Every year since I was in Uni, I have got together with a special group of friends. This annual weekend is always fun and great for catching up with all the gossip and news. One of our group is always allowed to get a room to herself however. Having an unfortunate habit of grinding her teeth once asleep, it was easier to give her a solo room than keep an unhappy roomie awake with the persistent grinding that can only be described as second only to fingernails down a blackboard in making me cringe. Known as bruxism, abnormal grinding of the teeth is a common problem that can affect a good percentage of the population. Other than being annoying for sleeping partners and room mates, this habit has the potential to cause damage not only to my friend’s teeth but also may be creating issues with the temporomandibular joint (TMJ).
The TMJ is the joint that links the mandible (the jaw bone) with the rest of the skull. Important for speech, eating, drinking and breathing it can be affected by injury, movement disorders and degenerative wear and tear (arthritis). Inflammation and the resultant pain can occur due to injury such as a blow to the chin, heavy chewing, or over activity such as in bruxism. Issues with the neck, poor posture, stress and even vestibular disorders of the inner ear causing dizziness can create abnormal muscle activity around the head and neck, creating problems in the TMJ.
Sometimes a TMJ derangement may occur where the disc structure within the joint may displace, causing symptoms such as temporary locking and painful clunking as it returns to its original position. In more severe cases the joint does not relocate and it remains painfully locked in a condition known as closed lock. This distressing condition may require urgent medical or physiotherapy treatment to assist with reducing the muscle spasm and restoring normal movement to the joint. Similarly open lock may occur whereby too much movement in the TMJ may result in it becoming locked in an open position.
Physiotherapy can be very successful in treating painful TMJ conditions. Identifying joint swelling, stiffness, muscle spasm or weakness and treating these symptoms can usually settle most conditions within a few weeks. At times, simple techniques to relax overactive jaw muscles can allow for self-management. Long standing conditions may take longer. In the case of excessive bruxism, occlusal night splints may be prescribed by a dentist to reduce wear on the teeth and compressive load on the TMJ.
As in all painful conditions, correct assessment is important to ensure that other conditions are not causing pain around the TMJ. The trigeminal nerve, nerves from the upper neck and even shingles can cause pain in this region. If symptoms do not settle quickly, further medical investigations may be needed.