Frequently Asked Questions of Temporomandibular Joint (TMJ) Disorders

• Do more men or women get it?

  TMJ disorders (also known as TMD) affect mostly women but men also suffer from it. This is a multifactorial problems and one common factor that we know is stress. We know that stress increases the likelihood of bruxism (teeth grinding) and other lifestyle related conditions, which may result in TMJ problems.

• Age group of people likely to contract it?

  The number of patients with TMJ disorders declines with age. In fact, older people without teeth seldom face TMJ problems.

• Percentage of the population likely to have this problem?

  Epidemiology studies have shown that more than 70% of most urban populations suffer from some forms of TMD during ones´ life time.

Usually the patient complains of pain on the sides of the face or head, noise in the jaw joints, uneven bite and problems with jaw movements such as closing the mouth and moving the jaw side wards. In some cases, one might experience neck and/or shoulder pain, clicking and popping sounds in the jaw joint, and difficulty in moving the jaw joint which in turn affects talking, eating and even smiling.

TMJ disorders cannot be inherited. Factors such as traumatic injury to the jaw joints and ill-fitting dental fillings can trigger TMJ problems. A poor bite or multiple missing teeth could be a triggering factor too. Occasionally, if one attempts to open the jaw too wide and dislocates the jaw joint, this may damage the cartilage in the jaw joint and cause TMJ problems in the future. Not too long ago, the ex-World Champion in hotdog eating was reported to have injured his TMJ when he was training to retain his hotdog-eating world title. He eventually could only open his mouth for approximately 25% of his normal opening and he had to withdraw from the competition.

One of the most common characteristics amongst patients in big cities is stress. We know that bruxism is related with day time stress. When a person is highly stressed, he or she is more likely to grind his teeth during sleep. Bruxism usually happen at 3 stages: when we are falling asleep, when we are closed to waking up and when we are dreaming. Normally we can generate bite force as high as 150 pounds. However, when we grind our teeth at night, we could generate bite force that are way higher than that. Imagine someone who has been grinding their teeth during the night time, the jaw muscles are tired in the morning. This results in jaw pain during the day. This is called myofascial pain and is one form of TMJ disorder.

• In terms of diet?

  We definitely need to take care of the TMJ! It is very common to see food being super-sized nowadays. However, big food require big mouth opening. It is important to understand that Asian in general have smaller mouths. When you want to have that super-sized burger next time, may be you want choose one that is normal size. They taste equally good anyway. Choose regular-sized food items if possible and cut food into small pieces before eating. Dietary supplements for the joint such as glucosamine will also strengthen the jaw joints' cartilage as well as speed up the healing process.

• In terms of physical avoidance?

  Living in a tropical country, we do have more than our fair share of opportunities to munch on ice. Instead of ice cube, grinded ice is another option.

• Use of a bite piece (if a person grinds teeth unconsciously, especially at night)?

  Scientific studies have shown that there is no definite way to stop bruxism but the symptoms can be alleviated by using a mouth guard during night time. The guard helps to cushion the force/pressure on the jaws which results from teeth grinding.

Symptoms include clicking sound and pain in the jaws or the facial muscles. There are two types of pain. The first is a sharp muscle pain confined to one area also known as the trigger point whereas the second type is pain in the joint which signals that the joint itself is inflamed.

Treatment depends on what type of TMJ problem the patient is experiencing. A proper diagnosis is the key to successful treatment. For instance, if the patient underwent a dental procedure recently, then it is possible that the TMJ problem is triggered by the dental procedure and should be treated accordingly.

Bruxism can be easily treated with dental appliances such as the mouth guard. If the patient is experiencing a locked jaw (a type of TMJ disorder) which is an inflammation of the jaw joint, he might benefit from an injection of steroids or painkiller into the jaw joint.

In case where we see missing teeth or poor bite is the reason for the symptoms, then a dental rehabilitation using crowns, denture or dental implants may be the solution.

However, for pain conditions which are difficult to pinpoint, a visit to a neurologist or a specialist dealing with pain may be needed.

The physiotherapist uses devices such as an ultrasound machine to help relax the muscles, making them less inflamed and less painful. Some forms of massages like head, neck and shoulder massage will also help the patient to de-stress. Meditation, guided imagery, yoga are also known to help reduce stress.

Surgical treatment can range from minor one to total joint replacement. Surgery does not always guarantee good results. Long term scientific studies revealed mixed results from most forms of TMJ surgeries. The US National Institute of Health, consensus is that jaw joint surgeries should be reserved after other conservative treatment modalities are exhausted. In fact, conservative remedies such as mouth appliances would help most of the patient greatly.

We know that healing of a skin cut take days, healing of damaged nerve tissues are the slowest. TMJ treatment typically requires more than 2 months. This is simply due to the fact that healing of jaw joints, the associated cartilage and muscle require time.

It is known that recurrence is a not uncommon in TMJ disorders. However, if the cause was sorted out before, re-treatment is usually rather straight forward.

The patient may become a sufferer of chronic pain. Functional limitations may drive the person into depression. If it is a bite-related TMJ condition, over a long time, the bite would most likely not get better.

One of the most common questions from our patients is that: would I get worse, unable to eat, laugh and talk in the future? In fact, we seldom see a slow deterioration of the condition from a functional point of view even though the clinical symptoms and pain may persist if the condition was left untreated. Treatments are to aim at re-gaining the lost function and get rid of the discomfort. If there is a lot of pain or limitation in jaw movement, a person should see a specialist to sort it out.

After the detection of symptoms and discomfort, if it does not disappear after 2 weeks, the person should seek professional help.

A clinical examination will identify what muscles are affected by the TMJ disorder. A clinical exam also helps to indicate if the condition is bite related. The most common examination is an X-ray of the TMJ and the teeth. The X-ray will show if the bite is in proper place and if there is any discrepancy between the fitting surfaces of the jaw joint. A MRI scan is also useful to examine the jaw muscles.

The most important thing to watch out is not to over use it. Imagine one has a sore knee; we would not want to run a marathon to heal it or testdrive it. The same principle applies to a recovering TMJ.

TMJ is a multifactorial clinical problem. A lot of people have had it or are suffering from it. Do not let it go and suffer in silence. The key is to sort it out and treat it early.