Temporomandibular Joint Syndrome

What is the Temporomandibular Joint Syndrome?

The two joints that link your lower jaw to your skull are known as the temporomandibular joints (TMJ). They are the joints that move and rotate in front of each ear and are made up of the mandible (the lower jaw) and the temporal bone (the side and base of the skull).

TMJs are some of the most complicated joints in the body. The mandible may move up and down, side to side, and forward and back due to these joints and many muscles. Smooth muscle activities such as eating, talking, yawning, and swallowing may take place when the mandible and the joints are appropriately positioned.

Several disorders can emerge when these components (muscles, ligaments, disk, jaw bone, temporal bone) are not aligned or synced in movement.

Temporomandibular Joint TMJ syndrome is a group of disorders that affect the jaw joints as well as the muscles and ligaments that surround it. Trauma, an incorrect bite, arthritis, or wear and tear can all contribute to it. Jaw soreness, headaches, earaches, and face pain are common symptoms. TMJ problems can cause discomfort in the jaw joint and the muscles that regulate jaw movement.

Temporomandibular disorder (TMD) is another name of TMJ syndrome and refers to a range of orofacial diseases that are separated into those that affect the masticatory muscles and those that affect the temporomandibular joint (TMJ). TMJ discomfort, limitation of mandibular mobility, and TMJ noises are common symptoms. These symptoms may disappear on their own without the need for additional therapy. If not, conservative procedures are employed first, with favorable results in the majority of patients.

The National Institute of Dental and Craniofacial Research criteria of TMJ syndrome: (You can have one or more of these criteria at the same time.)

• Myofascial pain. TMJ syndrome in this kind is the most frequent. It causes discomfort or soreness in the fascia (the connective tissue that covers the muscles) and the muscles that regulate the function of the jaw, neck, and shoulders.
• Internal joint derangement. This might be a dislocated jaw, a misplaced disk (the cartilage cushion between the head of the jaw bone and the skull), or an injury to the condyle (the rounded end of the jaw bone that articulates with the temporal skull bone).
• Degenerative joint disease. This includes jaw osteoarthritis or rheumatoid arthritis.

What causes Temporomandibular Joint Syndrome?

TMJ syndrome's etiology is poorly known, although it is thought to be complex; proper care of the disorder necessitates identification of predisposing and contributing elements.

The etiology of myofascial and intraarticular TMDs differs. A myofascial condition, as the name indicates, affects the muscles involved in mastication, causing them to become tense, weary, and uncomfortable. Stress, parafunctional behaviors like bruxism and improper posture, psychological problems like depression and anxiety, and autoimmune illnesses are all connected to muscle dysfunction. TMD is frequently associated with chronic pain syndromes such as fibromyalgia.

Intraarticular diseases are caused by inflammatory or mechanical causes that affect the joint itself, the most frequent of which is articular disc displacement. Trauma, capsular inflammation, osteoarthritis, hypermobility, and inflammatory disorders such as rheumatoid arthritis are other intraarticular causes. It is unknown if malocclusion contributes to TMD.

What are the signs and symptoms of Temporomandibular Joint Syndrome?

Temporomandibular dysfunction symptoms include soreness, clicking and crepitation of the TMJ, and varying degrees of mandibular restriction. Pain is usually caused by function; spontaneous pain in the TMJ region indicates a different origin. Pain in the neck and scalp might be worse by masticating, yawning, or talking for lengthy periods of time. Anterior disc displacement or osteoarthritis may be linked with a click, crepitus, or pop while opening or shutting the mouth.

TMD patients also have headaches and ear symptoms such as otalgia (ear pain), tinnitus, vertigo, ear fullness, and perceived hearing impairment. Otological symptoms, on the other hand, are more prevalent in myofascial disease, which is thought to be owing to the shared embryological origin of several middle ear structures and masticatory muscles.

Pain

A typical sign is pain in the TMJ and masticatory muscles. A dull aching across the joint, ear, and temporal fossa might be continuous or intermittent. It is most typically detected while moving the mandible or palpating the afflicted areas. Mechanical stress and muscular exhaustion can produce myogenic pain. Articular pain is caused by overuse, trauma, or degenerative changes in the articular and periarticular tissues.

Joint Sound

Crepitations and clicking are two frequent joint noises. The sound of clicking is caused by an uncoordinated movement of the condylar head and articular disc. Crepitations are complex noises produced during mandibular movement by the roughened, uneven articular surfaces.

