The temporomandibular joint (TMJ) is among the most closely utilized and underappreciated joints within the human physique. Mechanically, the TMJ is what means that you can open and shut your mouth, and to a lesser extent, prolong and transfer your jaw backward and forward. Functionally, it facilitates consuming, speaking, and facial expressions. With out a TMJ, McGruff the crime canine wouldn’t be capable to “Take a chew out of crime,” and Jaws would have by no means turn into a savage predatory celebrity of the deep blue sea. Simply kidding. Everyone knows from “Shark Week” that sharks don’t even have a TMJ, however you get the thought.
Structurally, the TMJ is a fancy joint that includes a number of muscular tissues working in live performance with uniquely formed cartilage to permit for the highly effective actions of chewing, in addition to the effective actions concerned with speech. Like so many components of the human physique, the TMJ often solely receives consideration when one thing goes improper.
The grind of grinding
Grinding of the enamel, also called bruxism, is a quite common drawback. For many individuals this happens at night time throughout sleep (nocturnal bruxism). Because it happens throughout sleep, many individuals are unaware that they’re even doing it, however the noise generated might be insufferable for a sleep companion. Folks with nocturnal bruxism typically get up the subsequent morning with tightness and soreness of the jaw muscular tissues. Bruxism over time may cause destruction of tooth enamel, the formation of gaps between enamel as enamel begin to shift, and harm to the TMJ joint. Some individuals who endure from bruxism are first identified throughout routine dental visits when enamel destruction is famous.
Snap, crackle, pop
Various research have proven that TMJ dysfunction can exacerbate headache problems, and that profitable remedy of TMJ dysfunction can enhance the headache dysfunction. As a headache specialist, I routinely consider the TMJ. In the course of the examination, I palpate the joint, whereas the affected person makes completely different jaw actions. I can typically really feel, and at instances hear, the dysfunction within the joint. These issues are often because of the misalignment or harm that has occurred to the tendons, ligaments, and/or cartilage concerned with jaw actions. When extreme, the TMJ can painfully “lock,” and the individual is unable to maneuver their jaw till the joint is realigned, which may at instances require surgical procedure. These points can happen in affiliation with bruxism, extreme jaw clenching, jaw trauma, and at instances with none clear trigger.
My night time…guard in shining armor
A quite common remedy for TMJ dysfunction is the usage of a nightguard, which is a plastic mouthpiece that covers the enamel, and prevents enamel on enamel contact. A nightguard is often fitted to the higher (maxillary) enamel. Typically, a dentist fabricates customized nightguards. Though often costlier, customized nightguards are a better option than over-the-counter variations for numerous causes. Customized night time guards are typically thinner and extra snug. As well as, customized night time guards are molded particularly to an individual’s enamel and chew. If a nightguard doesn’t match nicely, it may really trigger shifting of enamel and worsen TMJ signs. Though bruxism has by no means been a major drawback for me, I put on a nightguard to forestall enamel put on and shifting of enamel. After utilizing a nightguard for numerous years, I inform sufferers that not sporting my nightguard is like not placing on my seatbelt after I get within the automotive. It’s a disruption in my routine, which may at instances depart me feeling stressed.
Different therapies for TMJ dysfunction embrace injections instantly into the joint and jaw surgical procedure. One of many much less invasive and fewer painful therapies is the usage of botulinum toxin (Botox). Cosmetically, Botox works by enjoyable the muscular tissues that, when overactive, may cause wrinkles. Equally, when injected into jaw muscular tissues, they relieve tightness, ache, and put on on the TMJ. Two of my sufferers had very giant jaw muscular tissues from fixed clenching over time, and with Botox injections the contour of their faces modified. One in every of these sufferers mentioned, “I hated having these large jowls. My jaw line is far smoother now, and my ache is actually gone.” Relating to unintended effects, one other one in every of my sufferers requested, “Dr. Mathew, does injecting Botox within the jaw muscular tissues trigger any unintended effects?” I suggested her, “Injecting an excessive amount of Botox may cause jaw weak spot when chewing one thing robust like steak, which is usually a good factor.” She responded, “How can jaw weak spot be a great factor?” I replied, “In case you are experiencing jaw weak spot, it will likely be troublesome so that you can complain about me.”
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