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  Dental Facial Pain (TMD/TMJ)

Overview

Many adults suffer from chronic facial pain. Some common symptoms include pain in or around the ear, tenderness of the jaw, clicking or popping noises when opening the mouth, or headaches and neck pain.
Two joints and several jaw muscles make it possible to open and close the mouth. They work together when you chew, speak or swallow. They include muscles and ligaments, as well as the jaw bone--the mandible (lower jaw) with two joints called the temporomandibular joints or "TMJ."


The TM joints are among the most complex joints in the body. Located on each side of the head, they work together to make many different movements, including a combination of rotating and gliding actions used when chewing and speaking.


Several muscles also help open and close the mouth. They control the lower jaw (mandible) as it moves forward, backward, and side-to-side. Both TM joints are involved in these movements. Each TM joint has a disc between the ball and socket (see diagram). The disc cushions the load while enabling the jaw to open widely and rotate or glide. Any problem that prevents this complex system of muscles, ligaments, discs and bones from working properly may result in a painful TMJ disorder.


Diagnosis & Treatment
A dentist can help identify the source of the pain with a thorough exam and appropriate x-rays. Often, the pain may be from a sinus problem, a toothache or an early stage of periodontal disease. But for some types of pain, the cause is not easily diagnosed. The pain may be related to the facial muscles, the jaw or the TM joint.


Some TM problems result from arthritis, dislocation or injury. All of these conditions can cause pain and dysfunction. Muscles that move the joints are also subject to injury and disease. Injuries to the jaw, head or neck, and diseases such as arthritis, might cause some TM problems. Other factors relating to the way the upper and lower teeth fit together (the bite) may cause some types of TM disorders. Stress and teeth grinding are also considered as possible factors.


Diagnosis is an important step before treatment. Part of the dental examination includes checking the joints and muscles for tenderness, clicking, popping or difficulty moving. Your complete medical history may be reviewed, so it's important to keep your dental office records up-to-date. Your dentist may take x-rays and may make a "cast" of your teeth to see how the upper and lower teeth fit together. Your dentist may also request specialized x-rays for the TM joints. Depending on the diagnosis, the dentist may refer you to a physician or another dentist.


There are several treatments for TMJ disorders. They may include stress-reducing exercises, wearing a mouth protector to prevent teeth grinding, orthodontic treatment, medication or surgery. Treatment may involve a series of steps beginning with the most conservative options. In many cases, only minor, relatively non-invasive treatment may be needed to help reduce the pain.