Jaw Pain: Diagnosing Temporomandibular Joint Disorders

Q: Jaw Pain: Diagnosing Temporomandibular Joint Disorders

Dear Fenny： Patients with poor dental health who frequently undergo prolonged dental treatments or have malocclusion, leading to compromised chewing function, are at high risk for the various symptoms of temporomandibular joint (TMJ) disorders that you described. <br>Due to the d

Long-term dental pain and pain in the cheeks?

Hello Dr.
Huang, I would like to ask about the diagnosis of temporomandibular joint (TMJ) disorders.
My symptoms include the following: 1.
I have experienced difficulty biting down hard while eating and sudden locking of the jaw.
2.
My cheeks have been frequently sore lately.
3.
I sometimes wake up at night with sudden pain, possibly from biting my tongue.
4.
I have a habit of experiencing left-sided headaches.
Over the past two years, I have undergone dental treatments on the left side: the innermost tooth had root canal treatment that lasted nearly a year but is still painful; the dentist suspects it may be caused by an impacted tooth, which was surgically removed (October 2008) but there was no improvement, and I still experience occasional pain.
On the right side, due to an accident, the last tooth fractured and after root canal treatment, the dentist indicated that a crown lengthening procedure was necessary (January 2009).
Recently, I have been experiencing alternating pain on both sides.
The dentist has advised me to see an oral and maxillofacial specialist, but I am unsure about what to do.
Thank you, Fenny.

Fenny, 30~39 year old female. Ask Date: 2009/07/27

Dr. Huang Zhicheng reply Dentistry

Dear Fenny: Patients with poor dental health who frequently undergo prolonged dental treatments or have malocclusion, leading to compromised chewing function, are at high risk for the various symptoms of temporomandibular joint (TMJ) disorders that you described.
Due to the dislocation of the articular disc within your TMJ, when the joint moves laterally during chewing or shifts forward and downward, the disc may dislocate anteriorly, resulting in a clicking sound or even causing the jaw to lock, making it difficult to open or close.
You may experience a sensation of the jaw being stuck.
It is advisable to consult a dentist specializing in occlusion for pharmacological treatment or to use a functional occlusal splint, which can provide relief.
Sincerely, Dr.
Chih-Cheng Huang, Director of Dentistry, Taoyuan General Hospital.

Reply Date: 2009/07/27

More Info

Hello Fenny,
Thank you for reaching out with your concerns regarding your jaw pain and the potential diagnosis of Temporomandibular Joint Disorders (TMJ disorders). Your symptoms, including difficulty chewing, episodes of your jaw locking, pain in your cheeks, and nighttime discomfort, are indeed indicative of TMJ issues. Let’s break down your symptoms and explore the potential diagnosis and next steps.

Understanding TMJ Disorders
TMJ disorders encompass a range of conditions affecting the temporomandibular joint, which connects your jawbone to your skull. This joint is crucial for various functions, including chewing, speaking, and swallowing. Symptoms can vary widely but often include:
1. Jaw Pain: Pain in the jaw joint or surrounding muscles, which can radiate to the face, neck, or shoulders.

2. Limited Jaw Movement: Difficulty opening or closing the mouth, often described as the jaw "locking" or "catching."
3. Clicking or Popping Sounds: Noises when moving the jaw, which may or may not be accompanied by pain.

4. Headaches: Tension-type headaches or migraines can be associated with TMJ disorders due to muscle tension.

5. Facial Pain: Discomfort in the cheeks or around the eyes.

Your Symptoms
1. Difficulty Chewing: The need to exert significant force while chewing can indicate muscle fatigue or joint dysfunction.

2. Jaw Locking: This symptom is particularly concerning as it suggests a possible displacement of the disc within the joint.

3. Cheek Pain: Frequent pain in the cheeks can be a result of muscle strain or inflammation around the TMJ.

4. Nighttime Pain: Pain during sleep, especially if you are biting your tongue, may indicate bruxism (teeth grinding), which is often associated with TMJ disorders.

5. Headaches: The left-sided headaches you experience could be tension headaches stemming from TMJ dysfunction.

Dental History
Your dental history is also significant. The root canal treatments and subsequent issues with your teeth may contribute to your jaw pain. The extraction of impacted teeth can sometimes lead to changes in jaw mechanics, which may exacerbate TMJ symptoms.

Next Steps
1. Consult a Specialist: Since your dentist has recommended seeing an oral and maxillofacial surgeon or a specialist in TMJ disorders, this is a crucial step. They can provide a comprehensive evaluation, including imaging studies like X-rays or MRIs, to assess the joint's condition.

2. Physical Therapy: Many patients benefit from physical therapy focused on the jaw. This can include exercises to strengthen the jaw muscles, improve flexibility, and reduce pain.

3. Pain Management: Over-the-counter pain relievers or anti-inflammatory medications can help manage pain. In some cases, your doctor may prescribe muscle relaxants or other medications.

4. Dental Appliances: A custom night guard or splint can help alleviate pressure on the jaw and prevent teeth grinding during sleep.

5. Lifestyle Modifications: Stress management techniques, dietary changes (avoiding hard or chewy foods), and practicing good posture can also help alleviate symptoms.

Conclusion
TMJ disorders can be complex and multifactorial, often requiring a multidisciplinary approach for effective management. Your symptoms warrant further investigation, and seeing a specialist will be essential in determining the best course of action. Please keep an open line of communication with your healthcare providers, and don't hesitate to seek a second opinion if you feel it's necessary.
Wishing you relief and a clear path to recovery!
Best regards,
Doctor Q&A Teams

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