1. TMJ (Temperomandibular Joint)

2. Bruxism

JAW JOINT (TEMPEROMANDIBULAR JOINT) DISORDER

The jaw joint is also known as the 'temporomandibular joint', known for short as the 'TMJ'. The makeup of the temporomandibular joint includes the hinge jaw joint (the bridge for the lower jaw or mandible) and temporal bone of the skull located in front of each ear, the muscles surrounding the jaw, and the jaw itself. It can be felt by placing your fingers just in front of your ears, and opening and closing your mouth.

The joint allows the jaw to open, close and move to the side and forward. It plays an important role in jaw functions such as talking, chewing, bite (occlusion) and yawning. It is one of the most complex and frequently used joints in the body. A TMJ disorder may affect one or both joints, often causing pain and limiting jaw function. Symptoms usually arise in early adulthood, but children and the elderly can also be affected

Causes and Symptoms of TMJ Disorders

Disorders of the TMJ can be caused in a variety of ways, including :

	Missing teeth
	Grinding or clenching of teeth, which may be linked to stress
	Emotional or physical stress and tension in the jaw muscles
	Injuries such as fractures or dislocations of the TMJ
	Degenerative diseases such as osteoarthritis and rheumatoid arthritis
	Wrongly shaped dental fillings, crowns or bridges.
	In some people, the cause of their TMJ disorder is difficult to diagnose and may include several of the above factors.
In different people, TMJ disorders can cause different symptoms, which may vary from mild discomfort to severe pain. For example, pain may be sharp, searing and intermittent, or dull and constant.

Symptoms may include:

	Limited jaw movement.
	Difficulty in opening the mouth.
	A stuck or 'locked' jaw.
	Clicking, grating or popping noises from the jaw joints.
	Pain when chewing, yawning or opening the jaw widely.
	Pain in or around the ears and cheeks.
	Headaches, and occasionally, migraine-like headaches and nausea.
	Earaches, loss of hearing or ringing in the ears.
	Face, neck, back and shoulder pain .
	A feeling of muscle spasms.
	Toothache.
	Clenching and grinding of teeth .
	An uncomfortable bite or 'occlusion' (that is, the contact of the teeth in the upper and lower jaws as they meet during chewing or when the jaws are closed).

Diagnosis of TMJ Disorders

	An accurate diagnosis is very important to ensure that the right treatment is undertaken. Before starting treatment your dentist will make a diagnosis based on a clinical examination and your medical and dental history. During the examination the dentist will note the exact location of pain, stiffness or soreness, the range of jaw movement and any noises in the jaw joint. The dentist may examine your bite, tooth wear and movement of teeth. To assist with diagnosis your dentist may recommend.
	Plaster moulds of your teeth to see if your occlusion (bite) is correctly balanced.
	An X-ray examination .
	Completion of a questionnaire and a pain diagram to assess how your symptoms affect your quality of life.

Managing the Pain through Self-Help Until You Reach the Right Dentist

There is also a wealth of self-help remedy suggestions to treat TMD symptoms. However, these remedies do not treat the cause. In fact, TMD treatment through the right dentist is less costly, less time intensive, and produces a fully satisfactory result.

Although the following self-help remedies will not treat TMD on a long-term basis, temporary relief may be found with the following:

	Heat and Cold Packs :
	Heat and cold packs applied to the side of the face and temple for 10 minute intervals may reduce the intensity of the pain affecting the muscles and surrounding area of the jaw.
	Limit Jaw Movement :
	It is important to avoid large movement of the jaw such as singing and wide yawning. Also, do not apply pressure with your hand against your jaw for an extended time period such as during sleep or with a phone receiver.
	Diet :
	Choose soft food, and stay away from foods that require the mouth to open wide or repetitive chewing. The wrong types of foods include chewing gum, taffy, pretzels, and raw carrots.
	Physical Therapy, Biofeedback and Massage :
	In some cases, physical therapy, biofeedback, and massage may provide temporary relief from TMJ.
	Relaxation and Stress Management :
	Learn how to relax and lessen stress. This can reduce tension in the jaw joint. Your dentist may recommend a stress management program.

Dental Treatment :

It is important to receive dental treatment for any teeth requiring restoration. Tooth decay may affect the bite that is a contributing factor to TMJ.

Treatment for Interferences in the bite :

If it is determined that there is no structural disorder in the joint, but there are deflective interferences on the teeth that affect the bite and result in improper jaw closure, then you may undergo occlusal equilibration to allow for the lower jaw to fit properly into the temporomandibular joint socket, or your dentist may elect to correct the bite with an appliance.

Occlusal Appliance Therapy :

Occlusal splints (also known as bite plates) may be used to take pressure off the jaw joints and teeth. These are usually worn at night and should not have any permanent effect on the position of teeth. Custom made by your dentist, occlusal splints must be adjusted regularly and monitored for some months.

Medication :

In some cases, your dentist may recommend short-term medication to help relieve symptoms and assist other treatment methods. Your dentist may prescribe a painkiller, anti-inflammatory, anti-anxiety agent, antidepressant, sedative or muscle relaxant. Take medication only as directed. Your dentist will be happy to answer any questions you may have regarding medication. Read the Consumer Medicine Information, which most prescription medicines have in the box.

