TMJ

Dental occlusion is the way in which the jaws bite together, but for some this is not a simple process and problems may occur.

What is TMJ?

TMJ stands for the ‘temporomandibular joint’ which connects your skull to your lower jaw. The movement of this joint allows your mouth to open and shut, playing a key role in the act of chewing from one side to the other.

What problems can occur?

If the teeth do not fit together in the correct way this not only results in problems for the teeth, but can also affect the temporomandibular joint, the gums and the muscles involved in jaw movement. These issues are collectively known as ‘occlusal’ problems. Symptoms of occlusal problems can include:

• Severely worn teeth
• Teeth prone to breaking
• Misaligned teeth
• Loose crowns
• Fractured fillings
• Permanent toothache
• Tenderness when biting

Gums, grinding and the muscles

A faulty bite can worsen problems such as receding gums or loose teeth. Pain, grinding or clicking in the jaw joints, a buzzing or ringing in your ears, and trouble with closing or opening your mouth are indicative of something wrong in how your teeth meet. If the jaw is not in the correct position the muscles can become tired because they have to work harder, often leading to what is known as muscle spasms.

The primary symptoms include:

• Constant migraines or headaches
• Sinus pain
• Pain behind the eyes
• Pain in the shoulders and neck
• It can also affect the muscles in the back

How will I know if there is a problem?

Many will not be aware that they are doing it but clenching or grinding your teeth can be a sign of a problem. This is sometimes a result of anxiety, while many people clench their teeth if they are concentrating on an arduous task. You may also find that you have a stiff jaw when you wake up or tenderness when you bite. This could be a result of grinding or clenching your teeth while you sleep.

In most cases, people who grind their teeth do so during sleep and are unaware of the condition. Those who get serious headaches or pains in their shoulders and neck will likely not link this to jaw problems, even if they also suffer from discomfort or pain on the side their face, around the jaw joints or ears, or trouble when moving their jaw.

All of the above symptoms can be signs that you have a TMJ problem. If there are any teeth missing towards the back of the mouth it can cause an unbalanced bite, creating uneven pressure on the teeth. These symptoms together are all known as TMJ syndrome.

How can I get treatment for occlusal problems?

You should first make an appointment with your dentist to analyse your condition. They may refer you to a specialist in occlusal problems. It could be that some muscles are sore when they are tested, while worn areas in your teeth may be a sign that you have been grinding your teeth. This is a common symptom of an incorrect bite.

If the dentist deems the cause to be an incorrect bite they may suggest the patient uses a soft temporary night guard to fit over the lower and upper teeth. The appliance will be measured and fitted to make sure the teeth meet correctly and do not strain the muscles. You may be advised to wear the appliance all the time or only during night. If it succeeds in relieving the symptoms your bite may require permanent correction.

Equilibration/Tooth Adjustment

Careful adjustments can be required to help your teeth meet correctly. Changing the position and direction of the slopes which guide the teeth together will often help in repositioning the jaw.

Tooth Replacement

The temporomandibular joint requires an equal amount of support from both sides of each jaw. The action of chewing will only work correctly if all teeth are in the appropriate positions. Teeth that are missing usually require replacement in the form of bridgework or a partial denture.

Replacement will not be carried out before a diagnosis is confirmed through the use of an appliance that has relieved the symptoms fully. For some patients, relief will be instant but for others it will take a fairly long time.

Medication

Certain drugs can be administered to offer pain relief, but this will often be a temporary solution. Some women may also be helped by hormone replacement therapy.

Exercise and Diet

Relief can be provided if less stress is placed on the joint, in the same way as any other joint pain. Corrective exercises, external heat and a soft diet can all be helpful in achieving this. Another solution is physiotherapy exercises which your dentist can demonstrate.

Relaxation

Relaxation therapy and counselling can help many patients. The techniques will help them grow more aware of situations which are stressful and teach them how to control tension.

Will straightening my teeth help?

If the teeth are misaligned or in completely the wrong bite position, an orthodontic appliance can help to align them and improve jaw function.

How many people are affected by these problems?

The symptoms are experience by as many as one in four people. It affects both men and women equally, but it tends to be more common for women to seek treatment. Hormonal changes such as the menopause can often trigger symptoms.

Many will have missing teeth and imperfect occlusion, but not have the symptoms described above because they have adjusted to the problem. The symptoms may appear but go away soon after in times of increased tension or stress. Or it could be that the gums and teeth are affected immediately, leading to:

• Worn, flattened teeth
• Broken fillings, crowns and teeth
• Loose teeth
• Sensitive teeth
• Toothache

You should see your dentist if you suspect TMJ is the cause of your dental problems.