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TMJ Disorder -TemporoMandibular Joint Message Board

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For What It's Worth????

A jaw-locking experience

Advice on what you can do if youíre diagnosed with TMJ
By Joseph J. Marbach

April 11 ó If youíve ever experienced your jaw locking or sometimes you find itís just too painful to chew, youíre not alone. More than 10 million Americans suffer from something called temporomandibular joint disorder, otherwise known as TMJ. So how do you know you have it and what can be done about it? Dr. Joseph Marbach of the University of Medicine and Dentistry of New Jersey gives advice on what you can do if youíre diagnosed with TMJ.

TEMPOROMANDIBULAR JOINT SYNDROME (TMJ) is referred to by several names such as TMD and the term we use in our technical research, Myofascial Face Pain. The term TMD is a confusing label ó donít use it. Myofascial is too technical, so we will just call it TMJ here. To have TMJ you must have pain in at least some of the muscles of the face, sides of the head, neck and shoulders. In addition, some people have clicking or popping noises in the temporomandibular joint and/or restricted jaw opening. Neither of the latter two are necessary or sufficient for a diagnosis of TMJ.

TMJ is characterized by muscle pain associated with localized areas of tenderness on palpation at specific tender points. Of great importance is the fact that for probably most sufferers, the pain is not confined to the head and neck, but can be found throughout the body. Many of these people have what is called fibromyalgia. TMJ is for many just part of a chronic body-wide pain condition. Other symptoms are commonly found in TMJ patients. Some may be related to the disorder but are not yet proven to be so. For example, many sufferers complain of great fatigue, other have irritable bowel syndrome, and some experience greater premenstrual pain, while others are depressed and anxious. More will be said about the emotional state of patients later.

Remember there are other serious facial pain problems that are not TMJ. For example, chronic headaches, facial neuralgias, even arthritis can mimic TMJ. You need a health care professional to tell the difference and it can be important.


The estimated prevalence of chronic TMJ ranges from 6 to 12 percent or between about 10.5 and 20 million adults, in a general population sample. The vast majority (90 ó 95 percent) of those who seek care are women. It affects women regardless of ethnicity or socioeconomic status. On average, the age of women seeking treatment is about 32 to 38 years, and, of these care seekers, 68 percent are between the ages of 20 and 50. In other words, TMJ is essentially a disorder of women in their childbearing years. We believe TMJ often starts in the late teens and twenties. It often has an on and off pattern at the beginning so it is a little hard to be sure when it starts. Unfortunately, it does not go away with the onset of menopause.


TMJ is not a stress disorder. About 40 percent of TMJ patients have suffered from severe depression and many are tense and nervous. In an extensive and complex study we published in November 1999, we wanted to know which came first, the depression or the pain. If the depression came first, then TMJ could be a psychological problem. We showed conclusively that the onset of TMJ came first. The conclusion is clear, depression is the result of living with the stress of chronic pain. TMJ and its chronic pain are extremely stressful. Rounds of consultations and diagnostic tests that do not show anything, not to speak of the costs and time loss, has to be among the most stressful experiences someone can have. On top of this, many doctors tell patients that stress is a cause, when in fact it is a result of TMJ. Everyone has some stress in his or her life, but only women get TMJ in large numbers.


There is mounting evidence that TMJ and its twin fibromyalgia is due to a problem in the way the central nervous system handles pain. In other words, women with TMJ feel more pain than others. No only that, they can feel pain in many places at once compared to most of us. If you have a headache and someone steps hard on your foot, you will notice the headache will temporarily go away while our attention focuses on our foot. In contrast, TMJ sufferers will feel pain in the foot and the headache as well.


Many TMJ patients are told they are tooth grinders, also called bruxism, and they believe it. It makes as little sense that people with sore jaws would tooth grind, as it does that someone with a sprained ankle would routinely go jogging. We know for a fact that TMJ sufferers modify their diets to eat less rough foods. The more jaw pain they have the less they chew in general. Also, dentists cannot tell whether someone grinds his or her teeth unless the doctor directly observes the patient during sleep and sees the grinding ó an unlikely scenario. Even if teeth are worn there can be other explanations for it. For example, heavy use of carbonated sodas and fruit juices can cause tooth wear. Dentists used to adjust patientsí bites for TMJ, leave teeth looking worn. Then the next dentist tells the patient she grinds her teeth.

Bad bites have nothing to do with TMJ. In a study we did, we found that the worse the bite the less the TMJ. Remember, itís women who get TMJ, and men also have their share of bad bites.


In a study we published in the March 2001 issue of the Journal of the American Dental Association, we found that most patients did not respond to them. Given the expense, the likelihood of no effect and the potential for side effects, we concluded that we cannot recommend that dentists make them for their patients.


We are actually making great progress in treatment. First of all, get the right diagnosis. Be sure you have TMJ before starting treatment. Rule out other things especially if you are male, or younger than 15 and older than 50. We know that correct early and aggressive treatment gets the best results. Long term follow-up shows that of our patients, 40 percent had complete relief, 40 percent were pain free most of the time, and that only about 20 percent had persistent pain. Most of the latter also had fibromyalgia. Even this group can be helped with conservative care.

The focus of treatment is the reduction of pain. Chronic pain is harmful to peoplesí immune systems and their emotional health. It ruins lives. Even without knowing the specific causes of a disorder, reduction of pain without doing harm is our first and chief goal.

New medications such as Neurontin that act on the nervous system are helpful. Neurontin slows down the transmission of pain signals and is very safe. Amitriptylin, a tricyclic antidepressant, has excellent muscle relaxant properties in very low doses. It does not act as an antidepressant at those dosages. The newer antidepressants such as the so-called SSRIs need to be approached very carefully, as some make the pain worse. Injecting the sore muscles with anesthetics and low-dose steroids are very effective and very safe. This technique can bring quick relief and hope to many, especially if begun early enough. There are physical therapies patients can do at home to stretch and coordinate their muscle movements that offer good relief. Do not get a bite plate and stay away from surgery. Caught and treated early, more than 70 percent of patients can get great relief.

Remember, TMJ is a problem of the nervous system and not a mental disorder.

Open and close mouth (wide) 10 times.
Then, place fist under chin and open mouth against resistance 3 times.
Repeat steps 1 and 2 a total of 3 times.
Repeat this exercise sequence three (to four) times a day before meals.

With mouth closed, place the front portion of the tongue on roof of mouth (against the palate) as far back as possible. Press your tongue hard against the roof (palate). DO NOT CURL YOUR TONGUE.
While keeping the tongue pressed hard against the roof of the mouth, slowly open mouth, and hold in place for ten (10) seconds.
Rest for ten (10) seconds, then repeat the exercise (Steps 1 and 2 above) six (6) times before each meal (3 times per day) for the first two days.
After doing the exercise for two days, increase the number of times you do it to 12 times before each meal (3 times per day) for a total of 36 times.
After doing the exercise 12 times (3 times per day) for two days, increase again, to 18 times before each meal (3 times per day) for a total of 54 times.
Continue with exercises (18 times, 3 times per day) for the duration of time specified by your doctor.
Side effects: At the beginning of the exercise period, you may experience some soreness in front of the ear on the side youíre having trouble with. Once the exercise regime has taken effect, this soreness should go away.
*Remember: The tongue is positioned with the mouth closed, and then the mouth is opened while keeping the tongue in place

These findings are based on research, most of which have been supported by funds from the National Institutes of Health, and the National Institute of Dental and Craniofacial Research

[This message has been edited by Elaine (edited 01-30-2002).]

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