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A Jaw-Drop​ping Condition

January 14, 2010 By:
Frank Rosci. JE Feature
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Almost anyone with temporomandibular joint syndrome will admit readily that pain associated with this dental disorder can be severe to excruciating.

Pain from TMJ, also known as temporomandibular joint disorder, exhibits itself in front of either one ear or both, sometimes as a headache. Basically, the mandible bone of the lower jaw is pushed back toward the ears whenever someone with the condition either chews or swallows, causing head and neck pain.

According to Dr. Michael E. Pliskin, chair of the department of oral and maxillofacial pathology medicine and surgery, Kornberg School of Dentistry at Temple University, "TMJ is actually a misnomer. It's really TMD, but can be referred to as TMJ/TMD, and it can affect the joint but is primarily a muscular problem."

The condition "can be permanent or chronic, but people are not born with it," he said.

According to Pliskin, the disorder has three causes: macro-trauma, which occurs when something hits someone's jaw, for example, in an auto accident, or when one's jaw is impacted in a fall; micro trauma that affects those who either grind or clench their teeth, particularly in their sleep; and joint disease that displaces the disc attached to one of the temporomandibular joint muscles, that can lead to arthritis of the jaw in extreme cases.

He noted that it occurs when stress "is put on muscles that control the mandible, causing them to spasm. The condition can then move from the muscle to the joint," which is "when the clicking and popping sounds common to TMJ/TMD can be heard when the jaw is opened and closed."

A number of treatments or precautions can be applied well before surgery, said Pliskin, including the use of pain killers, not opening one's jaw too widely, physical therapy and injections of local anesthetics.

"Most cases get better by themselves after about three to six weeks, even as soon as within 24 hours," with exceptions being "those that are accident-related," he said. "In these cases, a conservative therapy is the use of compresses, eating soft foods and using a mouth guard at night to reduce muscle spasms."

Dr. D. Walter Cohen, chancellor emeritus of the College of Medicine at Drexel University, conceded that the "pain can be very, very excruciating -- to the point that people can't function properly."

To begin to treat the disorder, the first step is to see a dentist who can make a differential diagnosis, he said. "A dentist should make sure there are no broken bones where the mandible joins with the skull."

Dentists can also use X-rays, and feel for pressure points in the muscles of the jaw and neck to reveal the condition, he said.

In addition to pain killers, experimental work is being done with electronic devices that can ease pain by relaxing muscles, added Cohen.

Over at the University of Pennsylvania's School of Dental Medicine, Dr. Thomas P. Sollecito, professor and chairman of oral medicine, said that the disorder affects women -- from mid-teens to pre-menopausal -- five times more than it affects men; no one seems to know why.

In general, he remarked, the condition, which doesn't target any ethnic group in particular, affects 5 percent to 10 percent of the population, of whom 50 percent to 66 percent will seek treatment. Of those, 10 percent to 15 percent will develop the condition as a chronic one, and 2 percent will need surgery.

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