Mandibular Movement Restrictions

Movement restriction of the mandible can occur during opening, closure, protrusion, and lateral excursion. It might be caused by a muscular or ligamentous limitation, or by a disc displacement.

Dislocation

The patient may be unable to seal his or her mouth because to condyle displacement from the fossa. The patient can either reduce the dislocation himself or report it to the physician.

Otologic Symptoms

TMJ pain is particularly obvious in the auricular areas. Other symptoms of articular pain include tinnitus, ear itching, and vertigo.

Recurrent Headaches

Patients describe headaches as the pain and tenderness of masticatory muscles along the temporal region. It can be associated with other types of headaches, such as migraine pain.

How is TMJ syndrome diagnosed?

TMJ syndrome is usually difficult to diagnose. Most of the illnesses that come under that category have no established tests for diagnosis. To diagnose your illness, your doctor may recommend you to a dentist or an ear, nose, and throat (ENT) expert.

A doctor may check you to discover whether there is any swelling or soreness. They may also employ a variety of imaging tests. These are some examples:

• X-rays. X-rays of the jaw and teeth often require you to bite down on a tiny mouthpiece while the dentist swings an imaging machine around your head. These X-rays will allow your dentist to see the bones in and around your jaw, as well as the positioning of your teeth.
• CT scan. A CT scan of the jaw provides your doctor with a more comprehensive view of the bones and joint tissues than a standard X-ray.
• MRI. An MRI of the jaw will tell if there are any structural issues with the jaw. An MRI scan, also known as magnetic resonance imaging, employs a magnetic field to produce detailed pictures of organs and tissues.

What is the General Management of TMJ syndrome?

TMJ can be detected by monitoring and manually inspecting the mobility of the jaw joint by a doctor or dentist. Dental X-rays may be utilized to aid in the diagnosis of jaw discomfort. To gain a more comprehensive look at the bones and cartilage, a CT scan or MRI may be required.

For jaw pain and clicking, the key instructions are to rest the jaw as much as possible and consume only soft foods. Physical therapy (PT) can assist strengthen facial muscles and urge patients to adjust habits that may be contributing to TMJ. Wearing a splint or bite plate helps to keep the mouth and jaw in place and reduces teeth grinding at sleep.

Stomatognathic treatment refers to the combination of physical therapy and splinting. If the pain is severe enough to necessitate additional medical attention, doctors will typically prescribe pain medications, anti-inflammatories, muscle relaxants, or a combination of these.

Surgery is only utilized in rare circumstances when the jaw has "frozen" or where TMJ irritation and discomfort has become persistent.

Acupuncture and TCM therapy can help decrease inflammation and discomfort associated with TMJ issues without dangerous surgical procedures or the negative side effects that corticosteroids and other medicines might cause.

Temporomandibular Joint Syndrome and Oriental medicine

The Temporal Mandibular Joint (TMJ), often known as the major jaw joint, is one of the most complex joints in the body. TMJ dysfunction can cause discomfort in your jaw, face, head, and, in some cases, neck and shoulders. This illness is commonly referred to as TMJ syndrome and can cause teeth to gradually deteriorate. That's because the jaw might become misaligned, resulting in damaged or chipped teeth. TMJ disorder can be caused by an accident or significant stress. Men are three times more likely than women to get the illness.

TMJ is associated with stomach functions and an imbalance in the stomach meridians, according to traditional Chinese medicine. Because the stomach meridians flow via the jaw area, when stress or trauma produce an energy imbalance, the stomach's energy stagnates.

Traditional Chinese medicine practitioners frequently utilize a multi-step strategy to address both the physical symptoms and the underlying cause of TMJ pain. TMJ is caused by a variety of factors, the most common of which are severe jaw clenching or teeth grinding (usually while sleeping), incorrectly fitting dentures, frequent chewing of gum or ice, abnormal teeth alignment, or jaw arthritis.

Acupuncture can be used to restore equilibrium to the organs that govern the TMJ. Acupressure, when done correctly by a well-educated patient, can also aid with TMJ.

TMJ headaches, jaw stress, and neck discomfort can be reduced by massaging certain parts of the body connected with major meridians. Begin by massaging the Hegu, which is found on the back of each hand where the thumb and index finger bones connect. The energy of the stomach and big intestine is stimulated by massaging this region.

