What is TMJ?
TMJ technically stands for Temporo-Mandibular Joint which is anatomy-speak for the joint where your jaw bone attaches to your skull. However, we often use the initials TMJ to talk about a wide variety of problems related to this area of the body. If someone says “I have TMJ” they usually mean that they have some kind of trouble with the jaw joint or the muscles, ligaments or tendons around it.
What are the symptoms of TMJ?
The most common TMJ symptom that brings people to the ENT doctor is PAIN. Many people have clicking or popping of the jaw, but this does not tend to be worrisome or mysterious to those who experience it. What tends to drive people to seek medical attention is pain and pressure (or sometimes just vague discomfort) of the ear or neck on one or both sides. TMJ is almost never the first thing people think of when they have these symptoms; more likely a person will think they have an ear infection or, if the surrounding muscles are involved, “swollen glands.” In a person with no prior ear history and a normal hearing test, TMJ is just as likely a diagnosis (if not more so) than either of these things.
Inflammation in the joint itself causes pain in the ear, sometimes toward the front of the ear opening and sometimes deep within the ear itself. It can also cause a feeling that the ear is blocked or stuffy, even a feeling that there is hearing loss, though an objective measure of hearing will be normal in these cases.
If the tendons and muscles are inflamed, the pain/tenderness can be near the corner of the jaw, in front of the ear and radiating into the face, or at the temple. Spasm of larger upper neck muscles can accompany TMJ troubles; this can cause discomfort in the larger muscles of the neck in the front and back of the neck, even radiating to the sternum and shoulder.
Inflammation can also trigger increases in headache, especially in the temple area and cheeks.
What causes TMJ?
Very often, TMJ is associated with clenching and/or grinding of the teeth. People can clench or grind their teeth when awake, but more often do so involuntarily in their sleep. Some people do not know that they do this, though the dentist may note some wear and tear on the teeth of those that do. One can generate very strong forces through the muscles during sleep that are almost impossible to emulate when awake—this causes soreness of the muscles and joint especially if the forces are repeated every night over time. TMJ is also more likely if the upper and lower teeth do not fit perfectly together—this puts more stress on the joint during chewing.
Like any arthritis, TMJ arthritis is also more common with age, especially if arthritis elsewhere is present. People with soft-tissue disorders like fibromyalgia can also be prone to TMJ problems.
Because tooth-clenching behavior (both awake and asleep) is more common in times of stress, clinicians notice that patients who present with TMJ problems are often going through a particularly stressful period of time.
What can I do about it?
The most important part of getting better is getting the proper diagnosis from a TMJ Doctor in one of our Philadelphia offices. TMJ must be differentiated from ear infections and other problems with the neck. This can usually be done with a thorough physical exam and hearing test. Once the diagnosis is made, TMJ treatment does NOT involve the use of antibiotics or require special scans or x-rays, though scans may be used to differentiate TMJ from other causes of neck pain. NSAID medications, warm packs and soft foods are the mainstays of treatment for simple flare-ups that may be related to a stressful life event. However, recurrent or chronic troubles may benefit from addressing other underlying issues such as tooth grinding or dental malocclusion; this can be achieved with oral appliances to decrease grinding and protect the teeth and joints. Spasm and/or tension in the jaw and neck muscles can be addressed by techniques such as physical therapy. For severe flares, anti-inflammatory steroids and/or muscle relaxant medications may be prescribed.
If you have ear pain, normal hearing and no ear drainage or history of previous ear infections, it is likely that you have TMJ! You can make an appointment with BergerHenry ENT to confirm a proper diagnosis and get on the road to feeling better.