TEMPOROMANDIBULAR JOINT SYNDROME, better known as TMJ, was first diagnosed more than fifty years ago. It was not until the last decade, however, that any real expertise was developed towards treating it.

TMJ SYNDROME is one of medicine's masqueraders. It has the capacity to trigger an array of symptoms with seemingly unrelated medical causes. For this reason, TMJ is popularly known as "the great imposter."

WHAT IS TMJ?

The TEMPOROMANDIBULAR JOINT is the anatomical name for the jaw joint. It is the joint located in front of your ears, connecting the upper and lower jaws and allowing the mouth to open and close. Opening and closing at least 2000 times a day, it is the most frequently used joint in the body.

TMJ DISORDERS OCCUR WHEN THE JAWS DO NOT OCCLUDE PROPERLY. THIS IS CALLED MALOCCLUSION, OR INCORRECT BITE, AND IS A PRIMARY REASON FOR TMJ. OTHER CAUSES CAN BE A CLENCHING OR GRINDING OF THE TEETH, LOSS OF POSTERIOR TEETH, NATURAL WEAR, INJURY, ARTHRITIS, OR AN IMBALANCE BETWEEN THE TONGUE AND FACIAL AND CERVICAL MUSCLES.

The symptoms of a TMJ Dysfunction are varied and may seem unrelated. Because of this, the condition is frequently undiagnosed or misdiagnosed. Often, the patient is referred to ear, nose and throat orthopedic specialists or neurologists, with results being consistently negative.

TMJ SYNDROME

TMJ SYNDROME develops when the jaws, imbalanced, are aggravated by stress related or poor postural habits. The muscle supporting the jaw soon strains to return to its natural position.

A DRAWING OF THE SKULL INDICATING THE LOCATION OF THE TM JOINT AND THE NORMAL POSITION OF THE CARTILAGE DISC ON THE HEAD OF THE CONDYLE.

THE TMJ IS A "BALL AND SOCKET" JOINT

In exerting excessive pressure on the TEMPOROMANDIBULAR JOINT, the ligaments can usually return to their physiological position. Unfortunately, this causes them to become bruised and stretched and the disc that normally allows them to go back into place may cause further misalignment.

After a period of time, this additional strain makes the already tense muscles go into spasm. The whole system breaks down and the jaw just wants to rest. Other parts of the body may tense up in response. Before long, a chain reaction of stress and muscle spasm can be distributed throughout the body.

WHIPLASH & THE TMJ

Extrinsic injury can result from a blow to the face, jaw, or TEMPOROMANDIBULAR JOINT complex. Whiplash injury is a very common cause of extrinsically induced trauma to the TMJ. Whiplash injuries have traditionally been perceived as rather minor injuries not related to serious or permanent side effects. We now know that this is no longer true.

In the absence of conclusive data after testing, the patient was often advised to seek psychological help to "learn to live" with his problem.

Studies indicate, however, that many of these "seemingly unrelated" symptoms can develop several hours to several months after the injury. It is for this reason that routine use of seatbelts is often recommended.

REFERRED PAIN

We now know that the muscles of the face, jaw, neck and shoulders can "refer" pain to the head in the form of a headache when they are in spasm.

The vascular circulation of these muscles is often limited because of their tautness. Where circulation is poorest, metabolic waste products build up and form trigger points in the tissues. Trigger points can refer pain anywhere in the body.

MAP OF REFERRED PAIN

("RED SPOTS" indicates trigger points)

YOU COULD HAVE IT!!

1. Headaches
2. Earaches
3. Tenderness in the jaws
4. A clicking or popping sound in the jaws
5. Neck or shoulder pain
6. Dizziness and lightheartedness
7. Ringing in the ears
8. Fullness in the sinuses
9. Limited jaw movement
10. Pain in the eyes or the back of the eyes

TREATMENT

The simplest first-aid remedies for TMJ pain include moist heat packs or ice packs; temporary adherence to a soft diet; muscle-relaxing and pain relieving medications.

Giving the jaw a rest from unnecessary movement, such as gum chewing, eating hard foods, or even talking a great deal can relieve pressure and strain. Ultimately, learning to deal with stress by reducing or eliminating jaw muscle tension in response to it, is the only effective long term solution.

Special mouth appliances or "splints" may be prescribed to prevent clenching of the jaws and to relieve tension on the muscles. The appliance compensates for the imperfections in the bite, preventing further damage from bruxing, gnashing, clenching, grinding, as well as from poor posture. Inconspicuous, it is easily tolerated by most patients, generally worn 24 hours a day, and removed only during meals and for cleaning.

The physician or dentist begins treatment with the spastic muscle. As the jaws return to their proper position, much of the musculature returns to their physiological state of normalcy.

In most cases patients wear the appliance for a period of 4 to 6 months but they begin to notice a decrease in symptoms as early as 7 to 14 days.

Badly abused muscles may continue to cause pain so that these trigger points in the tissue will have to be treated individually. One theory is that blood cannot circulate properly in spastic muscle so the tissue becomes malnourished. Even while relaxed, trigger points may continue to refer pain.

Local anesthetics have been effective in breaking up this build up, however, it is the needling of these trigger points that is even more important than the substance injected into them. Other methods may also be used on these highly resistant pain referral areas.

TEMPOROMANDIBULAR JOINT SYNDROME is frequently misdiagnosed, and most often undiagnosed. Many people cannot place the origination point of their pain.

The good news is that, when identified and treated early, the cure rate is outstanding - about 90%. If left undiagnosed and allowed to become chronic, the cure rate drops drastically, with the patient eventually retaining some permanent symptoms.