How Acupuncture treats TMJ syndrome?

Acupuncture is a traditional Chinese medical method that uses needles at particular locations on the body's surface to harmonize human body physiology, restore compromised functions, and heal illnesses. It has been shown to have local and central analgesic effects, anti-inflammatory effects, anxiolytic effects, and increased immunological protection.

Acupuncture can help relieve inflammation and discomfort caused by a variety of illnesses, including musculoskeletal problems such as TMD. Acupuncture is efficient in reducing pain sensations by reducing inflammation in the location of origin of the pain and stimulating the production of endorphins and other neurotransmitters that aid improve emotions of well-being. Acupuncture can also assist the muscles that control jaw function to relax, reducing the "clicking" or "popping" associated with TMJ issues.

TMJ is frequently associated with various sorts of "obstruction" condition in Traditional Chinese Medicine (TCM) theory. Physical and mental stress and trauma can produce Qi energy stagnation and/or blood stagnation. Cold, heat, wind, and wetness can all induce painful obstructions or blockages of energy and blood in certain parts of the body.

TMJ patients may not always have dental or myofascial pain, a clicking jaw, or restricted movement. They might possibly be suffering a number of other symptoms that are connected. A TCM practitioner will consider the big picture of how a patient is feeling and treat them accordingly.

A person suffering from Liver Qi stagnation, for example, may have:

• Facial muscle tension
• Neck pain
• Feelings of anger or anxiety
• Ringing in the ear, tinnitus
• Headaches

A person suffering from Wind/Cold Bi Syndrome may have the following symptoms:

• Acute onset of pain
• Pain shifts from one site to another.
• Aversion to wind and cold
• Fever, chills
• Ear ache, ringing in the ears

TCM, being a comprehensive kind of treatment, helps not only to reduce jaw discomfort and swelling, but also to address the underlying cause. Patients who got acupuncture therapy reported less pain and muscular soreness than those who did not, according to a comparative study aiming to evaluate TCM treatment for TMJ syndrome.

A clinical trial comparing groups of patients treated with acupuncture for TMJ discomfort and restricted mobility versus those treated with decompression splints. Both groups had pain relief and enhanced mobility, and the researchers concluded that acupuncture can be used as an adjunct or alternative treatment. A stiff, aching jaw joint might be a subsequent sign of another, more serious illness, such as rheumatoid arthritis or fibromyalgia. Acupuncture can also help with these issues.

Acupuncture is a successful therapy for scientific grounds, according to modern studies. Findings in Western medical journals suggested that acupuncture lowers pain feeling by direct nerve stimulation, which alters the quality of transmission along nerve cells. Acupuncture, according to another study, may decrease nociceptive (i.e., related to pain) trigeminal nucleus caudalis and spinal dorsal horn neurons by modulating the release of neuropeptides and neurotransmitters.

How Acupuncture is Performed?

Needles may be put into the painful location, as well as around the ear and jaw. However, because the meridians are interconnected, needles can be put at the elbows, knees, and big toe. These distant areas can also change the flow of Qi through the jaw, relieving pain and inflammation. Acupuncture points are added to correct various imbalances found in the body. Correcting the general flow of energy in the body can aid in the relief of stress and other potential contributors to TMJ problem.

An acupuncturist will check and analyze a person's condition before inserting one or more thin, sterile needles and offer recommendations. During the process, most people will sit or lie down. Single-use, disposable, sterilized needles should be used by the acupuncturist. Following needle insertion, people may experience a momentary stinging or tingling sensation. They may then feel a slight pain at the needle's tip.

Typically, the needles will remain in place for 20-60 minutes, depending on the operation. In rare cases, the acupuncturist will heat the needles after insertion. The frequency of treatments required by a person is determined by their specific circumstance. A person suffering from a chronic disease, such as TMJ syndrome, may require one or two treatments every week for several months.

Comparison between Acupuncture and other treatments of TMJ syndrome

Jaw appliance therapy (stabilization splint or bite guard), medicines, physiotherapy, home self-care, and surgery are being used to treat TMD. Acupuncture can be used alone or in conjunction with the other therapy methods listed above. Nonsteroidal anti-inflammatory medicines (NSAIDs), analgesics (opioids), antidepressants, and muscle relaxants are some of the medications used to treat TMJ issues. Local corticosteroid injections may be recommended in severe situations. Acupuncture does not interfere with these contemporary medical treatments and may frequently be used in place of them as therapy without the danger of adverse effects.

