Jaw Joint Pain Nothing to Yawn About
11/01/2007

Other joint pains usually get the most of our attention, but here Glenn Clark discusses problems with the ever-laboring temporomandibular joint for TMJ Awareness Month.
By Beth Dunham

Many painful things can go wrong with the temporomandibular joint, or TMJ. This articulation between the lower jaw and the skull, unique among human joints with its complicated hinging and sliding motion, does a lot of work during a person’s lifetime -- any problems can have a big effect on a patient’s daily life.

Because of its central role in speaking, eating and any other motion involving the jaw, the joint accumulates wear and tear just like knees, hips and spines, says Glenn Clark, director of the School of Dentistry’s Orofacial Pain and Oral Medicine Graduate Program. And with November marking TMJ Awareness Month, Clark wants to help patients understand just what TMJ disorders really are.

“A lot of patients will come in and ask, ‘Do I have a TMJ problem?” he says. “Well, TMJ is a very generic descriptor; it’s like saying you have a ‘back problem’. It doesn’t give a diagnosis; it just tells you that there’s something wrong with your temporomandibular joint.”

The National Institute of Dental and Craniofacial Research estimates that over 10 million Americans are affected by TMJ disorders. Clark says TMJ problems often manifest as difficulties with opening the jaw during eating or talking, noises and pain during jaw movement, headaches and other, often radiating pains in the jaw, neck or facial region. Many patients complain of a painful “clicking” or “popping” sensations in the joint, and some problems can cause the jaw to lock altogether.

He adds that with the complex construction of the joint and the near-dislocation that accompanies its normal motion, the factors leading to TMJ problems are just as varied as the symptoms they cause.

“Within the general description of TMJ disorder, there can be several sub-problems,” he said. “Just as in other joints, TMJ pain can be caused by arthritis, slipped discs in the joint, muscle spasms, pinched nerves, deformities, tumors, trauma, infections, secondary reactions to medications and other problems. TMJ is a very broad term.”

With the many problems the joint can face, it takes thorough analysis to make a diagnosis and select the right kind of treatment; it’s not just a “one disease, one treatment” approach, Clark says. Treatments range from simple relaxation techniques and exercises, oral or injected pain medication, muscle relaxants, oral stabilization splints or bite guards and, in serious cases, surgery to repair the joint.

Often, truly fixing the problem means assessing a patient’s lifestyle, he adds. Stress level and other behavioral or emotional factors can cause physical reactions such as jaw clenching or teeth grinding that lead to discomfort and pain.

“Just like back pain, neck pain, shoulder pain, carpal tunnel syndrome and other pains, daily behaviors can be a large part of the cause,” Clark says. “If you don’t take the time to understand the patient, ask lots of questions and interpret the information you get from all these sources, then you won’t know the cause and you won’t treat the patient very effectively.”

Clark reinforces this approach with the residents in the School of Dentistry’s Orofacial Pain and Oral Medicine Center – oftentimes, asking the right questions is just as important as performing the correct tests.

“The underlying cause of many problems is often found in the patient’s history,” he says. “You don’t get that from simply saying, ‘open wide and let me look.’”