The temporomandibular joint (TMJ) is where the lower jaw connects to your temple, just in front of your ear. Disorders and dysfunctions associated with the joint (sometimes referred to as TMD, or temporomandibular joint dysfunction/disorder) can result in severe pain, persistent headaches, and disrupted sleep. Left untreated, TMJ issues can have some unexpected, and serious, consequences.
Disease of the TMJ is very common. It’s estimated that one in three adults in will report one or more symptoms of TMD in their life.
Signs and Symptoms
There are many signs and symptoms of TMJ dysfunctions, or TMD. These include:
- Pain when chewing
- Neck and/or back pain
- Limited ability to open the mouth wide
- A jaw that locks or has limited movement, either open or closed
- Frequent popping and clicking in the jaw
- Persistent headaches, particularly first thing in the morning
- Ear pain or “infections” that don’t respond to medication
Cause of TMJ Dysfunctions
TMJ dysfunctions are typically caused by a variety of issues, often working together. Jaw injuries can lead to TMD, as can joint diseases such as arthritis. Teeth grinding (bruxism) and tension in the head and neck muscles can make TMD symptoms worse, or in some cases cause the pain.
Stress is linked to TMD, but whether it’s a symptom or a cause is less clear, and can vary on the individual situation.
Nervous habits such as fingertip biting and chewing on pens or pencils can also contribute by overworking the joint. Poorly fitted full or partial dentures can also lead to issues.
While up to one in three American adults will report these symptoms, it’s also worth noting that TMD has also been called “the Great Imposter”. Many of the signs and symptoms overlap with, or are identical to, a host of other, unrelated problems.
For that reason, to properly identify TMJ dysfunctions it’s crucial to get the joint checked by a dentist. You may discover that the dysfunction in your jaw is actually coming from elsewhere in your body.
Managing TMJ Dysfunctions
Most TMJ problems will actually clear up by themselves over time. Rarely is medical intervention actually required.
Treating the discomfort
For alleviation from TMJ discomfort, apply a cold or warm press to the effected area and massage gently. Mild painkillers might also be used to help with the pain.
Preventing TMJ Dysfunctions
Eating a soft diet, with food cut into small and manageable pieces, will take some of the strain off the TMJ. Avoid hard, chewy, or sticky foods where possible. Try to not open your mouth overly wide, even when yawning.
A relaxed mouth should have teeth slightly apart with the tongue resting on the floor of the mouth. Lips should be just touching, or even slightly apart. There should always be a slight space between upper and lower teeth except when chewing, speaking, or swallowing.
For severe, persistent, or unmanageable TMJ problems, it’s best to talk to your dentist. They’ll perform a thorough examination of the area, including X-rays if needed.
A dentist’s treatment plan for TMJ can involve many approaches. You may simply need to be educated on some effective relaxation techniques to prevent you putting too much strain onto your TMJ.
Sometimes a referral to a physiotherapist is necessary. This is particularly the case if it’s determined that the TMJ dysfunction is actually originating from another part of the body. As neck, back, and head muscle tension can lead to TMJ pain, you may discover that the source of the dysfunction could be as far away as your feet.
Chiropractors are sometimes referred if the source of the discomfort is discovered to be along the head and neck. Relieving the tension from these areas will remove the strain from the jaw and alleviate the symptoms.
Behavioural therapists are recommended if it’s determined that some sort of habit is stressing the TMJ or relevant muscle groups. Oral fixations such as chewing on pens or pencils can overwork the TMJ and cause problems. Addressing these behavioral issues will address the TMJ pain.
One form of medical intervention that your dentist might provide is called an occlusal splint, or night guard. These are made of plastic and custom-fit to your teeth. They help to keep your jaw in an ideal position while you sleep, to help the TMJ relax. Taking the strain from the TMJ over the course of a few hours at night can sometimes completely clear TMJ dysfunctions.
You may also be referred to one of several dental specialists, such as an oral surgeon, an orthodontist, a periodontist or prosthodontist. These people typically have many years of specialist training in the mechanics of the jaw and how best to treat them.
If all else fails, if no method or treatment provides results, then and only then will surgery be considered. You will be referred to an oral and maxillofacial surgeon, who specializes in surgeries of the mouth, face and jaw.
