The Problem with Joint Sounds

 Merry Christmas to one and all!  I hope you are having a wonderful Christmas day.  Last week I talked about some of the symptoms and causes of temporomandibular disorders (TMD).  Many people never have discomfort in their TMJ even if joint sounds are present.  Unfortunately though, these warning signs can progress and get worse with time.  Patients may experience any or all of the following symptoms:

• A jaw that “catches” and/or is difficult to move when opening and closing your mouth
• Earaches without an infection
• Ringing or a sense of fullness in one or both ears
• Frequent headaches
• Neck and/or shoulder pain
• Sensitive teeth when no dental problems can be found
• Jaw pain or a stiff jaw when chewing, biting, eating or yawning
• Jaw pain or soreness that is more prevalent in the morning or late afternoon
• A jaw that locks open or closed

The most important part of any treatment is proper diagnosis.  Your dentist will do a thorough examination to determine if the cause of your TMD is joint related.  This will typically include a health history and thorough assessment of your head and neck.  They will evaluate the musculature that allows the joints to function for pain, tension or tenderness, listen to the joints for specific types of sounds, evaluate the way your teeth function against each other when you chew, do range of motion studies to assure that TMD has not limited your jaw movements.  Every person with TMD is different and your dentist will tailor the treatment plan to your needs.  Some of the treatments may include:

A Little TLC 

Ever sprained your ankle?  If so, you know keeping weight off the ankle helps it to heal.  When injured, the temporomandibular joints (TMJ) need the same treatment.  That’s why self care is so important and home treatment can be very effective.  Chewing strains the TMJ.  When symptoms are bad, you may not be able to chew at all.  To get through times when your symptoms are worst, try these simple tips.

• Choose soft foods to eat and stay away from chewing gum or anything hard.
• Avoid opening wide to bite into foods such as apples, carrots and corn on the cob.  Instead, cut foods into bite-sized pieces.
• Grind or finely chop meats and other tough foods.
• Use ice and moist heat.  When symptoms first appear, apply a cold gel pack or ice wrapped in a towel to the joint for 15 to 20 minutes several times a day to numb the site.  After a couple of days switch to moist heat to relax the musculature.  The simplest way to apply moist heat is to fill a white tube sock (please make sure it is a clean one!) with the cheapest white rice you can get.  Tie a knot in the sock so you literally have a “sock full of rice”.  Place the rice filled sock in the microwave for approximately three minutes on high.  The sock will mold to your jaw and deliver moist heat for 30 to 45 minutes.  Do this as needed throughout the day.  You can use and reheat the same sock of rice over and over again.  I’ve had mine for several years now and use it any where I have a muscle strain.
• Restrain yawns to avoid opening wide as this can irritate the joints as well.
• Maintain good posture during the day when working at a desk or computer station.  Also consider an orthopedic pillow to support your head and neck while you sleep.
• Manage your stress to reduce clenching and grinding your teeth.

Using Medication

Some medications used to treat TMD are available by prescription only, but others that can work very well are available over-the-counter.  The medication type and dosage will depend on the specific problem you have.  Some common medications include:

• Anti-inflammatories and analgesics – Ibuprofen and other non-steroidal anti-inflammatory (NSAIDs) medications are often very effective.
• Muscle relaxants – these medications are often used to treat pain by easing muscle tension. 
• Antidepressants – At higher dosages, these medications are used to treat depression, but some can be given at very low dosages and often help relieve TMD symptoms when related to bruxism.

Next week I will discuss treatment alternatives that can be provided by your dentist and other health care professionals for the treatment of more severe temporomandibular disorders.