Temporomandibular Disorder

 

 

 

Have you experienced any of the following symptoms at least once a week?

• Feeling restricted or unable to open your mouth fully.
• Pain in the face or jaw joint area when opening wide, yawning, or chewing.
• Hearing a "click" or "pop" sound in the jaw joint when opening or closing your mouth.
• Experiencing a locked jaw that can only be closed by moving the chin side to side.
• Pain in the temples.

 

 

 

 

 

 

If you have experienced any of these symptoms, it may indicate an abnormality in the chewing muscles or jaw joints, collectively known as the masticatory system. This group of symptoms is abbreviated as T.M.D.

 

 

Temporomandibular Disorders (T.M.D)

     Temporomandibular Disorders (T.M.D) refer to a group of disorders involving the masticatory system, including bones, ligaments, joints, and muscles used for chewing. Patients often feel pain in the face and mouth area. Symptoms similar to TMD but not directly caused by the bone, ligament, or muscle system are not classified as true TMD. These may be caused by other factors, such as dental or periodontal diseases, fractures, ear-related conditions, infections, various types of tumors, circulatory issues, or neurological disorders. Sometimes, patients may experience TMD symptoms alongside other systemic abnormalities.

 

 

 

 

 

 

Causes of Temporomandibular Disorders

Several factors can reduce the adaptability of the masticatory system and lead to TMD:

 

• Trauma: Occurs when the force applied to the chewing system exceeds its normal capacity, such as from falls, car accidents, sports injuries (e.g., ball impact), or physical assault to the jaw. It can also result from sudden over-exertion, like biting unexpectedly hard objects (e.g., a pebble in rice), keeping the mouth open for long periods during dental work, or long-term teeth grinding (bruxism).
• Jaw Structure: This can be a result of genetics, growth patterns, or consequences of previous treatments, such as improper orthodontic work.
• Psychosocial Factors: Conditions affecting an individual's ability to cope with life's problems. Studies show that TMD patients often exhibit higher levels of anxiety and depression compared to the general population. Stress can lead to muscle tension and pain.
• Systemic Factors: Various systemic diseases may be involved, including endocrine disorders, tumors, arthritis, abnormal joint pressure/lubrication, or neurological and vascular issues. Medical consultation may be required.

 

 

 

 

Symptoms of Temporomandibular Disorders

     Symptoms can occur at any age, though they are less common and less severe in children. The risk increases with age. While the severity varies, pain can significantly impact the function of the masticatory system. It is most commonly found in women aged 20-40. Women seek treatment more often than men at a ratio of 3:1 to 9:1, possibly because women tend to be more attentive to their health.

 

Common Symptoms Include:

1. Pain and Tenderness in Facial Muscles and Jaw Joints

     This is the most common symptom of TMD that prompts patients to visit a doctor or dentist. Areas often affected include the face, ears, jaw, and temples. Pain usually increases during chewing, yawning, or speaking. Pressing on these areas often results in increased pain. Facial muscle pain is typically diffuse, dull, or feels like pressure, caused by poor blood flow and muscle contraction. Joint pain, however, is often sharp and intense, occurring with jaw movement and subsiding quickly when at rest.

 

2. Jaw Joint Noises

     These usually occur while opening or closing the mouth, or moving the jaw sideways. A "click" or a loud "pop" may be heard during movement. This can be caused by irregular joint surfaces. If there is sound without pain, treatment may not be necessary. In elderly patients, a "grating" or "crepitus" sound (like dragging wood over gravel) may occur due to joint degeneration, tissue damage, or rough cartilage surfaces.

 

3. Deviation of Jaw Movement

Normal jaw opening and closing follows a straight line (Image 2A). In TMD patients, three types of deviation may occur:

 

• S-Curve: The jaw deviates when opening but returns to the midline when closed.
• Lateral Deviation: The jaw shifts to one side and does not return to the midline even at full opening.
• Jerky Movement: Opening the mouth is not smooth or continuous, often found in patients with muscle pain.

             

            

 

 

Self-Care for Jaw Muscle and Joint Problems

     People with bruxism or TMD may experience pain in the face, ears, jaw joints, or chewing muscles (cheeks and temples). You should follow these self-care steps to alleviate symptoms:

 

1. Choose Soft Foods

     Avoid sticky or hard foods like fried nuts, hard candy, dried squid, gum, and hard candies. Avoid biting into whole fruits like apples or guavas. Instead, eat small pieces or consume soft foods like rice soup or porridge.

 

2. Chew on Both Sides

     Practice chewing on both sides of your mouth, either simultaneously or alternating. Do not rely on one side exclusively. Use your back teeth for chewing rather than protruding your chin or using your front teeth.

 

3. Apply Warm Compresses to Painful Areas

     Heat a small damp towel in the microwave for about 1 minute or until warm. Moist heat is more effective. Apply to the painful muscle or joint for 10-20 minutes, 3-4 times a day. Some may find alternating between warm and cold compresses helpful. This helps relax muscles and reduces the need for pain medication.

 

4. Avoid Habits that Stress the Jaw Joint

     Avoid clenching teeth, grinding teeth, biting cheeks or lips, leaning your chin on your hand, or holding a phone between your shoulder and ear. These often happen unconsciously. Observe yourself during work or exercise. For nighttime teeth grinding, consult a dentist as it is harder to control.

 

 

 

 

 

 

 

5. Maintain Proper Jaw Resting Position

     The most comfortable position is with the tongue slightly touching the roof of the mouth behind the upper front teeth, with teeth not touching and jaw muscles relaxed. Monitor your jaw position throughout the day.

 

6. Get Enough Sleep

     Ensure restful and adequate sleep. Keep the bedroom quiet and dim. Avoid sleeping on your stomach.

 

7. Avoid Opening the Mouth Too Wide

     Opening too wide while experiencing pain can worsen symptoms (e.g., yawning or long dental procedures). Practice yawning with your tongue touching the roof of your mouth to limit the opening.

 

 

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If you require other dental treatments, inform your dentist about your jaw issues in advance.

 

 

Avoid activities that cause uneven pressure on the jaw, such as sleeping on one side, leaning on your chin, reading while lying on your stomach, shouting, or singing loudly, as these can increase pain.

 

 

 

 

8. Use Pain Relief and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

     You can take over-the-counter pain relievers like Paracetamol, Aspirin, or NSAIDs to reduce muscle or joint pain, but please consult a doctor for proper guidance.

 

9. Observe Pain Triggers

     Keep a daily log of your pain and the activities that trigger it. Try to avoid those specific behaviors or events.

 

 

 

 

 

 

10. Learn Jaw Exercises

     Slow and gentle jaw exercises can improve mobility. Since individual needs vary, consult a dentist or physical therapist for a personalized exercise plan.

 

11. Practice Relaxation Techniques

     Deep and slow breathing helps the body relax. Find techniques that work for you, such as listening to soft music or practicing positive thinking to help manage pain.

 

 

 

If symptoms persist, please schedule an appointment with a specialist in masticatory systems.

 

 

 

 

Edited

13/09/2023