What is the Temporo-Mandibular Joint and why is it important?

The Temporomandibular Joint (‘TMJ’), is the joint where the lower jaw (the ‘mandible’) joins the bottom of the skull (at the ‘temporal bone’), immediately in front of the ear on each side of the head. It moves every time you chew, talk and swallow. It is one of the most frequently used joints of the body.

Temporomandibular joint (TMJ) problems affect large proportions of the population at one time or other. A recent systematic review and meta-analysis in 2021 concluded that the prevalence of the joint problem was 31% for adults and 11% for children and adolescence. Women are more likely to suffer from TMJ problems than men. TMJ problems often have significant psychological (stress factors) , as well as physical causes.

What are the causes of TMJ pain- dysfunction

• According to The National Institute of Dental and Craniofacial Research , recent studies in India TMJ pain has drastically increased due to stress in patients working in the IT fields. Increased levels of stress in patients are associated with elevated levels of cortisol, and increased bioelectric activity of the masticatory muscles which control this joint. Stress is again a factor for para functional habits like grinding your teeth, nail bitting, lip bitting, cheek bitting or over use of chewing gum, which increases the wear on the cartilage lining of the joint, and gives it little opportunity to recover between meals. Many people are unaware of these habits unless an onlooker tells them.
• If you chew habitually on one side of your mouth, you concentrate all the ‘wear and tear’ on one side rather than equally on both sides. This can occur if you have a tooth problem on one side, or recent dental work that causes you to favour one side. Malaligned teeth that do not fit together properly (most commonly the last molar called the wisdom teeth , due to its position causes an‘improper bite’) can also be at fault.

In each of the above circumstances, a faulty chewing pattern takes place that creates one focus of wear of the cartilage lining of the joint space. When that spot wears down, pain occurs. A form of arthritis occurs which is called TMJ Dysfunction (dysfunction means faulty or painful function).

How do u know them by the Symptoms

• Jaw pain (either at rest or when eating)
• Headache (may be worse in the morning) – migraine
• Limitation of jaw opening
• Locking of the jaw
• Earache
• ‘Clicking’, ‘popping’ or ‘grinding’ sounds of the TMJ
• Dull ache in face or neck, shoulder stiffness

The usual focus of pain is over the joint, immediately in front of the ear, but pain can also radiate elsewhere. The pain often causes spasm in the adjacent muscles, which are attached to the bones of the skull, face and jaws. Therefore, the pain can be felt at the side of the head , the cheek, the lower jaw, and the teeth. They can lock wide open (‘dislocate’), or in some severe cases prevent the jaws from fully opening.

Usually patients tend to misinterpret TMJ pain as ear pain .As the most common focus is the ear. When an earache is not associated with other ear related symptoms (e.g. hearing loss or discharge) and the eardrum looks normal, the doctor will consider the possibility that the pain comes from TMJ dysfunction.

How do we treat the temporomandibular joint (TMJ)?

Early self examination

You can locate that joint by putting your finger on the triangular structure in front of your ear. Then move your finger just slightly forward and press firmly while you open your jaw all the way open and shut. The motion you feel is in the TMJ. You can also feel the joint portion if you put your little finger into your ear canal with the fingernail facing backwards. Then press forward as you open and close your jaw again.

---

Also Read: Neck Pain: Symptoms, Causes, Treatment, And Exercise

---

If it has been detected fairly early it will probably respond to these remedies.

Measures to reduce the damage to the joint:

• Psychological counseling for stress
• Proper sleep and sleep positioning
• Wisdom teeth extraction in case of hindrance
• Chew evenly, left and right.
• Stop clenching, gritting or grinding your teeth.
• Stop chewing gum.
• Avoid hard, chewy foods.

Measures to encourage the healing process:

• Apply a heat pad for half an hour at least twice daily, more often if you find this useful.
• Take paracetemol, aspirin or other anti-inflammatory medicines in a dose your doctor recommends. Anti-inflammatories are particularly effective for TMJ dysfunction. Antibiotics are usually ineffective. Checking for dental problems and readjusting your bite can help.

Stubborn cases of TMJ dysfunction may require further consultation with an oral surgeon or dentist. They can fit you with a splint to open your bite and decrease bruxism (grinding your teeth while sleeping).

Few cases might even require surgery which ranges from arthroscopy, arthrocentesis to total join replacement which is reserved for severely damaged joints with end stage disease that has failed all other more conservative treatment modalities. Hence earlier the diagnosis the more simpler and conservative the treatment option remains in case of this complex structural temporomandibular joint.