IF SYMPTOMS PERSIST By DR. JOSE PUJALTE JR. “My noble friend, chew upon this.” — William Shakespeare (1564–1616), English dramatist, poet. Brutus, in Julius Caesar, Act 1, sc. 2, l. 171. Dr. Jose Pujalte Jr. Ok, never mind if the Bard meant “reflect” or “ruminate” for “chew.” It just sounded appropriate for an article on the TMJ or the temporo-mandibular joint. This articulation is what makes it possible for us to gnaw on meat, talk and shout, and do a hundred other things that involve opening and closing the jaws. And, as in most of our anatomy, we only know it exists when it hurts. The TMJ. It’s easy to mislabel the TMJ as a ginglymus or hinge joint. But it doesn’t move like the elbow or ankle. These joints move only in plane (uniaxial). The TMJ is in fact a ball-and-socket joint. Its movement is more complex – the lower part hinges yes, but the upper part slides. The lower jaw (mandible) has rounded ends or condyles that articulate with the socket ends of the temporal bone of the skull (maxilla). The condyles move in and out in talking, yawning, chewing, etc. These movements are incredibly precise but they don’t double hinge. Any larger jaw opening and you’d be a boa constrictor. Besides being covered by slippery cartilage, a disc is in between the joint to absorb shock and add to smooth movement. Strong muscles – one of the strongest in the human body – complete the TMJs. My TMJ Hurts.  The jaw can hurt occasionally right there at the articulations. TMJ pain becomes bothersome when it lasts for weeks and when it begins to interfere with activities we take for granted (eating and talking). I don’t have local figures but in the US, the National Institute of Dental and Craniofacial Research estimates that 5 to 15% of the population has TMJ disorders. More women than men are affected. The most frequent causes are: trauma to the jaw – as in a knock-out punch, joint degeneration, rheumatoid arthritis. However, the most common cause of TMJ disorders is stress.Under a lot of stress, a person my involuntarily strain her back, sweat, knit her brow, upset her stomach, OR clench her jaw. This clenching is associated with a stiff neck or grinding of the teeth. The problem worsens with habit. Add to this other bad habits like biting on pencils and chewing gum that overuse the jaw muscles and you have a full-blown TMJ pain in the you-know-where. Signs and Symptoms. TMJ disorders present with the following:

• Joint locks – making it an effort to close or open the mouth.
• Facial pain.
• Difficulty masticating (chewing) and discomfort as well.
• Pain around the ears.
• Clicking or grating when chewing or just opening the mouth.
• Pain around the jaw and tenderness too.
• Headache.
• Uneven bite (some teeth meet or touch prematurely).
• Uncomfortable bite.

Diagnosis. Fortunately, there are many health professionals to approach – your favorite dentist, oral and maxillofacial surgeon, ENT specialist, or head and neck surgeon. X-rays, CT Scan, or an MRI – standard imaging workhorses will guide the good dentist (or doctor) on what to do next. A TMJ specialist (could be any of the above) checks the jaw’s range of motion – any abnormality in movement whether there’s catching or clicking. Dental treatment may be necessary and in some cases, surgery of the TMJs. Treatment. Rest and avoiding chewing gum or sticky food are all that may be needed to relieve TMJ symptoms. Other conservative steps focus on treating pain by warm compress on the tender areas of the jaw, the use of over-the-counter pain killers, stretching exercises, and massage for jaw muscles. A dentist may recommend a biteplate or plastic device worn over teeth to align the upper and lower jaws. This kind of splint reduces pressure on the TMJs. If teeth grinding is noted, a night guard appliance is used during sleep. Other treatments include corticosteroid injection into the joint space in severe inflammation, corrective dental work, athrocentesis or the irrigation of the joint for infection or inflammation. In degenerative arthritis, partial or total joint replacement for the TMJ is now available. But don’t underestimate the healing power of relaxation. Make sure there’s time to relax those tight jaws. E-mail: [email protected]