Jaw
Jaw Noshing chewy favorites like caramel apples or thick, juicy steaks. Giving your mate a heartfelt, passionate kiss. Laughing it up with old friends. None of these pleasures would be possible without the jaw.
But that hard-working joint can also be the focal point of pain--even if the jaw itself doesn''''t hurt one bit. It''''s the culprit behind temporomandibular joint disorder (TMD), a malfunction in the jaw mechanism that can lead to many other kinds of pain around the head, neck and shoulders.
The temporomandibular joint, which connects the jawbone to the skull, allows the jaw to open, close and move from side to side and backward and forward. But occasionally, the jaw gets out of alignment. The result is an upset in the meshing of the upper and lower teeth that can eventually lead to a spasm of the jaw muscles, says Neil Gottehrer, D.D.S., director of the Craniofacial Pain Center in Abington, Pennsylvania. That sets off a chain reaction of other disorders, he notes. "I''''d say that fewer than a quarter of my patients come in with a complaint of an aching jaw. They call TMD the great imposter, because it mimics many other symptoms. Some people have headaches, neck pain, shoulder pain, earaches, sore throat or dizziness."
You might also have clicking or popping sounds while opening or closing your jaw, fullness in your sinuses and pain while chewing, according to Dr. Gottehrer.
It''''s a frustrating disorder that affects about 20 percent of the population, although it''''s been estimated that only 5 percent of those people are actually being treated.
One problem is the extreme range and severity of symptoms, says A. Richard Goldman, D.D.S., director of the Institute for the Treatment and Study of Headaches and Facial Pain in Chicago. "TMD is a field pregnant with knowledge and misknowledge. The pain can be so mild as not to be noticed or so severe as to render the patient suicidal."
What causes temporomandibular joint disorders? Often it''''s major trauma, of which there are two kinds, says Gerald J. Murphy, D.D.S., president of the American Academy of Head, Neck and Facial Pain and a dentist in Grand Island, Nebraska. The first kind, known as direct trauma, includes blows to the jaw produced by mishaps during sporting events, by car accidents or by fistfights. The second, referred to as indirect trauma, involves whiplash injuries. These can be related either to neck injuries or to jaw injuries. A significant percentage of jaw-related whiplash injuries involve both the temporomandibular joint and its associated muscles, ligaments and tendons, he notes.
But sometimes it''''s the result of more subtle factors. Some people have developmental problems of the jaw or temporomandibular joints, such as a deep underbite--a condition where the bottom jaw protrudes. Others may develop temporomandibular disorders when they lose their back teeth and don''''t have them replaced--resulting in a bite change. In addition, tooth grinding, also known as bruxism or jaw clenching, may over a period of time result in a temporomandibular disorder, notes Dr. Murphy.
TMD can be a maddening ailment, but it doesn''''t have to make you feel helpless. There are many ways to prevent this painful intruder from becoming a pain.
Keep your chin up. A person with a whiplash injury has heavy stresses on the neck muscle, says Dr. Murphy. This may cause the head to automatically come forward, which can put heavier stress on the muscles of the jaw. You should concentrate on not habitually jutting your head forward--a posture often acquired by those who work at computers all day. "Changing your head posture changes your jaw position," he says. "Over the course of time, that relates to developing TMD."
Get out of the clench. Constant tooth grinding makes a person''''s jaw muscles tighten up and become spastic. That jaw action pulls the joint slightly out of place, according to Charles Longenecker, D.M.D., a dentist in private practice in Emmaus, Pennsylvania.
Grinding your teeth while you sleep--a major aggravator of the temporomandibular joint--can be remedied with a mouth guard. In some cases medication (usually tranquilizers) also reduces the muscle spasms, says Dr. Longenecker. "We put a hard plastic appliance over the upper teeth that keeps the teeth separated. So the lower teeth can glide over smooth plastic instead of biting into the upper teeth."
| Where''''s That Pain From? Despite its mysterious nature, temporomandibular joint disorder (TMD) is actually fairly easy for a dentist to diagnose. If you report symptoms that sound like they might be TMD, your dentist will probably ask you for a thorough history to find out what makes the pain worse, when it came on and from where the pain emanates, says Gerald J. Murphy, D.D.S., president of the American Academy of Head, Neck and Facial Pain and a dentist in Grand Island, Nebraska. One way to check for TMD is by finding out how widely you can open your mouth, according to Charles Longenecker, D.M.D., a dentist in private practice in Emmaus, Pennsylvania. Your mouth opening is measured between the biting edges of your incissors. It is normally 50 millimeters--almost two inches--but it''''s difficult to open your mouth that wide if you have TMD. A physical exam also tells a story. "When the doctor pushes in front of your ear, you may feel discomfort," says Dr. Longenecker. "If you press on the muscles inside and outside your mouth that support your jaw, there may be tenderness." The doctor might take x-rays to check for deformities in your jaw joint. If those don''''t show the problem, an MRI (magnetic resonance imaging) or CAT (computerized axial tomography) scan might be needed, Dr. Murphy notes. While a standard x-ray only shows a front or side view of your jaw joint, an MRI shows soft tissue and can be used to determine whether or not your jaw disk is out of position. A CAT scan is an even more detailed evaluation of the joint, allowing the doctor to view different sections of your jaw. How do you know if the doctor has given you a correct diagnosis? Usually, time will tell. "If the patient doesn''''t see a reduction in symptoms in three to five weeks, the doctor should reassess the diagnosis," says Dr. Murphy. "If it''''s a habit-related problem, the habit that''''s causing the condition will have to be modified." |
A hard plastic day splint that fits over the lower teeth is available for people who habitually clench their teeth during the day, he adds. See your dentist about getting one.
Jack up your jaw. Doing daily isometric exercises is a great way to stretch and contract the jaw muscles affected by TMD, says Dr. Gottehrer. One recommendation: Put your finger under your chin and try to open your mouth against slight resistance. Open your mouth about a half-inch with your finger still pressed against the chin--then close. Repeat 10 to 15 times twice a day. This relieves facial pain by stretching facial muscles that may be in spasm.
Exercises like that pay off, according to a six-month study of young adults with TMD conducted at the University of Sydney in Surry Hills, Australia. The study involved 44 people who had clicking in their jaws. One group of 22 did jaw exercises; the other didn''''t. Researchers found that 18 of the 22 who did jaw exercises were able to banish the clicking. In the other group there was no change.
Avoid steak. Whenever your TMD acts up, go on a soft diet, says Dr. Murphy. Eat things such as well-cooked vegetables, pudding, gelatin desserts, soup, finely chopped ground beef--foods that don''''t require heavy chewing--for three to four weeks.
Fight inflammation. Take ibuprofen regularly to ease pain and swelling, says Dr. Murphy. To calculate how much you need to take, consult your physician or follow the label directions, recommends Dr. Murphy.
Stay on your back. Lying on your stomach while you sleep is "the worst thing in the world," says Dr. Gottehrer. "It''''s not a normal body posture and puts stress on the jaw. I recommend sleeping on the side or back if possible."
See also Skeletal System
