Temporomandibular Joint Problems and Orthodontics
What is the Temporomandibular Joint (TMJ)?
The TMJ is the joint between the lower jaw (mandible) and the skull and is situated in front of the ear canal. The joint has a cartilage disc (articular disc) that sits on top of the head of the joint (mandibular condyle) and separates it from the skull (see diagram). This disc cushions the joint and allows it to move freely when the 4 powerful chewing muscles that are connected to the jaw move it when eating and talking.
What is Temporomandibular Joint Dysfunction (TMD)?
TMD is a group of conditions associated with the chewing function of the jaw.
- Jaw and face pain
- Jaw joint noise: clicking, crunching, grating or popping
- Limited mouth opening
- Jaw locking
- Pain radiating along the cheek bone or down the neck
Studies show that the frequency of TMD signs and symptoms increase with age and is more common in females. The likelihood of adolescents suffering from jaw joint dysfunction is anything between 5% and 35% – which means up to 1/3rd of teenagers may suffer from TMD. Whilst it may happen during brace treatment, Temporomandibular joint problems are not caused by orthodontic treatment but could be triggered by certain factors including; trauma (blow to face or jaw), unexpected wide mouth opening, biting down on something hard, grinding teeth and tooth clenching (often at night), stress, nail biting, uneven bite, or altered chewing pattern to avoid a sore tooth.
Sometimes there is no obvious cause but problems can be associated with other stress related disorders such as tension, headaches, or lower back and abdominal pain. What is clear is that most jaw problems are made worse by chewing and at times of stress – and having a jaw problem can also cause stress which exacerbates the problem.
What is happening to cause the symptoms?
- The muscles in and around the jaw joint tightening up causes the pain. The tightening of the muscles also limits how much the mouth can open
- The cartilage disc being stretched out of its normal position and moving abnormally during jaw movements causes the joint noise. Due to the proximity of the joint to the ear this noise seems loud to the individual suffering from TMD but sometimes others may also hear it
- The disc slipping forwards in the joint and getting stuck in that position causes locking of the joint and the limited mouth opening
What can you do to improve your problem?
The most important thing is not to worry. In the vast majority of cases the symptoms will go away on their own, however this can sometimes take a few months. Even with treatment the problem takes time to improve.
What treatment is effective for TMD?
- Soft Diet: avoid foods that require a lot of chewing, cut up food as small as possible, and eat on the affected side (if both sides are affected then try and alternate). Avoid biting with your front teeth
- Pain Relief: anti-inflammatory pain killers such as Ibuprofen are by far the most effective way to relieve both soreness and inflammation in the joint
- Local Heat: use a hot water bottle wrapped in a towel applied to the side of the face – this increases blood flow to the muscles and will help them relax
- Eliminate Habits: avoid nail biting, lip biting, holding/tearing things with your front teeth, clenching and grinding
- Rest: try and support the jaw when yawning and try not to talk too much. Imagine what it’s like when you have a stitch – trying to carry on activity when you should be resting makes the stitch come back
- Exercises: on the next page is a helpful exercise to help the muscles relax and help the cartilage return to the normal position. You must do these at least twice a day for 5 minutes a session
- Bite Raising Appliance: these are similar to a sports guard, mainly worn at night and can help an acute episode of jaw pain
- Medication: some anti-depressants have been found to be useful in helping to relax muscles and may be recommended
- Surgery: in severe cases you may need to be referred to the hospital to discuss options for surgery
What exercise can I do?
It is important to set aside 2 five minute periods each day at a time when you are relaxed – for example just before you get up and go to bed. Sit upright in a chair to perform the following exercise:
- Close your mouth and make sure your teeth are touching but do not clench them. Rest the tip of your tongue on the roof of your mouth just behind the top front teeth
- Run the tip of your tongue backwards towards the softer part of the roof of your mouth, going as far back as you can – keeping the teeth together
- Slowly open your mouth whilst ensuring your tongue stays in contact at the back of the mouth. Stop when you feel your tongue being pulled away and hold this position for 5 seconds
- Close your mouth and relax for 5 seconds
- Repeat the whole procedure slowly but consistently over the 5 minute period
As you open your mouth you should feel the tension in the back of your neck and under your chin. The first few times you do these exercises watch yourself in a mirror to make sure that the teeth are
moving vertically with no side to side movement. If there is sideways movement, you should open the mouth more slowly to control it.
If you are carrying out the exercises properly there will be no clicking or noise from the joints. If there is, restart and continue to practice until it is click free.
Do not do the exercise more than twice a day at the start. After the first week start to increase the time spent doing the exercise as this will help strengthen the muscles that close your mouth.
You may find that the pain is worse for a while at first; this is because you are not used to the
movement. Persevere and over time this will subside. After 2-3 weeks of doing the exercise your muscles will be re-trained and your jaw should not click when you open and close.
Diet during your treatment
- Never bite your nails
- Never bite your lower lip
- Avoid biting on your front teeth
- Keep you upper and lower teeth apart when at rest