Musculoskeletal Conditions / Temperomandibular Joint (TMJ) Problems

The temporomandibular joint connects the lower jaw, called the mandible, to the temporal bone at the side of the head. If you place your fingers just in front of your ears and open your mouth, you can feel the joint on each side of your head. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. Muscles attached to and surrounding the jaw joint control its position and movement.

When we open our mouths, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft disc lies between the condyle and the temporal bone. This disc absorbs shocks to the TMJ from chewing and other movements.

The temporomandibular joints are complex and are composed of muscles, tendons, and bones. Each component contributes to the smooth operation of the TMJ. When the muscles are relaxed and balanced and both jaw joints open and close comfortably, we are able to talk, chew, or yawn without pain. We can locate the TMJ by putting a finger on the triangular structure in front of the ear. The finger is moved just slightly forward and pressed firmly while opening the jaw. The motion felt is from the TMJ.

We can also feel the joint motion if we put a little finger against the inside front part of the ear canal. These maneuvers can cause considerable discomfort to a patient who is experiencing TMJ difficulty, and doctors use them for making the diagnosis.
 

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Both males and females can get TMJ diseases/disorders. However, 90% of those seeking treatment for TMJ are women, most between puberty and menopause. Recent research has focused attention on the relationship between sex hormones and pain. A study conducted by Dr. Linda LeResche, University of Washington in Seattle, demonstrated that women on hormone replacement therapy were 77% more likely to seek treatment for jaw pain than those not undergoing such treatment. Also, women on oral contraceptive therapy were 19% more likely to seek treatment. Evidence is emerging in support of a biological explanation for why there are more women suffering from TMJ pain.

A possible explanation is structural differences, as in connective tissues, smooth muscle, or cartilage. Several other studies find an equal distribution of TMD symptoms among men and women, yet claim that females outnumber males eight to one in seeking treatment. There is wide speculation as to why this is true. Some feel women utilize the health care system more than men do; others state that women have a lower tolerance for pain. However, since women most affected by TMD are between the ages of 18 and 40, it stands to reason that detailed scientific studies should be carried out to assess the influencing effect of female sex hormones on the development of the jaw joints and temporomandibular joint disorders. In studies with baboons, estrogen receptors were found in the females' TMJs, but none were found in the males. Scientists are unsure whether the presence or absence of hormones makes a difference in pain, the perception of pain, or function. It is interesting to note that a past scientific study has shown that male and female mice experience pain and can respond to pain differently.

TMJ pain disorders usually occur because of unbalanced activity of the jaw muscles and/or jaw muscle spasm and overuse. Symptoms tend to be chronic, and treatment is aimed at eliminating precipitating factors. Many symptoms may not appear related to the TMJ itself. Common symptoms include:

· Headache: 80% of patients with a TMJ disorder complain of headache, and 40% report facial pain. Pain is often made worse while opening and closing the jaw. Exposure to cold weather or air-conditioned air may increase muscle contraction and facial pain.

· Ear pain: 50% of patients with a TMJ disorder notice ear pain but do not have signs of infection. The ear pain is usually described as being in front of or below the ear. Often, patients are treated multiple times for a presumed ear infection, which can often be distinguished from TMJ by an associated hearing loss or ear drainage (which would be expected if there really was an ear infection). Because ear pain occurs so commonly, ear specialists are frequently called on to make the diagnosis of a TMJ disorder.

· Sounds: Grinding, crunching, or popping sounds, medically termed crepitus, are common for patients with a TMJ disorder. These sounds may or may not be accompanied by increased pain.

· Dizziness: 40% of patients with a TMJ disorder report a vague dizziness or imbalance (usually not a spinning type vertigo). The cause of this type of dizziness is not well understood.

· Fullness of the Ear: 33% of patients with a TMJ disorder describe muffled, clogged, or full ears. They may notice ear fullness and pain during airplane takeoffs and landings. These symptoms are usually caused by Eustachian tube dysfunction, the structure responsible for the regulation of pressure in the middle ear. It is thought that patients with TMJ disorders have hyperactivity (spasms) of the muscles responsible for regulating the opening and closing of the Eustachian tube.

· Ringing in the Ear - Tinnitus: Because of a complex neurological interaction between the TMJ joint and the facial and vagus nerve, 33% of patients with a TMJ disorder experience noise or ringing (tinnitus). Of those patients, half will have resolution of their tinnitus after successful treatment of their TMJ.

Other symptoms include:

• facial pain; jaw joint pain; often in combination with neck, shoulder, back pain and/or headaches
• popping, grating or clicking sounds with movement of the jaw joint
• pain in the joints of the face when opening or closing the mouth, yawning, or chewing
• swelling on the side of the face and/or mouth
• a bite that feels uncomfortable, "off," or as if it is continually changing
• limited opening or inability to open the mouth comfortably
• deviation of the jaw to one side
• the jaw locking open or closed

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