Specialist Management :

If pain and dysfunction are severe and chronic and initial conservative treatment has not been effective in relieving symptoms and restoring jaw function, the dentist may refer the patient to a specialist or an oro-facial pain clinic.

Surgery :

Very rarely, surgery may be required. On average, only about three in every 2,000 people will require surgery. Your dentist will refer you to an oral and maxillofacial surgeon, if surgery may be needed.

Teeth Grinding (Bruxism)

WHAT IS BRUXISM ?

Bruxism is an excessive clenching or grinding of the teeth that is not a part of normal chewing movements. It can lead to excessive wear on the teeth and may cause permanent damage to the teeth and the jaw joints. Excessive clenching and grinding are not normal, healthy actions of the jaws. In some adults and children, clenching and grinding may occur during the day or at night. They typically have no conscious control over this excessive clenching and grinding, particularly when it occurs during sleep.
      

The Function of the Jaws

Three muscle groups are associated with bruxism, as shown in the figure. The temporalis and masseter muscles bring the jaws together. The lateral pterygoid muscles move the jaw from side to side. The strength of jaw clenching determines the force of tooth grinding. Grinding does not occur if the person clenches, or if the mouth is open. Slight relaxation of the clenched jaw allows grinding movements across the teeth as the jaw is moved slightly forward and slightly to the side.
       

The Causes of Bruxismhe causes of bruxism are still being studied. Combinations of physical and p

Studies have shown that night bruxism is a sleep disorders other abnormal anatomy of the teeth or jaws (including 'high spots' on fillings) that can cause an improper occlusion (also called 'bite') and lead to bruxism behavior.      

Signs and Symptoms of Bruxism

	Pain in the teeth and sensitivity to heat and cold
	Chronic muscular facial pain with tension headaches, caused by intense muscle contraction.
	The noise, noticed by partners, friends or relatives, that occurs as the teeth are ground together.
	An abnormal alignment of the teeth, caused by uneven tooth wear.
	Flattened and worn tooth surfaces, which may reveal the underlying yellow or orange dentine layer.
	Micro fractures of the tooth enamel.
	Broken or chipped teeth.
	Loose teeth with possible damage to the tooth sockets.
	Stiffness and pain in the jaw joint (temporomandibular joint or 'TMJ') that cause restricted opening and difficult chewing; sometimes the jaw joint may suffer damage that is slow to heal (refer to the ADA patient education pamphlet Common Disorders of the Jaw Joint, available from your dentist).
	Earache or pain in the jaw joint.
The variation in signs and symptoms reflects the strength of clenching and grinding involved in bruxism. People who clench their teeth tightly may experience tension-related headaches but may have little or no damage to the teeth or jaw joint. Tight clenching alone puts minimal pressure on the jaw joint. Those who experience severe grinding may have damaged teeth and jaw joint problems. People with mild tooth grinding may have worn teeth surfaces but no jaw joint pain or teeth sensitivity. These individuals may not even realize that they have bruxism.

Before Treatment

Your dentist needs to know your medical history to plan the best treatment. Fully disclose any health problems you may have had.

Tell the dentist if you have had an allergy or bad reaction to antibiotics, anaesthetics, or other medicines.

	Previous treatment related to bruxism or jaw surgery.
	Psychological distress or psychiatric illness.
Give the dentist a list of ALL medicines you are taking or have recently taken. Include medicines prescribed by your family doctor and those bought 'over the counter' without prescription.

Treatment of Bruxism

Treatment aims to:

	Find and remove the causes of bruxism.
	Change the behavior that causes bruxism.
	Repair the damage that bruxism often causes .

Finding and Removing the Causes of Bruxism

Your dentist will look for local problems likely to lead to abnormal contact among upper and lower teeth. Your bite may need to be improved. If pain is a symptom, your dentist will look for related causes, such as an ear infection or a temporomandibular disorder.

Your dentist may prescribe :

	Painkillers for muscular facial pain, headaches and jaw joint pain.
	Muscle relaxant medication to help relax the jaw muscles.
If your dentist suspects that you have general health problems, he or she may recommend an examination by a medical practitioner. Your dentist may recommend counselling, stress management or relaxation methods for stress-related causes of bruxism.

Changing Bruxism Behavior :

Therapy aims to achieve changes in behavior by teaching the patient how to rest the mouth.
 
 An occlusal splint (also called a night guard) is an option for someone with mild to severe grinding behavior. Worn at night, the splint is made from moulded plastic that fits over the upper or lower teeth. It prevents further wear of the tooth surfaces.

Some patients may require muscle relaxant tablets at night.

Repairing Damage to Teeth :

Treatment may be necessary to repair damaged teeth. Dental fillings, crowns or inlays can replace damaged tooth surfaces. Root canal treatment may be required where tooth fractures extend into the pulp. In extreme cases, extraction of badly damaged teeth may be the only option. Partial dentures, dental bridges or implants can replace missing teeth. Orthodontic treatment can realign misplaced and crooked teeth.