Jaw Disorders

Introduction

Jaw disorder is a painful condition of the lower jaw with clicks or popping sounds on opening the mouth, decreased mouth opening, and spasms of surrounding muscles.

We have two jaws-upper and lower jaw . During all the movements of the jaw, while eating and speaking, only the lower jaw moves. The upper jaw is fixed and does not move.

Why This Occurs- The Anatomy of the Jaw

In the realm of jaw movement, we have two key players: the upper and lower jaw. When we eat and speak, it’s the lower jaw that does the lion’s share of the work. The upper jaw, however, remains stationary.

JAW disorder (Pain, Clicks) occurs when the muscles and ligaments around the Temporomandibular Joint ( TMJ ) or bones forming the joint become inflamed or irritated. The condition may be acute or chronic, and the resulting pain may be mild or severe.

Symptoms of TMJ/Jaw Disorders (pain, clicks)?

Jaw disorders are most common in 20 to 40 years of age and are more common in women than in men and are associated with-

• Jaw pain, facial pain, unexplained headaches and neck pain
• Tinnitus (ringing in the ear), ear pain, and heaviness.
• Sound of clicking while opening or closing the mouth or during chewing
• Difficulty in chewing food
• Changes the way upper and lower teeth fit together.
• Swelling on the side of the face.
• Tooth pain.
• Untreated cases may lead to Jaws that “lock” in the open- or closed-mouth position.

Neglected cases may lead to long-term problems such as sleep apnoea, sleeplessness, depression, and anxiety in patients which can cause and trigger TMJ pain again as a vicious cycle.

Causes for Jaw/TMJ Disorders (Pain, Clicks)?

It is difficult to pinpoint the causes leading to this TMJ disorder. But probable causes include-

• A misaligned or uneven bite (malocclusion)
• Jaw injuries,
• Arthritis,
• Joint erosion,
• Teeth grinding or bruxism (habitual grinding of the teeth mostly at night) and habitual jaw clenching.

Diagnosis Of TMJ/Jaw disorder (Pain, Clicks)

You can examine yourself and see whether you have TMJ Disorder (pain, clicks)

• Listen to and feel your jaw when you open and close your mouth. Do u hear any sound of clicking?
• Observe the range of motion in your jaw by sliding the joint in all directions.
• Press on areas around your jaw to identify sites of pain or discomfort.
• Look for facial asymmetry while opening the mouth.
• Misalignment of the teeth.
• Does your jaw lock while yawning or opening the mouth widely

If you have one of these symptoms, then you might be having TMJ dysfunction. Once you visit us, we will examine you completely and will require the following investigations for diagnosis-

• Dental X-rays to See the status of your teeth and jaw
• CT scan to provide detailed images of the bones involved in the joint and to rule out arthritis
• MRI for detailed analysis of the joint space, joint disk, or surrounding soft tissue. This is not done in TMJ dislocations
• TMJ arthroscopy is sometimes used in the diagnosis of a TMJ disorder. During TMJ arthroscopy, a small thin tube (cannula) Is inserted into the joint space with a small camera (arthroscope) to view the area and to help determine a diagnosis.

Treating TMJ/Jaw disorders (Pain, Clicks) Without Surgery

TMJ Disorders can be treated by either surgery or conservative management depending on the conditions. All the disorders are initially treated with non-surgical and conservative treatment

• Painkillers like NSAIDs
• Muscle relaxants
• Application of moist heat and cold packs,
• Soft diet
• In a few cases, low-dose antidepressants release the patient of the anxiety and sleeplessness associated with the disorder.
• Mouth guard for night and splints to be worn 24 hours a day.
• Ultrasound therapy to relieve soreness or improve joint movement.
• Pain medication or local anesthesia can be injected into painful muscles of the face (called “trigger points”) to relieve pain.
• Avoid extreme jaw movements-

• a) Be mindful of opening your mouth while yawning.
• b) keep your chewing movement to a minimum.
• c) Improve your posture to reduce neck and facial pain.
• d) Keep your teeth slightly apart as often as you can to relieve pressure on the jaw.
• e) To control clenching or grinding during the day, place your tongue on the palate behind your upper front teeth.
• f) Learn relaxation techniques to help control muscle tension in the jaw.

TMJ/Jaw Disorders (Pain, clicks) Surgery at Kayakriti

When non-surgical methods have failed to give relief in TMJ disorders, then surgical treatment can be opted for. The various modalities of treatment available are-

1. Injection of steroids into the joint space – This reduces the inflammation and pain associated with problems within the bone across the joint.

2. Arthrocentesis – This procedure is performed under local anesthesia. It is done when-

• steroid injection does not give any relief in pain or
• reduce the inflammation and
• the condition has progressed to even having difficulty opening the mouth.

Arthrocentesis is also done when the jaw suddenly locks in the closed position. It is done with the help of a needle inserted into the TM joint and then irrigation is done with saline fluid to wash off the debris and the products of inflammation out of the joint.

3. Arthroscopy- This procedure is performed under general anesthesia. A small incision is made in front of the year and Arthroscopy with the light is inserted in TMJ and the whole joint is inspected and washed under vision. Any piece of inflamed tissue or debris is removed.

Because arthroscopic surgery is performed through tiny incisions, there is less scarring, a shorter recovery time, less discomfort, and fewer complications compared with open-joint surgery.

4. Open-joint surgery – It is done under general anesthesia and a longer incision is placed within the curvature of your ear which is very well hidden.

What are the indications for open TMJ surgery?

Open joint surgery is indicated in

• If you hear a clicking sound from the joint + an MRI reports internal derangement of the articular disc. In this, we need to repair or reposition the articular disc of the joint.
• Any tumors in and around the TM joint
• TM joint dislocations
• Severe arthritis of the bony structures involving the joint which leads to TM Joint replacement.

Risks of TMJ Surgery

Open joint surgery has a longer healing time and a chance of injury to frontal branch of the facial nerve (temporary paresis of muscle of the forehead) but still is the surgery of choice in patients with recurrent painful clicks and joint dislocations.

Recovery After TMJ Surgery

Within 48 hours of surgery, the patient begins physical therapy to regain the proper jaw movements.