TMJ & TMD

Helping People With TMJ Disorder in Tucson

What is the TMJ?

TMJ stands for temporomandibular joint. It is the joint that is located in front of your ear and connects the temple of your skull to the mandible, your lower jaw bone. We all have two TMJs: the right and the left one.

TMJ is the most complex joint in the body. We have to move both TMJs at the same time and cannot choose to only move one joint. The temporomandibular joint has two distinct movements unlike any other joint in the body. The initial motion is a rotation/hinge movement that is followed by a translation/sliding movement.

We use our TMJs daily and more frequently than any other joint in our body. Every time we talk, chew, bite down or swallow we put the TMJs to work.
In order to open and close the mouth to eat or speak, our TMJs must be functioning properly. These joints, which are moved by muscles and stabilized by ligaments, are therefore part of an orthopedic system, which can be compromised by overuse, disease, or trauma. Once present, a TMJ problem is typically associated with pain and/or limitation of jaw function. When we have a problem with TMJ, it is described as TMD, which stands for temporomandibular disorder.

Abnormal TMJ anatomy

The tissues inside the jaw joint can become injured and cause pain. Sometimes the TMJ disc gets moved out of place or gets damaged. When the disc is unable to move normally or is worn out and damaged it causes joint clicking, crepitus or locking.

Movement of the jaw

The disc is positioned between the temporal bone and mandible and moves with bones always being centrally located in between the two bones

What is TMD?

TMD stands for temporomandibular disorders. We use this term when TMJ does not work correctly, when the normal TMJ anatomy is altered or when pain is present.

TMDs are classified into Temporomandibular Joint Disorders and Masticatory Muscle Disorders.

Joint TMDs

The tissues inside the jaw joint can become injured and cause pain when you try to move your jaw, to talk, or to eat. Sometimes the shock-absorber the disc gets moved out of place and damaged. When the disc is unable to move normally, it can cause pain with joint noises. This can also lead to jaw sticking or locking when you try to open your mouth.

The bone and soft tissues of the jaw joint can also break down over time in a disease known as arthritis. The worn bone and disc can make crunching sounds or cause pain for some people. Arthritis can be caused by wear and tear on the joint. Osteoarthritis is more common in older people. But the pain may also be related to joint diseases that affect the whole body, such as rheumatoid arthritis.

Muscle  TMDs

Masticatory muscles are large chewing muscles which attach our jaw to the skull. These muscles work to open and close mouth and move the jaw from side-to-side as we talk or chew. While moving the jaw, we also use muscles to support our head and neck. Like any other muscles, masticatory muscles can become painful, tired, or tense from overuse and cause acute muscle pain or myalgia.

In some instances, muscle pain persists. Sometimes the brain confuses continuous pain signals and we might feel the pain in other places. This can lead to widespread jaw pain, neck pain, or headaches.

Myofascial pain is most often described as a dull and aching pain, soreness or tiredness.

Muscles may contain trigger points, which are the “knots” or hyperirritable areas in the muscle tissue, which can cause persistent local muscle pain or may cause referred pain.  Referred pain is a pain stimulus originating in one part of the body being felt in another muscle or muscle group. 

Myofascial trigger points weaken the muscle in which they are present. The muscle experiences a constant state of contraction as the active trigger point tenses the muscle fiber, creating a taut band of muscle tissue. This taut band can become hard and rope-like and feels painful or stiff for the individual experiencing it. The affected muscles may have restricted motion and become quickly fatigued.

Muscle pain is treated depending on a particular diagnosis.

Patients with chronic myofascial pain may typically need to undergo several treatments to alleviate the pain symptoms associated with the condition. A comprehensive treatment plan may include the following treatments:

• Muscle stretching, moist heat, massage therapy, maintaining good posture and anti-inflammatory diet.
• Medications: Over-the-counter or prescription NSAIDs, such as ibuprofen and naproxen can help a patient manage the pain. Muscle relaxants are often prescribed as well.
• Trigger Point Pressure Release involves the application of gradually increased pressure at a muscle trigger point is meant to soften the knotty muscle tissue of the trigger point and taut band.
• Spray and Stretch technique involves the application of a very cold spray that temporarily distracts the muscle, allowing a doctor or therapist to stretch the muscle to the point of release. Once a trigger point is released, the muscle is moved throughout its full range of motion. A patient must continue to perform stretching and strengthening motions at home.
• Trigger point injections: In this treatment, a local anesthetic, such as lidocaine, or anti-inflammatory medication is injected into the tender knotty tissue of the muscle trigger point. The injection works to relax the tension of the trigger point and relieve associated pain, allowing the trigger point to be released and more effectively addressed with physical therapy.
• Physical therapy: Contraction of the muscle due to a taut band and muscle trigger point may be relieved with physical manipulation by a trained professional. Massage movements in long strokes along the affected muscles and stretching exercises may help to relieve muscle tension. Dry Needling is another technique physical therapist may do.

TMD Symptoms

TMD Diagnosis

Proper diagnosis will be reached through thorough exam and it is crucial to establish in order to properly treat and manage the condition you have.

