Temporomandibular disorders are frequently associated with sudden or gradual changes in the way teeth meet (dental occlusion).
Inability to chew, painful mastication, pain in teeth, changes in the way upper and lower teeth meet are commonly reported. Sudden changes are seen in cases associated with fractures in the temporomandibular joint condyle, body of the mandible, and in some cases with acute displacement of the TMJ disc. Spasms in the muscles of mastication are commonly associated with gradual changes in the dental occlusion.
In some cases, pre-existing bite problems can contribute to TMD problems, especially when associated with parafunctional habits such as clenching and grinding. Research does not support the role of dental occlusion problems (malocclusion) as the sole causative factor for TMD disorders. It’s usually associated with other causative factors and plays a secondary role.
Pain in the temporomandibular joint area, in front of the ears, may be sharp, stabbing or radiating to the ears.
Pain is usually aggrivated by moving the jaw, and is worse in the morning. Pain can be the result of inflammation in the tissues behind the TMJ condyle, the TMJ disc or the capsule that covers the TMJ area. Acute and chronic displacement of the disc can also lead to pain. Spasms in the lateral pterygoid muscle, which is a small muscle attaching to the TMJ condyle and the disc is another reason for pain.
Treatment may involve the use of medications such as anti-inflammatories, muscle relaxants. Intraoral appliances are also used to unload the TMJ area, and keep the teeth away from each other.
Clicking sounds, crepitations (like sand paper sounds) and loud popping sounds may be signs of structural pathology in the joint.
Clicking sounds are usually due to disc displacement with reduction. It is an abrupt alteration or interference of the disc-condyle structural relation during mandibular translation with mouth opening and closing. A reciprocal clicking noise that is heard during opening and again just before the teeth occlude during closing is the cause of the sound. Periods of jaw locking were the there is difficulty to open the mandible are common. There is a deviation of jaw movements and periods of jaw locking. Pain if present is precipitated at the time of disc reduction or joint movement, reproducible joint noise occurs usually at variable positions during mouth opening and closing of mandibular movements.
Common types of facial pain include burning, stabbing, sharp, tightness, throbbing and electrical type pain. There are many possible causes of facial pain. Those include the following:
- trauma or injury to the face, resulting in fractures, ligament tears
- muscle trismus
- trigeminal neuralgias
- dental problems such as abscesses, fractures and decay
- chronic or acute sinusitis
- temporal arteritis
- neurological disorders, and
- referred pain from the upper cervical spine.
Diagnosing and managing facial pain can be quite difficult given the complexity of the structures forming the head and neck and their unique interactions. Our multidisciplinary team formed of health practitioners with diverse dental and medical backgrounds can help diagnose the problem and come up with a management strategy.
Headaches are the most common symptom of dysfunction of the cra-niomandibular-cervical complex.
Common types include migraine and cluster headaches, mixed type headaches, arteritis and other vascular disorders. However, headaches have been shown to be mainly related to muscle contraction and muscle tension. In fact, a large component of medically diagnosed migraines in fact turn out to be muscle tension headaches.
Diagnostically, headaches can be differentiated by the type and quality of pain. Throbbing headaches are generally vascular in nature, dull deep pain usually muscular in origin, while burning pain most often is neurological in nature. The location of head pain also provides an indication as to the type of dysfunction.
Patients complaining of pain in the front of the head often refer to it as sinus pain. There is usually accompanying pressure along the upper anterior teeth, bridge of the nose, and pressure behind the eyes. This can be due to a reduction in posterior occlusal dimension causing heavy incisal contact.
Temporal headaches are mainly related to muscle contraction and fiber spasm of the temporalis muscle. Clenching, grinding or biting on objects while the jaw is in an anterior displaced position (edge-to-edge) generally creates pain in the anterior temporal group.
Deep dull pain, constant and aggravating in the back of the head, is usually a result of fiber spasms within the trapezius and sterrnocleidomastoid muscles. These muscles have strong large bodies which, when under tension, pull on their bony attachments to the occiput and mastoid areas. This leads to soreness in the bone and deep dull pain radiating up the back of the head and down the neck. The muscle tension may be independent of, or secondarily related to, vertebral displacement in the cervical and upper thoracic region.
Pain in the side of the face can be localized or radiating.
Localized areas of pain in the temple, zygomatic or masseteric regions are usually of muscular ori
Symptoms of eye problems are mainly tiredness, pressure and pain behind the eye; redness; and difficulty in focusing for long periods of time. Pain behind the eyes is usually found in conjunction with head pain due to C2 nerve impingement.
The pain is dull, constant and slightly relieved upon digital pressure in the area of the eye itself. There is an accompanying feeling of pressure behind the eye.
Difficulty in focusing is a very common symptom related to the muscles of the eyeball. The rectii muscles and the oblique muscles are af-fected in myofascial pain dysfunction and cannot function efficiently to control the position of the eyeballs.
Pain, stuffiness, pressure and ringing can be related to problems of the Temporomandibular joint and the muscles of mastication.
TMJ problems such as disc displacement, inflammation, trauma and fracture can refer pain to the ear due to its proximity. Parafunctional habits (cleching and grinding) may exacerbate ear problems.
On the other hand, middle ear problems may present itself as TMJ pain. Dental malooclusion and loss of posterior teeth are commonly asssociated with pressure in the retrodiscal area of the TMJ and can altimately cause ear stuffiness, pain and discomfort. Reducing that pressure through the utilization of dental appliances can be quite effective in managing such problems.
Cervical problems are very common in patients presenting with Temporomandibular disorders and orofacial pain.
In many cases, whiplash traumas have gone untreated for many years, resulting in postural changes and referred pain to the head. Cervical disc herniations are associated with pain, arm and finger numbness and can lead to headaches and facial pain. Upper cervical problems are commonly associated with frontal tension type headaches and pain behind the eyes. Patients with forward head posture can develop problems in the upper cervical region, the shoulders as well as the throat area. Difficulty swallowing is seen in some patients with dental malocclusion, especially with a history of anterior open bite.