“TMJ dysfunction is the most common cause of oro-facial pain after a dental cause,” says Dr. Nilesh Pagaria, oral and maxillofacial surgeon, Shri Krishna Hospital, Raipur, Chhattisgarsh. However, TMJ and muscle disorders (TMD) could manifest themselves in diverse ways — frequent headaches (especially in the temple region) caused by unknown factors, with even CT or MRI scans revealing no abnormality; chronic ear or facial pain with diagnostic tests showing normal results; pain in and around the TMJ region, soreness of the muscles around TMJ, radiating pain in the face, jaw or neck, stiffness of the jaw muscle, clicking, popping or grating of the jaw joint while opening or closing the mouth, difficulty in opening the mouth or limited movement of the jaw, a change in the way the upper and lower teeth come together; pain in the area of the forehead and the eyes; pain in the back of the head, possibly extending to the shoulders and neck; tinnitus (a ringing feeling in the ears); pressure on the eyes, sensitivity to light; dizzy spells, vertigo, nausea; lack of concentration; nervousness or sleeping difficulties; wearing out of teeth, teeth sensitivity or mobility.
“When these symptoms are seen in the absence of a specific, attributable or organic cause, medical and dental practitioners should consider TMD as a possible cause. While oro-facial pain and headache because of jaw muscle function and dental structures should ideally be managed by dentists, pain in the head and neck region unrelated to it should be should be referred to appropriate specialists,” recommends Dr. Nilesh Pagaria.
There are people who go through a battery of tests and consult a retinue of specialists, yet are still unable to zero in on the underlying cause behind their oro-facial pain. To identify TMD, doctors and dentists should observe the way the patient holds his head (posture), jaw pattern, condition of teeth, range of jaw movements, clenching of teeth, muscle spasm, etc., besides physical examination of the TMJ for pain, clicking sounds (crepitus) and tenderness of the jaw muscles, followed by evaluation of stress and underlying systemic conditions. Local anaesthetic nerve blocking can be helpful in finding out if oro-facial pain originates from the TMJ capsule or from associated muscular structures. CT scans of the joint can reveal structural changes in the bones, while MRI scans of the joint can find out soft tissue abnormalities. Sometimes fluid from the joints may be collected for evaluation and diagnosis.
“To diagnose and arrive at a treatment plan, the patient’s medical and dental history must be considered. As appropriate, treatment could be elimination of stress and para-functional habits, education and counselling to avoid factors and behaviours that may aggravate the pain, use of occlusal splints or mouth guards, medication, etc. adding, “common painkillers don’t work with TMJ, and surgery is not the answer to Myofascial Pain Dysfunction Syndrome (MPDS).”
Possible causes of TMD
* Injury to jaws following a fall.
* Systemic diseases such as rheumatoid arthritis and osteoarthritis that affects joints.
* SLE, psoriasis, hormonal imbalance.
* Jaw pattern and misalignment of teeth.
* Stress and psychological disturbances.
* Para-functional habits such as clenching, grinding of teeth at night, excessive use of chewing gum, fingernail biting.
* Faulty posture while holding the telephone between head and shoulder.
* Faulty posture while using computers and laptops.
* Lengthy dental procedures and intubation for anaesthesia during surgical procedures.