TMJ and Sleep Apnea
Sleep apnea is when your airways become blocked while you sleep, resulting in a lack of oxygen to the bloodstream. This is also accompanied by choking and snoring. This is generally caused by the soft tissues of the mouth, such as your tongue, collapsing and blocking your airways.
While TMJ disorders and dysfunctions are uncomfortable and can certainly interfere with quality of life, sleep apnea can be a much more serious condition. The frequent lack of oxygen not just to the brain, but other vital organs, greatly increases multiple health risks. People with sleep apnea, for example, are much more susceptible to cardiovascular problems like heart attacks.
Sleep apnea is one of the conditions which can present itself with TMJ dysfunction symptoms. As the most obvious signs of sleep apnea occur while people are sleeping — snoring, choking — it’s difficult for people to realize if it’s happening to them without being told by a partner.
Instead, people will be more aware of two things. Firstly, they’ll notice they wake up a lot during the night and frequently feel unrested no matter how long they sleep. Secondly, they’ll notice TMJ pains. The latter is caused by grinding, clicking, and jaw flexing associated with sleep apnea.
If you notice you have TMJ issues that don’t seem to go away, wake up frequently during the night, and are persistently tired, you may have sleep apnea. Discuss the issue with your dentist to find out more.
Causes of Sleep Apnea
Sleep apnea has a wide range of causes. Some people are predisposed to the condition due to the formation of their mouth and jaw. People with severe underbites, for example, will be more likely to suffer sleep apnea.
Various lifestyle factors can also attribute. Excessive weight around the neck, alcohol consumption, and smoking can all cause, or exacerbate, sleep apnea.
Treating Sleep Apnea
For many patients lifestyle and behavioral changes are the most effective ways of dealing with the condition, and no medical intervention is necessary. Weight loss, cutting down on alcohol intake, and managing their smoking habit will all produce results.
The gold standard of treating sleep apnea is a device called a Constant Positive Airway Pressure (CPAP) machine. It forces are through the nose while you sleep to keep the airways open. Unfortunately there’s some associated discomfort and noise, not to mention price, which many patients find undesirable or prohibitive.
Oral appliance therapy is a newer option, and its effectiveness is dependent on the patient’s individual condition. Oral appliance therapy works by locking the jaw into the ideal position while sleeping. This keeps the airways open and relieves strain on the TMJ, neatly treating both conditions together.
Lastly, surgery is also an option. As with TMJ it’s reserved for when other options simply aren’t working, or have been deemed unsuitable. Its effectiveness is also dependent on the exact circumstances of the patient.
How Serious is Sleep Apnea?
Sleep apnea might sound like an inconvenience, but the overall medical implications are actually fairly worrying.
If left untreated, severe sleep apnea is strongly related to both fatal and nonfatal cardiovascular problems.
Untreated sleep apnea is also linked to overall mortality. One study in particular concluded that the mortality rates of sleep apnea sufferers were “excessive” compared to the general population .
Driver fatigue is a leading cause of motor vehicle accidents which are often fatal . The constant sleep disruption caused by sleep apnea causes fatigue and drowsiness in sufferers. Driving simulation studies which compared drivers before and after treating their sleep apnea showed a marked decrease in accidents after treating the condition.
What’s the difference between TMJ and TMD?
TMJ refers to the joint itself — the temporomandibular joint. It’s where your lower jaw, your mandible, connects to the side of your head, the temple. TMD refers to disorders or dysfunctions of this joint.
Are TMJ problems common?
Very. Up to one third of adult Americans will suffer TMD issues in their life.
What are the main causes of TMD?
The main causes are overuse of the muscle in the joint, muscle tension in the head and neck, and developmental problems resulting in lop-sided jaw growth. If one side of the jaw develops differently to the other it’ll create stress on the opposite side which causes problems.
Is TMJ a serious problem?
On its own, no. However, TMJ disorder symptoms can mask a lot of other issues which can be fairly serious, such as sleep apnea.
If I have TMD, do I have sleep apnea?
No. You can have TMD without having sleep apnea; however, if you have sleep apnea, there’s a good chance you’ll have TMD.
Will I need surgery or medical treatment for my TMD?
Not always. Many TMD symptoms will clear on their own and can be both prevented and managed on your own. Persistent or severe problems will need to be investigated and may require behavioral or medical intervention.