Unfortunately, pharmacological therapies only give temporary relief from TMD symptoms. Acupuncture, on the other hand, can assist to reset the neuromuscular tension in the jaw by harmonizing the mind and body through a network of energy channels called meridians.

TMD is frequently caused by underlying stress stored in the jaw or constricted muscles in the jaw and face. Acupuncture can assist to reduce TMJ discomfort by relaxing these targeted muscles as well as decreasing general stress levels in the body. Long-term TMD care necessitates significant lifestyle adjustments. Dietary modifications may be required based on any underlying health imbalances found by the acupuncturist. Wearing a mouth night guard from your dentist will help reduce teeth grinding or clenching while you sleep. Bite plates can also aid in the correction of misalignment. Stress reduction, relaxation treatments, jaw stretching exercises, and changing chewing patterns are all helpful behavioral interventions. An acupuncturist can assist patients in making these lifestyle adjustments to alleviate TMJ symptoms.

Acupuncture can be used as a stand-alone treatment or as part of a complex treatment strategy for TMD (or any other problem). The approach provides a significant and successful alternative to occlusal splint therapy, and it is often suitable for individuals who have a low tolerance for occlusal splints. TMD symptoms were greatly alleviated by acupuncture and occlusal splints, according to a recent study.

Acupuncture may be used to supplement splint therapy in circumstances when the response to splint therapy is inadequate. When nocturnal bruxism persists, an alternate application might be the use of acupuncture to acquire early control of symptoms, followed by the advancement to an occlusal splint to control symptoms on a long-term basis. Acupuncture can help with TMD in both acute and chronic instances. Response times are related to the severity of the case; for example, acute patients respond rapidly whereas chronic instances take longer.

What are the Complications of Acupuncture?

Acupuncture has certain contraindications. Among these are:

• Patients on anticoagulant treatment
• Patients with cardiac pacemakers should avoid electroacupuncture.
• Using acupuncture therapy during the first trimester of pregnancy increases the risk of miscarriage.

The following are some common-sense acupuncture treatment instructions and precautions:

• If the discomfort from needle insertion persists, it should be withdrawn.
• Acupuncture is not appropriate for patients who are unable to sit still for the entire treatment period.
• If there is any evidence of probable infection at the place being evaluated for needle insertion, acupuncture therapy should be avoided.

General precautions should be strictly followed, including the use of sterile, disposable needles, aseptic techniques for needle insertion, observing patients for bleeding, counting needles before and after treatment, needling in the supine position, and advising patients not to drive after treatment.

Acupuncture has little complications if performed by a skilled, qualified acupuncturist who uses sterilized needles. Soreness and slight bleeding or bruises where the needles were put are common side effects. Because single-use, disposable needles are now the norm, the risk of infection is low. As previously mentioned, not everyone is a good candidate for acupuncture.

How can TMJ syndrome be prevented?

You may not be able to avoid TMJ syndrome, but you may be able to minimize symptoms by reducing stress, using physical therapy and exercises, and working with a dentist or doctor if you grind your teeth at night.

Wearing a mouth guard at night and taking muscle relaxants on occasion are two possible remedies for teeth grinding.

Conclusion

TMJ syndrome is a set of diseases affecting the jaw joints, as well as the muscles and ligaments that surround them. It can be caused by trauma, an improper bite, arthritis, or wear and strain. Common symptoms include jaw discomfort, headaches, earaches, and facial pain. TMJ disorders can cause pain in the jaw joint and the muscles that control jaw movement.

Acupuncture is a traditional complementary therapy that has a historic origin in China. It involves inserting small needles to stimulate specific parts of the body and its neural network. Acupuncture can help decrease inflammation and discomfort caused by a wide range of disorders, including musculoskeletal issues like TMJ syndrome. Acupuncture is effective in reducing pain sensations by reducing inflammation at the site of the pain and stimulating the generation of endorphins and other neurotransmitters that help improve feelings of well-being. Acupuncture can also help the muscles that govern jaw function relax, lessening the clicking that is linked with TMJ problems. Acupuncture carries little risk of side effects, and practitioners must carry a license to perform acupuncture procedures.