Sushil had been experiencing mild, intermittent pain in his face for some time, and had not noticed the clicking sounds that occurred whenever he opened and closed his mouth. But one day, when he opened his mouth to yawn, he discovered to his horror that he couldn’t close his mouth! Eventually, the cause was traced to Sushil’s worn-out temporomandibular joint (TMJ) in the head, the joint that connects the immovable upper jaw with the movable lower jaw and allows us to open and close our mouth, bite, chew, swallow, drink, speak, laugh and yawn.
Sushil was treated for this ‘open lock’ of the jaw and finally managed to close his mouth. Of course, this is a rare incident, one of the many possible consequences of TMJ disorders. But often, awareness of TMJ problems is lacking even among physicians and dentists.
“Obviously, despite being a frequently used joint that executes such complex movement for us, TMJ is much ignored, perhaps because it is not adequately covered in the dental syllabus, and due to its location in the head in the proximity of so many other structures, and also because it is highly influenced by its connection to teeth function and structure,” says Dr. S. Venkateswaran, orthodontist, who is about to publish his review paper on TMD.
Confusing symptoms
“TMJ dysfunction is the most common cause of oro-facial pain after a dental cause,” says Dr. Nirvikalpa, oral and maxillofacial surgeon, Apollo Hospitals. However, TMJ and muscle disorders (TMD) could manifest themselves in diverse ways — frequent headaches (especially in the temple region) caused by unknown factors, with even CT or MRI scans revealing no abnormality; chronic ear or facial pain with diagnostic tests showing normal results; pain in and around the TMJ region, soreness of the muscles around TMJ, radiating pain in the face, jaw or neck, stiffness of the jaw muscle, clicking, popping or grating of the jaw joint while opening or closing the mouth, difficulty in opening the mouth or limited movement of the jaw, a change in the way the upper and lower teeth come together; pain in the area of the forehead and the eyes; pain in the back of the head, possibly extending to the shoulders and neck; tinnitus (a ringing feeling in the ears); pressure on the eyes, sensitivity to light; dizzy spells, vertigo, nausea; lack of concentration; nervousness or sleeping difficulties; wearing out of teeth, teeth sensitivity or mobility.
“When these symptoms are seen in the absence of a specific, attributable or organic cause, medical and dental practitioners should consider TMD as a possible cause. While oro-facial pain and headache because of jaw muscle function and dental structures should ideally be managed by dentists, pain in the head and neck region unrelated to it should be should be referred to appropriate specialists,” recommends Dr. Venkateswaran.
There are people who go through a battery of tests and consult a retinue of specialists, yet are still unable to zero in on the underlying cause behind their oro-facial pain. To identify TMD, doctors and dentists should observe the way the patient holds his head (posture), jaw pattern, condition of teeth, range of jaw movements, clenching of teeth, muscle spasm, etc., besides physical examination of the TMJ for pain, clicking sounds (crepitus) and tenderness of the jaw muscles, followed by evaluation of stress and underlying systemic conditions. Local anaesthetic nerve blocking can be helpful in finding out if oro-facial pain originates from the TMJ capsule or from associated muscular structures. CT scans of the joint can reveal structural changes in the bones, while MRI scans of the joint can find out soft tissue abnormalities. Sometimes fluid from the joints may be collected for evaluation and diagnosis.
“To diagnose and arrive at a treatment plan, the patient’s medical and dental history must be considered,” advises Dr. R. Raghav Kumar, general physician. “As appropriate, treatment could be elimination of stress and para-functional habits, education and counselling to avoid factors and behaviours that may aggravate the pain, use of occlusal splints or mouth guards, medication, etc.,” says Dr. Nirvikalpa adding, “common painkillers don’t work with TMJ, and surgery is not the answer to Myofascial Pain Dysfunction Syndrome (MPDS).”
Possible causes of TMD
* Injury to jaws following a fall.
* Systemic diseases such as rheumatoid arthritis and osteoarthritis that affects joints.
* SLE, psoriasis, hormonal imbalance.
* Jaw pattern and misalignment of teeth.
* Stress and psychological disturbances.
* Para-functional habits such as clenching, grinding of teeth at night, excessive use of chewing gum, fingernail biting.
* Faulty posture while holding the telephone between head and shoulder.
* Faulty posture while using computers and laptops.
* Lengthy dental procedures and intubation for anaesthesia during surgical procedures.
