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.  

1               National Institute of Dental and Craniofacial Research (NIDCR). Facial Pain.

2               Von Korff M, Dworkin SF, Le Resche L, Kruger A. An epidemiologic comparison of pain complaints. Pain. 1988 Feb;32(2):173-83.

3               Dworkin SF, Huggins KH, LeResche L, Von Korff M, et al. Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls. J Am Dent Assoc. 1990 Mar;120(3):273-81.

4               National Institute of Dental and Craniofacial Research (NIDCR). TMJ (Temporomandibular Joint and Muscle Disorders).

5               Gonzalez YM, Schiffman E, Gordon SM, et al. Development of a brief and effective temporomandibular disorder pain screening questionnaire: reliability and validity. J Am Dent Assoc. 2011 Oct;142(10):1183-91.

6               Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992 Fall;6(4):301-55.

7               Validation Studies of the RDC/TMD: Progress toward Version 2. J Dent Res 87 (Spec Iss B), 2008.

8               Schiffman EL, Ohrbach R, Truelove EL, Tai F, et al. The Research Diagnostic Criteria for Temporomandibular Disorders. V: methods used to establish and validate revised Axis I diagnostic algorithms. J Orofac Pain. 2010 Winter;24(1):63-78.

9               Truelove E, Pan W, Look JO, Mancl LA, et al. The Research Diagnostic Criteria for Temporomandibular Disorders. III: validity of Axis I diagnoses. J Orofac Pain. 2010 Winter;24(1):35-47.

10           Truelove E, Huggins KH, Mancl L, Dworkin SF. The efficacy of traditional, low-cost and nonsplint therapies for temporomandibular disorder: a randomized controlled trial. J Am Dent Assoc. 2006 Aug;137(8):1099-107.

11           Hassmén P, Koivula N, Uutela A. Physical exercise and psychological well-being: a population study in Finland. Prev Med. 2000 Jan;30(1):17-25.

12           Dworkin SF, Huggins KH, Wilson L, et al. A randomized clinical trial using research diagnostic criteria for temporomandibular disorders-axis II to target clinic cases for a tailored self-care TMD treatment program. J Orofac Pain. 2002 Winter;16(1):48-63.

Should I Be Worried about Popping & Clicking in my Jaw?

Many of us at one time or another have noticed irregular and sometimes alarming sounds in our jaw joint when we open or close.  There's a pop or a click or even a grinding sound that we can't explain.  Some may experience discomfort associated with this, but even though it sounds painful, doesn't mean that it is painful.

Most audible noises in the temporomandibular joint (TMJ) are caused by the articular disc slipping out of it's normal position as the lower jaw hinges.  This disc is like a pillow of cartilage between the ball of the lower jaw bone (condyle) and the socket of the skull (glenoid fossa).  It functions to cushion the joint during chewing or other movements.  These joint sounds often occur from normal variations in the TMJ that alone do not indicate professional treatment.

When these sounds are accompanied with other symptoms like pain or limitation in range of motion that doesn't go away, then it is time to consult with the experts. Temporomandibular Disorders (TMD) are a set of conditions associated with this joint and it affects 5-12% of the population, mostly females of child-bearing years.

As an Oral & Maxillofacial Surgeon, Dr. Hopkin knows the anatomy and physiology of this joint better than most other dental professionals.  But don't worry, going to see a surgeon does NOT always result in a surgical procedure. The vast majority of TMD patients we see in the office find relief with alternative non-surgical treatments and are thrilled with the results.  If you think you are experiencing TMD, don't hesitate to make an appointment with Dr. Hopkin today!