By Dr. Ravindra Patil
Pain in the area near our ear, our jaw or the muscles on the side of our face, sometimes accompanied by a clicking or popping sound and/or restricted jaw movement is called Temporo-Mandibular Disorders or TMD in short. There is another abbreviation related to the joints of the jaws. It is TMJ for Temporo-Mandibular Joint. We have two TMJs on either side of our face.
Jaw pain reasons are many and may be due to TMJ disease or even mental stress!
TMD pain describes a group of conditions characterized by pain and dysfunction of the TMJ and/or the muscles surrounding it. It’s not always easy to figure out the cause of these symptoms. However, most TMD cases can be treated with conservative remedies. Only if these remedies are not useful should major procedures like dental treatment or surgery should be done.
The two TMJs that connect your lower jaw, the mandible, to the temporal bones of the skull on either side, are actually very complex joints that allow movement in three dimensions. The TMJ anatomy is that the lower jaw and temporal bone fit together as a ball and socket, with a cushioning cartilage disk in between. Large pairs of muscles in the cheeks and temples move the lower jaw. Any of these parts — the disk, the muscles or the joint itself — can become the source of a TMD problem.
For people suffering from TMD pain or for people having difficulty opening or closing their jaw, a thorough investigation workup is necessary to pinpoint the cause of the pain or difficulty in opening and closing the jaw.
The temporo-mandibular joint or TMJ can suffer orthopaedic problems like any other joint. These problems include inflammation, sore muscles, strained tendons and ligaments, and cartilage problems.
Heredity also plays a role in causing TMD. Compared to men, women appear to be more prone to it. As we age, the chances of getting TMD are higher. Physical and psychological stresses can also cause TMD. In some cases, jaw pain may be related to a more widespread, pain-inducing medical condition such as fibromyalgia. Fibromyalgia is a pain of muscles and connective tissue around the TMJ [or any other joint].
Because we have two Temporo Mandibular Joints, one on each side our the face, pain in left side of head, jaw pain left side, pain on left side of head above ear, pain in right side of head, jaw pain left side near ear or jaw pain one side, all permutations and combinations of pain are possible.
Clicking Sounds: some people with TMD hear a clicking, popping or grating sound coming from the TMJ when opening or closing the mouth. This is usually caused by a shifting of the cartilage disk inside the joint. This clicking or popping sound can sometimes be heard by anyone standing next to the patient. Clicking by itself is actually not a significant symptom because it has been found that over one third of all the population has jaw joints which click. However, if the clicking is accompanied by pain or limited jaw movement and function, or the jaw is getting ‘stuck’ in an open or closed position often, this definitely is TMD.
Every joint is operated by muscles. The jaw can be clenched by two pairs of very powerful muscles, the temporalis muscles and the masseter muscles. They are located on either side of our face. Pain in these muscles is significant and should be taken care of. Jaw pain is not so uncommon.
Pain on right side of the head or left side head pain, the side depends on which side TMJ is affected. Often both sides jaw pain may occur.
The reason for jaw pain may be muscle spasm of temporalis and masseter muscles.
The muscle pain may be felt in the cheeks (masseter muscles) and temples (temporalis muscles), where the two big pairs of jaw-closing muscles are located. If a person feels soreness and stiffness upon waking up in the morning, it’s often related to habits of clenching and/or grinding the teeth at night. If you have this type of nocturnal habit, it can be treated with a custom-made guard which is very helpful in decreasing the force applied to your teeth. This in turn will allow your muscles to relax and be painless. This will relieve pressure on your jaw joints. Some of the other self-care remedies are discussed below.
TMJ headache means headache or jaw pain caused because of TMD.
Pain that originates one or both jaw joints is called arthritis of the TMJs. When we look at X-Ray images of the TM joints, we may or may not find arthritic changes. The funny part is, some people have arthritic-looking TMJs but no symptoms of pain or dysfunction; while others have significant symptoms of pain and dysfunction but their joints look normal in X-Ray images. Alas, there is no permanent cure for arthritis anywhere in the body, but medicines definitely help in relieving arthritic pain and swelling.
As has been mentioned, a thorough investigative work up on a TMD patient will help in finding the cause of the pain and then treat or reduce the same. Sometimes an intervention as simple as switching to a soft diet which does not need thorough chewing can reduce stress on the muscles and joints and reduce pain.
Application of Ice and/or moist heat can help relieve swelling, soreness and inflammation. If the pain is caused because of muscle spasm, it can be relieved with gentle stretching exercises. Non-steroidal anti-inflammatory drugs [NSAIDs] and muscle relaxants can also provide relief. NSAIDs apart from reducing inflammation, also reduce pain.
Severe TMD cases may require more complex forms of treatment, which might include orthodontics, dental restorations like bridgework, or minor procedures inside the joint such as cortisone injections or lavage (flushing) of the joint. It’s rare for major surgery ever to be necessary in a case of TMD. Again, it’s important to try the wide range of conservative, reversible treatments available, and give them enough time to work as they almost always prove effective.
It is well known that chewing tobacco causes cancers of the mouth. But chewing tobacco also causes difficulty with chewing, swallowing, speaking or moving the tongue and jaw. Tobacco users find it very difficult to open their mouth and so are unable to eat properly. While the risk of cancer with tobacco chewing is great, the stiffening of the jaw and inability to open the jaw fully is also a major symptom. There may be cheek swelling too.
Many people who had been chewing tobacco and Gutkha for a few years, experience inability to open their mouth. The mouth barely opens more than 30 mm and the opening is further reduced over a period of time. The jaws become stiff. Such patient are firstly unable to eat because of small mouth opening. Besides, they are unable to eat spicy food. This condition is known as Oral Sub Mucous Fibrosis.
Stopping tobacco chewing is the first step in treating Oral Sub Mucous Fibrosis. Surgical treatment also helps open the jaw wide.
TMD, or Temporomandibular Disorders, is an umbrella term for various painful conditions that affect the jaw joints. There are different treatment approaches to TMD problems, but not all are based on science. It’s important to be up on the latest information and to be an educated patient. We have tried to provide useful information in this article about TMD.
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