Jaw Joint Disorder (TMJ): Causes, Treatment, and Ways to Relieve Pain

The temporomandibular joint disorder also referred to as TMJ, causes pain at a specific jaw joint called the TMJ joint and is a cause of distress for many people.

There are numerous ways to ease the symptoms of TMJ, either conservatively or through a surgical procedure. With all these available options, pain relief can be achieved.

Temporomandibular joint explained

The temporomandibular joint is created where the skull's temporal bone meets the lower jaw's mandibular bone at a specific joint. On the lower right of the image, you can see a cross-section where the condyle of the mandibular bone articulates (joins) with the temporal bone, with a disc (made of cartilage) between the bones. You can also see the position of the TMJ joint right in front of the ear canal.

You may have heard the terms TMD and TMJ and need clarification, but it's pretty simple. Temporomandibular disorders (TMD) are a group of conditions related to the area where the temporal bone meets the mandible. Of this group, TMJ is a specific type.

Causes of temporomandibular joint pain

The exact cause of TMJ is unknown; however, it appears to be due to a combination of factors, including disc displacement, genetics, trauma, environmental issues, and degenerative joint issues like arthritis.

More frequent causes are psychological issues like anxiety or depression, which lead to people clenching or grinding their teeth; a condition called bruxism.

Ways to relieve jaw pain

If you get diagnosed with TMJ, realize there are many ways to relieve symptoms. In addition, there are ways to cure the condition.

Medications

Medications are the first line of treatment for TMJ, and there are several classes.

Over-the-counter pain medications

Over-the-counter (OTC) pain relief medications like acetaminophen (Tylenol) can help, but use it sparingly since excessive use can lead to liver disease.

Non-steroidal anti-inflammatory medications

Non-steroidal anti-inflammatory medications can help with the TMJ joint's inflammation and reduce pain. These can be taken over-the-counter (OTC) or by prescription. Examples of OTC non-steroidal medications include aspirin, naproxen (Aleve), and ibuprofen (Advil, Motrin). To achieve the anti-inflammatory effect, a specific dose needs to be maintained.

In addition to the OTC anti-inflammatories, there are prescription-strength NSAIDs, including celecoxib (Celebrex), diclofenac (Voltaren), and meloxicam (Mobic), to mention a few.

Prolonged use of NSAIDs is not recommended since they can have side effects like stomach ulcers, stroke, nausea, vomiting, diarrhea, and constipation.

Muscle relaxers

Muscle relaxers can help, primarily when the symptoms are caused by muscle tightness. Commonly used muscle relaxers include carisoprodol (Soma), cyclobenzaprine (Flexeril), and methocarbamol (Robaxin). One common side effect of muscle relaxers is excessive drowsiness.

Antidepressants

Antidepressants can help with pain by what is believed to be interference in the pain-sensing pathway from the jaw to the brain, which interprets the nerve message as pain. Antidepressants in the tricyclic class have been helpful for this purpose, including amitriptyline (Elavil) and nortriptyline (Pamelor).

However, selective serotonin reuptake inhibitors (SSRIs) have been found to worsen TMJ symptoms. Examples of SSRIs include fluoxetine (Prozac), citalopram (Celexa), sertraline (Zoloft), escitalopram (Lexapro), and paroxetine (Paxil). Thus, SSRIs should be avoided to treat depression in people with TMJ or stopped if there is a resulting TMJ.

Opioids

Pain medications such as opioids can help with pain, but are in the addictive class. In other words, with continued use, it takes more and more to get the same pain relief effects.

Physical therapy

Physical therapy can help with instructions on stretching the jaw muscles. In addition, they can use modalities, including heat, ice, and ultrasound.

Night guards

A night guard has other names, including a bite guard, mouthpiece, mouth guard, occlusal guard, and night splint. A night guard is a removable appliance that covers the upper or lower teeth; it is worn at night, since most people who clench and grind their teeth do so at night.

A dentist can take a mouth impression with a special mold and then send it to a lab to produce a clear, custom, and firm mouth guard. There are also soft, flexible types produced by a mold or already fabricated.

Every person is different and can respond differently to the various types of mouth guards. You'll have to find which one works best for you.

Therapeutic injections

A therapeutic injection can be done when a needle is inserted to inject various substances, including:

• Lidocaine, an anesthetic;
• Corticosteroids;
• Hyaluronic acid (hyaluronate), a slippery and gooey substance;
• Botox (botulinum toxin).

Surgical options

Surgery is rarely done and reserved for cases with bone, disc, or joint space issues that don't respond to conservative treatments. There are three main types of surgery:

• Arthrocentesis. This places tiny needles into the joint space. Then a therapeutic substance is injected, or the joint is flushed with a solution to clear out debris and inflammatory agents.
• Arthroscopy. This involves the insertion of a small camera (scope) to view and treat the inside of the joint.
• Open TMJ surgery. This involves an incision over the joint and is considered more invasive due to the larger opening.

Open TMJ surgery is used for cases that involve the following:

• Excess bone or other tissue that needs removal;
• When the TMJ joint is fused, sometimes by a process called ankylosis;
• When the joint cannot be reached by the scope (mentioned above);
• With a misalignment of the bones, cartilage, or disc.

Diet restrictions

If you have TMJ, there are certain foods to avoid, including hard foods like apples, carrots, or hard bagels. In addition, avoid chewy foods like beef jerky, steak, and licorice.

Cognitive behavioral treatment (therapy)

Therapy can help, especially with daytime teeth clenching or grinding, stress relief, and help with bad habits like nail-biting.

To relieve stress, it's recommended you perform some sort of cardiovascular exercise, eat well, don't smoke, and get plenty of rest.