Articles

Temporal Mandibular Joint Disorder (TMJ)

Introduction

What should I know about TMJ?

In its 1996 consensus statement, the National Institutes of Health Consensus Development Conference defined temporomandibular disorders as follows: Temporomandibular disorders (TMD) refer to a collection of medical and dental conditions affecting the temporomandibular joint (TMJ) and/or the muscles of mastication, as well as contiguous tissue components. Although specific etiologies such as degenerative arthritis and trauma underlie some TMD, as a group these conditions have no common cause or biological explanation and comprise a group of health problems whose signs and symptoms are overlapping, but not necessarily identical. (1) In simpler terms, it is a condition which causes pain in the jaw muscle and has received a lot of attention as a cause of chronic headaches.

Although severe cases may require dental or oral surgery, most TMJ dysfunction is psychophysiologic in origin, or rather the result of nighttime jaw clenching and teeth grinding. This tension-relieving oral habit develops in response to situational and intrapsychic stresses and can lead to masticatory muscle fatigue and spasm. (2)

In the mainstream medical community, there is still a bit of confusion over the symptoms that can be classified and used in developing guidelines for diagnosis. So far there is a full range of symptoms from mild and hardly noticeable to severe. Often there are other diagnoses which describe symptoms of conditions such as arthritis, chronic dislocation, and growth disorders.

Statistic

National Institutes of Health, 1999.

    More than 10 million Americans have symptoms associated with TMD.

National Institute of Dental and Craniofacial Research, 1999.

    The disorders appear to affect about twice as many women as men.

Signs and Symptoms

[span class=alert]The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.[/span]

Symptoms of TMJ dysfunction include chronic, dull, aching one-sided pain around the jaw, behind the eyes and ears, and even down the neck into the shoulders. Jaw pain, clicking sounds, and difficulty opening the mouth widely, especially in the morning are characteristic. Other characteristics include locking of the jaw, muscle tenderness, clicking, decreased jaw movement, and joint deviation when opening it. Chewing often worsens the symptoms.

General

  • Pain in or near the jaw joint
  • Pain often is worse when chewing
  • Possible grinding of teeth during the night may make pain worse in the mornings
  • Clicking sound or popping of the jaw when mouth is opened
  • Headache or earache
  • May be unable to open the mouth widely
  • Sometimes the jaw may catch or lock in a certain position

Treatment Options

Conventional

Evidence suggests that TMJ dysfunction is frequently self-limiting. Treatment plans must be evidence-based and patient centered. The patient’s perception of pain, and impact on the quality of life are important issues to be considered. In the absence of any other presenting disease, the patient and practitioner should work together to devise a plan of patient self-management with education and understanding of the role of personal factors. Patients with underlying systemic joint diseases, or muscle conditions associated with systemic disease, obviously require treatment for the underlying problem.

Because TMJ dysfunction is largely psychophysiologic in nature, psychotherapy should be an important part of treatment. Most persons improve without formal psychiatric care, however, should receive counseling concerning areas of stress and tension. Education aimed at eliminating certain behaviors perceived to be harmful, such as clenching and grinding of teeth, is frequently beneficial. Other helpful symptomatic measures include dietary advice, local physiotherapy, analgesics, minor tranquilizers, and sometimes antidepressants.

Dietary advice includes cutting food into small pieces and using a diet that minimizes hard, repetitive chewing. Physiotherapy includes the use of local heat and massage to the muscles of mastication. This helps relieve the pain and muscle spasms. The use of analgesics such as aspirin and low dose non-steroidal anti-inflammatory drugs are also helpful in the relief of pain.

Nutritional Suplementation

This category contains no therapies clinically applicable to this disease state.

Herbal Suplementation


Kava

Kava has been used for centuries by South Pacific natives. The root is used in the preparation of a recreational beverage known by a variety of local names (kava, yaqona, awa) and occupies a prominent position in the social, ceremonial, and daily life of Pacific island people as coffee or tea does in the Western cultures. In European phytomedicine, kava has long been used as a safe, effective treatment for mild anxiety states, nervous tension, muscular tension, and mild insomnia. (3) , (4) Studies have reported that kava preparations compare favorably to benzodiazepines in controlling symptoms of anxiety and minor depression, while increasing vigilance, sociability, memory, and reaction time. (5) , (6)


St. John's Wort

St. John’s wort has gained a great deal of attention for its use in minor depression. Its popularity has stemmed from its extensive use by physicians in Europe as an agent of choice in the treatment of mild to moderate depression. There are a variety of studies which are claimed to support the use of St. John’s wort in treating depression. (7) , (8) , (9) Studies with St. John’s wort have centered around the use of a 0.3 percent hypericin content standardized extract at a dose of 300mg, three times a day. It is viewed as safe and effective in Europe and its monograph is part of the Commission E Monographs for herbal medicines in Europe.

References

  1. National Institutes of Health Consensus Development Conference Consensus Statement, Volume 0. 1996.
  2. Goroll AH, May LA, Muley AG. Management of Temporomandibular Joint Dysfunction, Primary Care Medicine, Office Evaluation and Management of the Adult Patient, 3rd ed. Philadelphia: JB Lippincott; 1995:1020-1.
  3. View Abstract: Volz HP, et al. Kava-kava Extract WS 1490 Versus Placebo in Anxiety Disorders--A Randomized Placebo-controlled 25-week Outpatient Trial. Pharmacopsychiatry. Jan1997;30(1):1-5.
  4. View Abstract: Singh YN. Kava: An Overview. J Ethnopharmacol. Aug1992;37(1):13-45.
  5. View Abstract: Munte TF, et al. Effects of Oxazepam and an Extract of Kava Roots (Piper methysticum) on Event-related Potentials in a Word Recognition Task. Neuropsychobiology. 1993;27(1):46-53.
  6. Drug Therapy of Panic Disorders. Kava-specific Extract WS 1490 Compared to Benzodiazepines. Nervenarzt. Jan1994;65(1Supp):1-4.
  7. View Abstract: Volz HP. Controlled Clinical Trials of Hypericum Extracts in Depressed Patients--An Overview. Pharmacopsychiatry. 1997;30(Suppl 2):72-76.
  8. View Abstract: Muller WE, et al. Effects of Hypericum Extract (LI 160) in Biochemical Models of Antidepressant Activity. Pharmacopsychiatry. 1997;30(Supp 2):102-07.
  9. View Abstract: Linde K, et al. St. John's Wort for Depression--An Overview and Meta-analysis of Randomised Clinical Trials. BMJ. 1996;313m:253-58.