Temporomandibular Joint Syndr... Health Article

Diagnosis

TMJ syndrome is most frequently diagnosed by dentists. The dentist can often diagnose TMJ based on physical examination of the patient's face and jaw. The examination might include pressing on (palpating) the jaw muscles for soreness or asking the patient to open and close the jaw in order to check for misalignment of the teeth in the upper and lower jaw. This condition is called malocclusion. The dentist might also gently move the patient's jaw in order to check for loose ligaments.

Imaging studies are not usually necessary to diagnose TMJ. In most cases, x rays and MRI scans of the temporomandibular joint will be normal. Consequently, these two tests are not commonly used to diagnose TMJ. If the dentist suspects that the patient has internal derangement of the disc, a technique called arthrography can be used to make the diagnosis. In an arthrogram, a special dye is injected into the joint, which is then xrayed. Arthrography can be used to evaluate the movement of the jaw and the disc as well as size and shape, and to evaluate the effectiveness of treatment for TMJ.

Another aid to diagnosing TMJ is a new questionnaire designed to discriminate between facial pain related to TMJ and myogenic facial pain, a chronic condition that is caused by trigger points in the muscles of the face and neck. The McGill Pain Questionnaire has been reported to have a high degree of reliability in distinguishing between patients with TMJ and patients with myogenic facial pain.

Treatment

In many cases, the cause of pain in the TMJ area is temporary and disappears without treatment. About 80% of patients with TMJ will improve in six months without medications or physical treatments.

Biofeedback, which teaches an individual to control muscle tension and any associated pain through thought and visualization techniques, is also a treatment option for TMJ. In biofeedback treatments, sensors placed on the surface of the jaw are connected to a special machine that allows the patient and healthcare professional to monitor a visual and/or audible readout of the level of tension in the jaw muscles. Through relaxation and visualization exercises, the patient learns to relieve the tension and can actually see or hear the results of his or her efforts instantly through the sensor readout on the biofeedback equipment. Once the technique is learned and the patient is able to recognize and differentiate between the feelings of muscle tension and muscle relaxation,

the electromyographic biofeedback equipment itself is no longer needed and the patient has a powerful, portable, and self-administered treatment tool to deal with pain and tension.

Stress management and relaxation techniques may be useful in breaking the habit of jaw clenching and teeth grinding. Tight jaw muscles are often relaxed by applying warm compresses to the sides of the face. Acupuncture may relieve the jaw tension associated with TMJ. Massage therapy and deep tissue realignment can also assist in releasing the clenching pattern. Extra calcium and magnesium can also help relax jaw muscles.

Allopathic treatment

Allopathic practitioners are increasingly recommending more conservative treatments for TMJ, on the grounds that the majority of patients can be successfully treated with noninvasive, reversible approaches. These include patient education and eating softer foods as well as medication and the use of bite plates.

Patients with TMJ can be given muscle relaxants if their symptoms are related to muscle tension. Some patients may be given aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) for minor discomfort. If the TMJ is related to rheumatoid arthritis, it may be treated with corticosteroids, methotrexate (MTX, Rheumatrex) or gold sodium (Myochrysine).

Patients who have difficulty with bruxism may be treated with splints. A plastic splint called a nightguard is given to the patient to place over the teeth before going to bed. Splints can also be used to treat some cases of internal derangement by holding the jaw forward and keeping the disc in place until the ligaments tighten. The splint is adjusted over a period of two to four months.

TMJ can also also be treated with ultrasound, stretching exercises, transcutaneous electrical nerve stimulation (TENS), stress management techniques, or friction massage. A 2002 study done at the University of Maryland found that all of these treatments are helpful to patients with TMJ, but none appears to be clearly superior to the others.

Surgery is ordinarily used only to treat TMJ caused by birth deformities or certain forms of internal derangement caused by misshapen discs.