By Dr. Ramon Duran
Of all the hinges that facilitate your bodily functions, the jaw joint is one of the busiest.
And also, one of the most problematic. TMJ pain, also known as TMD – temporomandibular joint disorder – affects about 15 percent of adults, most of them between the ages of 20 and 40. The TMJ is the joint on each side of your face attaching your jaw to the bottom of your skull. The muscles near them enable opening and closing of the mouth, but the disorder and pain occur when the joints get out of line or don’t move as they should.
Many factors cause TMJ pain – tooth movement, the wearing down of teeth, injury to the jaw, head or neck – and finding the right treatment can be difficult, says Dr. Ramon A. Duran.
“Due to the combination of sliding motions and hinging, the TMJ is the most complicated joint in the body,” says Duran (www.drramonduran.com), a dentist in San Juan, Puerto Rico, and author of Your Best Smile … For a Lifetime: Achieving Your Optimal Oral Health. “And because of its connection to the largest cranial nerve, the smallest misalignment can have a significant impact on the rest of the system. Any time your bite changes, it affects your TMJ.”
Dr. Duran lists different options for treating TMD:
- An occlusal splint. This is a plastic mouthpiece fitting over the upper and lower teeth so they don’t touch. “Besides protecting the teeth from grinding at night, it helps with teeth alignment by holding the jaw steady, relieving the muscle stress placed on the TMJ by the misalignment,” Dr. Duran says.
- Pain medication. “Muscle relaxers, pain killers, and other medications as prescribed may help with temporary relief of TMJ pain,” Dr. Duran says.
- Dental adjustments. “This involves making changes to the teeth to bring the bite back into balance. For many cases, it could be a matter of doing some minor adjustments in the enamel of your teeth; on some occasions, orthodontic treatment or a more extensive reconstruction could be needed,” Dr. Duran says. “For example, replacing missing teeth or using crowns or bridges to balance the biting surfaces.”
- Botox. “Since Botox works by blocking the nerve signals to the muscles, it may provide temporary relief to sore jaw muscles when used in small doses,” Dr. Duran says. He cautions, however, that this method is not approved by the FDA for use with TMJ issues.
- Surgery. While surgery is an option, “it should be avoided where possible,” Dr. Duran says, “because there are no long-term clinical trials showing the effectiveness of surgical procedures helping with TMJ disorders, and the treatment is often irreversible.” Three types of surgery for TMD: arthrocentesis, in which the dentist gives general anesthesia, inserts needles in the joint and washes it out; arthroscopy, which uses a special tool with a light and lens, hooked to a video screen; open-joint surgery, used when bony structures in the jaw joint are wearing down.
- Implants – “Artificial implants to replace jaw joints are also an option,” Dr. Duran says, “but should also be taken under the same strict considerations as surgery.”
“One of the biggest problems with TMJ issues is how long they take to manifest,” Dr. Duran says. “Good dentists should be on the lookout for conditions like frequent headaches, facial pains, tooth wear, and a history of root canals.”