TMJ Disorders

Temporomandibular joint disorders are a group of painful and debilitating joint issues that can easily be avoided or controlled.

You’ve probably heard a few people mention that they have ‘TMJ’; they hold the side of their face and express a world full of pain about their joint problems. It’s a pretty common problem. Studies suggest that it occurs in about 10% of the developed world’s population, above the age of 18. Women seem twice as likely to get it as men.

A good place to start is to understand what the temporomandibular joint (TMJ) is and then learn what can go wrong with it.

Your jaw is obviously a pretty mobile bone. You use it to chew, to talk and to do just about anything you need to do involving your mouth. You may have noticed it’s a pretty flexible joint, you can open your mouth wide, you can wiggle or move your jaw bone from side to side etc. It has a much higher degree of freedom of motion than say the knee joint or the elbow joint. There’s a reason why it is so. The technical description of this joint is that it is a ‘sliding ginglymoid joint’. I just love that word, ‘ginglymoid’. It just means ‘hinge’ in ancient Greek.

The jaw connects to the bottom of the skull on both sides of the head. The joint that it forms is a sliding-hinge joint. The points of contact between the jaw and the skull are very shallow grooves that allow for a huge degree of movement, that’s the beauty of the joint.

The downside of this freedom of mobility is that there is a lot of friction. Some of the strongest muscles in the body (tiny though they may be) rope the jaw bone to the skull and they generate huge amounts of friction when chewing or talking. The energy generated in that joint could wear down and crack reinforced concrete. The body combats this friction and these pressures by growing thin slivers of soft tissue called cartilage into the joint and covering the whole joint with a thin silvery membrane called a synovium. That synovium makes a fluid called synovial fluid which acts as a lubricant for the TMJ. Healthy TM joints move constantly, generating a lot of friction, but the synovium and joint cartilage take the heat by doing their job of reducing friction and making things bearable.

What happens when these cartilages, synovial membranes or the bones themselves are injured? Can’t stop eating can you? Now-a-days it is tough enough to just stop talking. Even then, there is persistent stress on the joint, and the systems in place to decrease that stress aren’t there to deal with it, or aren’t in proper working condition. This leads to inflammation and a world full of pain every time the jaw moves.

When the cartilage in the TMJ is damaged, you tend to get a clicking sound in the joint whenever you open your mouth wide. It’s one of the symptoms that people first notice when they have TMJ.

Other symptoms of TMJ disorder include:

• Pain or tenderness of the jaw
• Aching pain in and around the ear
• Difficulty chewing or discomfort while chewing
• Aching facial pain
• Locking of the joint, making it difficult to open or close the mouth

What causes TMJ?
Stress, tension and cigarette smoking seem to be triggers. People who tend to grind their teeth (Bruxism) especially at night seem to be at risk. People on certain antidepressants like Venlafaxine can suffer from TMJ disorder as a side effect of the medication.

The truth is that there are a lot of factors which can contribute all at once to the development of TMJ disorder, we don’t always know what causes it.

The mainstays of treatment are to first decrease the inflammation and relax the joint. NSAID pain killers, steroids, muscle relaxants and even certain tricyclic antidepressants are used for this. Lifestyle modification, like stress management, quitting smoking, stopping the offending medication comes next. Sometimes, bite guards are worn at night to prevent bruxism. In extreme cases, an ENT specialist may recommend corrective surgery on the joint to solve the issue. It is rarely needed, but it can solve the issue.

If you suffer from this disorder, talk to your doctor about your options and try to manage your stress levels and lifestyle a bit better. You are never going to be able to stop chewing and talking, so keeping those TM joints healthy is just being smart.