Wednesday 23 March 2016

What to do about TMJ Pain


At Dr. Hopkin's office, we treat more than just the mouth.  The structures of the jaw involved with function are also a hot topic with patients.  Many come to see us from their general dentist's office for relief of temporomandibular disorders (TMD).  TMD is a set of conditions in the temporomandibular joint (TMJ) that can include pain, headaches, muscle tension, limited range of motion in the jaw that may or may not be accompanied by audible popping or clicking noises in the joint.

Some patients only experience a single episode, while others experience recurring episodes.  While it isn't the case for the majority of individuals with TMD, some suffer chronic and persistent symptoms.    According to the National Institute of Dental and Craniofacial Research,  TMD is reported to affect 5-12% of the population with an annual cost of approximately $4 billion to treat those that seek treatment, which accounts for only 2/3's of sufferers.

The many causes of TMD include direct or indirect trauma to the face, dental treatment that requires a patient to open their mouths for an extended period of time, and sometimes even intra-oral injections.  There are also a number of systemic conditions that can involve the TMJ, like osteoarthritis or lupus.  Significant, long-term problems only occur in a small percentage of those with TMD pain.  For the vast majority, recurring TMD does not indicate a more serious problem.

In those chronic and persistent cases, it is widely agreed among experts that the root of the pain lies in the muscles surrounding the joint and not in the joint itself.  The primary muscles used for chewing and speaking are the temporalis and masseter muscles (see below).  Just like other muscles, they can change as a result of how they are used.  These changes can influence whether they perform their functions smoothly without pain and discomfort.  When the temporalis and masseter muscles are overused from clenching or grinding,  excessive muscle tension can result and cause one to feel achy, tender or tight.


One of the biggest contributors to TMD is stress.  Persistent external stressors can cause muscles to remain in a constant state of increased muscle tension which can lead to headaches, fatigue and pain.  Stress may also cause night time and/or daytime clenching or grinding of the teeth which can overuse those muscles.  Even habitual repetitive movements such a gum chewing or shifting the jaw can lead to muscle fatigue.  Most of the time, patients are unaware that they are contributing to their pain with these habits.  When muscles experience this hyperactivity, they can spasm or become strained which limits how far one can open their jaw.

There are a variety of treatments that Dr. Hopkin offers for pain relief that all include teaching patients how to manage their condition.  Even though he is experienced and highly capable of performing open joint surgeries, his course of non-surgical treatments are successful enough that the vast majority of his TMD patients don't require it.  





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