time. Changing habits, relaxing the area, and avoiding additional strain or injury will speed up your recovery considerably.
Should conservative measures be unsuccessful, please see you local dentist and/or oral surgeon. Additional treatments they may prescribe include use of a night-guard and even surgery.
Treatment that we provide if all other options fail include BOTOX injections.
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