Dr. Maruflu will perform a comprehensive exam which will consist of:

• A review of your medical, dental, and pain history
• A physical examination of your head and neck, including muscles, nerves, jaw joints, and mouth
• CBCT scan
• Additional testing which may include dental X-Rays, MRI, laboratory tests, diagnostic injections, or blood work.

After all of the information has been gathered and processed, Dr. Maruflu will  be able to properly diagnose your condition.

Causes of TMD

TMD usually has several symptoms and more than one cause. Sometimes only one, but more commonly several factors may be acting together, to cause TMD:

• Direct Jaw Injury: Getting hit in the jaw
• Other head, face or neck injury: getting hit in the chin, head, face, car accidents, sports accidents or whiplash injuries
• Injury due to jaw over-stretching from: wide opening during eating, long dental procedures, or inserting breathing tubes for surgery.
• Abnormal Habits: clenching/grinding teeth, fingernail biting, and chewing gum can lead to TMD in certain people. These habits can also make it harder to stop the pain.
• Psychological Factors: studies have shown that emotional stress, depression, and anxiety increase pain.
• Occlusion: research has shown that the way your teeth bite together (occlusion) is rarely the cause of TMD. In a small number of people, it may be part of why the pain is not going away.
• Prescription medicine: some prescription medicines can affect the brain and muscles. This can lead to more pain.
• Joint Diseases: several types of arthritis can happen in the TMJ, just like any other joint in the body.

Treatment of TMDs

Dr. Maruflu uses proven management protocol and non-surgical therapies for your TMD. She will inform you about the condition you have and your treatment will be designed based on your diagnosis. Dr. Maruflu utilizes a team approach and may involve other doctors or medical professionals in your treatment.

Your treatment will begin with a self -management therapy program tailored to your specific condition and needs. You will be educated about possible habits which you may be doing and taught techniques on how to avoid them. Dr. Maruflu may recommend intraoral orthotic appliance therapy and fabricate specific design for you, which will be custom made for you to address particular TMD you have to relieve symptoms you have. If needed, you will be instructed and taught to do stress-management techniques which will help reduce your stress and or anxiety levels. You may be asked to see a psychologist to benefit from biofeedback treatment. You will be instructed on how to do physical therapy modalities specifically for your TMD.  Dr. Maruflu will determine whether a physical therapist can help your TMD symptoms. Physical therapists are trained professionals that help patients rehabilitate from many types of injuries.  You may be recommended to have specifically tailored medical massage and therapy for your head and neck muscle pain. You may be advised to use natural remedies, follow the anti-inflammatory diet or will be given a prescription medication if necessary to manage your specific TMD.  The quality of our sleep will be assessed and addressed since sleep and pain are closely related. Dr. Maruflu may do therapeutic injections if they are needed. In cases of jaw fracture, congenital problem, cancer or severe, constant pain or loss of function, surgery may be necessary and needed and Dr. Maruflu will refer you to an oral surgeon to perform a specific type of surgery.

Self-management behaviors

• Eat softer foods
• Limiting your jaw opening during yawning or chewing, up to two fingers wide
• Resting your jaw muscles by avoiding heavy chewing on chewy, tough or hard foods such as bagels, nuts, certain meats, or candy
• Avoid playing musical instruments that strain your jaw or put pressure on your jaw
• Identify possible problems with sleep and working on a plan to improve your sleep
• Keeping a log of your specific pain and anything that you notice makes it better or worse

Habit avoidance and awareness techniques:

• Avoid grinding and clenching your teeth by keeping them slightly apart and the jaw relaxed in “N” position
• Avoid leaning on your hand/hands which applies pressure on your yaw
• Avoid sleeping on your stomach
• Avoid chewing on items that are not food, for example: fingernails, pencils or toothpicks
• Avoid chewing gum or ice cubes

Stress management techniques

• Relaxation techniques
• Deep breathing techniques
• Meditation practices
• Guided imagery
• Biofeedback

Physical therapy modalities

• Using cold packs or moist hot compresses as instructed
• Pressure point techniques
• Performing jaw and neck stretches or exercises
• Working on good posture
• Head and neck medical massage

Intraoral Orthotic appliance therapy

There are several designs of intraoral orthotic appliances. Yours will be custom made and its design will depend on your specific condition and symptoms. It should be used the way Dr. Maruflu will advise you to use it.

Therapeutic Injections

There are a variety of therapeutic injections which may be helpful to relieve your symptoms.  The injections are not the first line of defense, however, if and when necessary Dr. Maruflu may provide relief and treatment to your symptoms by performing the following types of injections:

• Nerve Blocks
• Joint and tendon injections
• Muscle trigger point injections
• Therapeutic Botox injections

Medications

Many medicines are available for discomfort. Some of these are natural remedies used for pain relief, while others are prescription medications to treat pain. Dr. Maruflu will provide you with a specific medication treatment plan if necessary to address your symptoms and specific condition you may have.

Sleep

Sleep and pain are closely linked and impact each other.  Proper sleep hygiene habits will be discussed and recommended. If needed sleep study will be recommended.

Surgery

In cases of jaw fracture, congenital problem, cancer or severe, constant pain or loss of function, surgery may be necessary and needed.

If you’re looking for a specialist to help with your TMJ disorder in Tucson, look no further than TMJ Care.