Temperomandibular Jaw Pain Dysfunction

Causes

Multi factorial, life style, stress, trauma to the joints muscles or jaws. Unbalanced bites especially jaw displacements, muscle spasm.

Aggravating factors

Lifestyle e.g lack of sleep, disturbed sleep, cold environment, life’s stresses

Trauma, changes in the mouth e.g. new restorations, loss of teeth, high fillings, jaw displacements. Dietary factors e.g. drinks with stimulants, red meat, coffee, cafeen.

History & features

Pain in and around the jaw joints usually one sided can be both.

Intermittent though often worse in the morning ,

May be worse after eating or stretching the jaw open.

Not relieved by most analgesics

May present as clicking or crepitus of the joints.

Muscles may be tender and area around the joint may feel tender to touch and pressure.

Xray findings : usually none as problem is often in the muscles and soft tissues.

Management:

Recognition of condition and giving the patient a diagnosis and name of the problem.

Exclude other causes, eg dental disease, partially erupted molar teeth, ENT causes.

Reassurance & resting the muscles.

Local conservative treatments:

Control & reduce stress, Yoga, palates, relaxation, hypno therapy.

Change diet: cut out Coffee, stimulant drinks eg Cola, Red Bull, soft diet, less red meat.

Warm moist heat during acute phases

Jaw exercises, stand in front of a mirror and open and close the jaw moving the jaw on closing to the side giving the pain. Try and hold the lower jaw so that the upper and lower tooth centre lines are in line with each other.

Regularise sleep patterns

Try analgesics ( often non effective)

Interventions:

Acupuncture is reported to give pain relief.

Medications:

Oral & Maxillofacial surgeons may prescribe low dose Tryciclic anti depressants which have a muscle relaxant effect.

Surgery:

 A last resort, Oral Surgeons may open the TM Joints but the risks are high especially of nerve damage and there is associated external facial scarring.

Oral / Dental

In many cases the arrangement of the teeth and bite is unbalanced and poor and may be associated with TMJ pain dysfunction. A direct cause and effect relation can not be drawn. However it is well recognised that an alteration in the bite patterns may either trigger TMJD or can relieve the symptoms.

Bite planes:

These are bite raising appliances normally constructed by Oral Surgeons and Dentists. They may be either a soft acrylic bite guard, a rigid plastic framework with a soft bite surface or a hard bite guard. The hard plastic bite guard may be trimmed to enable ideal functional jaw and tooth movements and such hard bite guards are called “ Michigen Splints”

It has been found that if patients have malocclusions especially where this is associated with par function and a jaw displacement, then treating the mal occlusion and removing the jaw displacement may give resolution of the TMJD.  However given the multi factorial nature of the condition and many options, no guarantee of success can nor should be given for any approach.

How can Somnowell assist in the treatment of TMD:

Like the “Michigen” splints and bite guards described, an appliance that changes the patients biting and parfunctional habits my reduce and resolve the TMDJ problem. By holding the lower jaw forward during sleep, the patient is discouraged from clenching and tooth grinding. The appliance probably de programmes the patients neuro muscular system.

The Somnowell  is longer lasting than any plastic bite guard and is considerably more comfortable, easier to maintain and durable.

As a by product of treating patients with Snoring and sleep apnoea, it is frequently reported by patients that in addition to resolving the primary condition, the jaw joint and grinding is controlled.