Be aware of pain and/or jaw "locking" episodes.

What is a "locking" episode?

A "locking" episode can occur during opening or closing movement. What happens is that the patient experiences an interruption of jaw movement - a "catch" or a "stop", and in order to complete the movement must jiggle, or somehow, self manipulate the jaw.

Why does it happen?

Referring back to my anatomy lesson, and in the simplest of terms, what is happening within the Joint is that the Articular Disk which rides on top of the Condyle Head is getting stuck in the wrong place and is preventing the Condyle Head from moving.

If I can jiggle my jaw and reduce the dislocation, why should I be concerned?

Because each time it happens more damage is occurring to the tissues in the Joint, and the tissues controlling the Articular Disk. As a consequence there is the risk that if the problem is not addressed by appropriate treatment, one day you will be unable to reduce the dislocation yourself, and you will require an emergency visit to a TMJ practitioner, if one is available in your community, or an oral surgeon. In severe cases, reduction can only be accomplished under general anesthesia.

What is a limited range of opening?

If you open your mouth as wide as you can, and then place the last three fingers of your hand (middle, ring, and pinky) perpendicularly (with your thumb pointing to the ceiling) between your upper and lower teeth, you have a normal range of opening, provided that you can do that without pain and strain. In general, two fingers, or less, is a limited range of opening.

I can get four fingers in. What does that mean?

Not much. You may either have thin fingers, or you have slight hyper-extension. In the absence of pain, and other symptoms, not to worry.

I can only get two finger in. Does that mean I need treatment?

Here comes a typical doctor's answer - "that depends". It depends on several factors. The most important being, to what degree is this restricted jaw function affecting your quality of life. If you have no pain, and it is the ONLY symptom you have, and you never think about it, and you can eat anything you want without pain and strain. The answer is no. Otherwise the answer is yes.

I hear a lot of noises in my TM Joints when I move my jaws. Sometimes there is a kind of click, and sometimes there is a crunching or grinding sound. What's happening?

Probably lots of things. Joint noises during jaw movements are a sign that the functional elements are not working smoothly. Crunching grinding noises are called Crepitus, and it is associated with hard tissue contact during movement. In order to explain Clicking, you have to first know that the Articular Disk has, what is most simply described as, a depression, in the middle of it. That depression, and the Condyle Head are supposed to move together in sync. When they don't, and the Condyle Head passes over the outside ridge of the depression, you get a Click.

Is the presence of these Joint sounds serious?

Again, in the absence of other symptoms, no. BUT these Joint sounds are a sign that the Joint is not functioning smoothly, and each sound's occurrence is a micro trauma to the Joint tissues. This means that as time goes on, a full blown TM Joint disorder may develop. The correct approach, if you have TM Joint sounds during jaw movements in the absence of all other symptoms, is to tell your regular family Dentist about them, and he will keep your condition under observation.

How are ear symptoms associated with TM Joint disorders?

It is due to the close location of the ear tissues to the TMJ. It's common to find on x-rays that the Condyle Head is improperly positioned in the Joint space such that it is in intimate contact with the Tympanic bone. The consequence often is ear pain in the absence of infection, a sense of fullness, or stuffiness, in one or both ears, and sometimes ringing in the ears. If you go to the "X-Ray Views" page, you can see these reasons graphically.

The hinge that connects the lower jaw to the temporal bone located in the skull, immediately in front of the ear on each side, is the temporomandibular joint. These joints have flexibility, which allows the jaw to move smoothly vertically and horizontally, enabling you to talk, chew, and yawn. Muscles that are attached to and surrounding the jaw control the movement and position of the jaw.

What Causes TMD?

The cause of TMD is not clear, but dentists believe that symptoms arise from problems with the muscles of the jaw or with the parts of the joint itself.

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 possible causes include:

• Grinding or clenching the teeth, which puts a lot of pressure on the TMJ
• Dislocation of the soft cushion or disc between the ball and socket
• Presence of 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 and 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
• Limited ability to open the mouth very wide
• Jaws that get "stuck" or "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?

Because many other conditions can cause similar symptoms – including a toothache, sinus problems, arthritis, or gum disease – your dentist will conduct a careful patient history and clinical examination to determine the cause of your symptoms.

He or she will examine your temporomandibular joints 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 dentist 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 of the joint.

Your dentist may decide to send you to an oral surgeon (also called an oral and maxillofacial surgeon) for further care and treatment. This oral healthcare professional specializes in surgical procedures in and about the entire face, mouth and jaw area.

What Treatments Are Available for TMD?

Treatments range from simple self-care practices and conservative treatments to injections and surgery. Most experts agree that treatment should begin with conservative, nonsurgical therapies first, with surgery left as the last resort. Many of the treatments listed below often work best when used in combination.

Basic Treatments

• Apply moist heat or cold packs. Apply an ice pack to the side of your face and temple area for about 10 minutes. Do a few simple stretching exercises for your jaw (as instructed by your dentist or physical therapist). After exercising, apply a warm towel or washcloth to the side of your face for about 5 minutes. Perform this routine a few times each day.
• Eat soft foods. Eat soft foods such as yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans and grains. In addition, cut foods into small pieces to decrease the amount of chewing required. Avoid hard and crunchy foods (like hard rolls, pretzels, raw carrots), chewy foods (like caramels and taffy) and thick and large foods that require your mouth to open wide to fit.
• Take medications. To relieve muscle pain and swelling, try nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil, Motrin, Aleve), which can be bought over-the-counter. Your dentist can prescribe higher doses of these or other NSAIDs or other drugs for pain such as narcotic pain relievers. Muscle relaxants, especially for people who grind or clench their teeth, can help relax tight jaw muscles. Anti-anxiety medications can help relieve stress that is sometimes thought to aggravate TMD. Antidepressants, when used in low doses, can also help reduce or control pain. Muscle relaxants, anti-anxiety drugs and antidepressants are available by prescription only.
• Wear a splint or night guard. Splints and night guards are plastic mouthpieces that fit over the upper and lower teeth. They prevent the upper and lower teeth from coming together, lessening the effects of clenching or grinding the teeth. They also correct the bite by positioning the teeth in their most correct and least traumatic position. The main difference between splints and night guards is that night guards are only worn at night and splints are worn full time (24 hours a day for 7 days). Your dentist will discuss with you what type of mouth guard appliance you may need.
• Undergo corrective dental treatments. Replace missing teeth; use crowns, bridges or braces to balance the biting surfaces of your teeth or to correct a bite problem.
• Avoid extreme jaw movements. Keep yawning and chewing (especially gum or ice) to a minimum and avoid extreme jaw movements such as yelling or singing.
• Don't rest your chin on your hand or hold the telephone between your shoulder and ear. Practice good posture to reduce neck and facial pain.
• Keep your teeth slightly apart as often as you can to relieve pressure on the jaw. To control clenching or grinding during the day, place your tongue between your teeth.
• Learning relaxation techniques helps control muscle tension in the jaw. Ask your dentist about physical therapy or massage. Also onside stress reduction therapy, including biofeedback.