TMJ, TMD and Jaw Pain

The temporomandibular joints (TMJ) are the structures that attach the lower jaw to the rest of the skull.  The TMJ along with jaw muscles, tendons and ligaments allow the jaw to move during chewing, swallowing, speaking and sometimes breathing.  TMJ Dysfunction (TMD) is a group of different disorders with similar symptoms.  Of the many different symptoms that can occur, the most common are pain and difficult or limited jaw movement. These symptoms may be due to a problem with the joint itself or more commonly, hyperactivity and spasm of the jaw muscles. Grinding and clenching of the teeth and chewing gum are the most common habits that cause TMD.  You can reduce muscular hyperactivity and prevent pain by practicing some simple exercises and avoiding things that cause muscle tension.

TMD can be managed by exercise/stretching, behavior modification, diet modification, physiotherapy and massage therapy. In some patients, appliances such as biteplates and night guards can be helpful. Medication such as ibuprofen may be used as needed short term and prescription medication such as muscle relaxants may also be needed.

It is important to understand that the majority of TMD problems are muscular. As such, they are usually self-limiting and most would resolve without treatment. The therapies are intended to speed recovery, provide pain relief and prevent re-injury. For more serious conditions, treatment by a medical and/or dental specialist may be necessary.

Exercises to stretch jaw muscles

The purpose of jaw exercise is to stretch the jaw muscles, rest them and prevent them from going into spasm.  Jaw exercise is designed to stretch the jaw muscles similar to the way an athlete stretches muscles before and after physical activity.   

Behavior modification

People who have TMD often have habits that cause the muscles to become exhausted and lose their ability to elongate.

Common habits to avoid

Tooth contact - your teeth should only touch a total of 20-30 minutes per day and only during chewing and swallowing

Clenching your teeth

Leaning you chin into your hands

Biting on pens, pencils, straws or other objects

Biting on cheeks, lips or fingernails

Chewing on ice

Intentional clicking, popping or side to side shifting of the jaw

Wide yawns (limit opening by keeping your tongue against the roof of your mouth)

Work tendencies to avoid

Cradling the phone between you head and shoulder (use a headset)

Spending hours in front of a computer without a break (get up hourly and take a five minute break)

Using a laptop computer while sitting on a bed or laying on the floor

Carrying a heavy bag or knapsack

Diet Modification

During episodes of TMD, a soft diet allows sore muscles to rest.

Food to avoid

Hard foods - hard bread, bagels, pretzels, pizza crust, hard fruits and uncooked vegetables

Hard to chew foods - tough chewy meats and chewy candy

Foods that require wide opening - apples, large heroes and sandwiches

If you think you may have TMD, it is best to seek a consultation with a healthcare professional.

Dr. Frank R. Egan

www.TeethOnTheMove.com

Retainers

If it was up to me, nobody would have to wear retainers and their teeth would never move. Unfortunately, it’s not up to me and retainers are necessary to hold your teeth in their new positions after braces or Invisalign treatment. That’s because it may take the gums and bones around your teeth up to two years to adapt to the new positions of your teeth. Until they adapt, the gums and bones will tend to move the teeth back to their old positions. Fibers in the gums are like stretched and compressed springs that put pressure on the teeth. It can take 18-24 months for those fibers to be replaced with new fibers that fit the new positions of the teeth. Retainers also safeguard against new changes caused by pressure on the teeth due to jaw growth and developing third molars, aka wisdom teeth.

A special retention plan is made for each patient according to his or her needs and preferences. The most common protocol is to wear clear “invisible” retainers full-time for two months and then traditional wire and acrylic retainers at night-time only for at least two more years.

                  

We start with clear retainers because they are easy to speak with, easy to wear full-time and virtually “invisible”. The wire and acrylic retainers are very durable and can last may years or even decades! By making two sets of retainers, patients have a spare set for emergencies. Some patients require specially designed retainers to accommodate unique challenges such as missing teeth. Others prefer a “fixed” retainer that is bonded directly to the teeth.

                    

Retainers sometimes meet their end prematurely. Dogs are attracted to retainers because of the smell of saliva and it only takes one bite to destroy a retainer. Retainers that are wrapped in a tissue or napkin often end up in the dumpster! The hard plastic case that came with the retainer is the best place to store it.

By the time 2 years have passed and growth is complete and any third molars have either grown in or been removed, an orthodontic patient is just like someone who was lucky enough to have their teeth grow in straight and aligned in the first place. Unfortunately, even those people may experience tooth movement over their lifetimes. Our bodies can change over time and our teeth are no exception. These changes typically occur very slowly, but may become noticeable over many years. For this reason, I generally recommend wearing retainers indefinitely one or twice a week. When a revision is necessary to undo changes of any kind, Invisalign is usually the treatment of choice.

Dr. Frank Egan

www.TeethOnTheMove.com