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By Dr. Rob Gausmann, DDS  – Printed April 22, 2013

Q. My jaw is frequently stiff, sore and pops. I also grind my teeth at night. Could this be TMJ and how could a dentist help?

When healthy and functioning well, the jaw and surrounding muscles should work harmoniously to allow chewing, talking, eating, smiling and numerous other benefits.  However, when one or several of the components are not working together, discomfort can occur. One example of this discomfort is associated with the jaw joints. Understanding how these joints work and what they provide is key to understanding jaw-associated discomfort. This movement is complicated and requires the synchronization of many parts.

TMJ

The Temporomandibular Joint (TMJ) can be thought of as a hinge that allows the lower jaw bone (mandible) to move away from the skull. These parts include multiple muscle groups, nerves, bones, teeth, and others. 

Two temporomandibular joints are located on each side of the skull near the ear. These particular joints are different from others in the body because they allow two separate movements. They provide movement of the lower jaw down and outwards from the upper jaw (maxilla) using one series of muscle movements, while the opposite movement (drawn back in) uses a different set of muscles. These muscles provide the motions that allow for chewing, speaking, and swallowing, but can also be a source of jaw discomfort if not working properly.


TMD
The name Temporomandibular Disorder (TMD) is the actual diagnosis given when the above components are not working together. This disorder can result from several sources including: grinding and clenching teeth, teeth not coming together evenly (malocclusion), trauma, and joint wear/disease.


Recognizing TMD  

The most common symptoms of this disorder include: nerve pain around the ear, surrounding jaw muscle and head discomfort, headaches, noises when the jaw moves, and loss of jaw opening. TMD could be caused by any one source or a combination of sources. Understanding which source(s) is causing the problem is helpful when determining treatment. 


The most common culprit of TMD is nighttime grinding and clenching – called Bruxism.  This (often in combination with daytime clenching) overworks the joint and causes noticeable discomfort. The effects on the joint by bruxing during the night is like going to the gym and lifting weights for hours on end. The muscles/joint were not designed for this purpose and the area becomes inflamed and uncomfortable. The source for bruxing is unfortunately the stress that life so easily provides. The best treatment would be to eliminate the stress, but since this is not always possible, several dental options exist. 


Dental Treatment Options
The options range from mouthpieces to extensive surgery.  A common (and relatively non-invasive) treatment is an appliance worn over the teeth called an occlusal splint (or night guard).  These not only help to protect the teeth, they position the teeth, jaw, and joint to minimize grinding and clenching at night, therefore reducing the overuse of the joint and associated muscles. If a splint does not help with the discomfort, other options include monitoring nerve function, reconstructive dentistry, orthodontics, and joint treatment or replacement.

TMJ discomfort can often be treated and is worth evaluation. Treatment may involve a team approach including multiple areas of medicine – dentist, surgeon, chiropractor, neurologist, etc… An important part of having a healthy mouth is ensuring all elements function together comfortably.

Dr. Rob Gausmann, DDS – Gausmann Family Dental

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