As part of the assessment of patients we carry out an examination of your jaw joints. They have a long name: Temporomandibular Joints (TMJ for short). The reason that we do this is because it is very common for people to have problems with their jaw joints and can develop them during later life. The muscles that we use to chew can also become problematic.
There are many causes for jaw joint and muscle pain, tenderness and stiffness. Something like 20-40% of any population will have jaw joint clicks. This happens when opening and sometimes closing your mouth. Problems are more common with this joint because it is so versatile. Most joints act like a hinge but our TMJs develop more problems because they slide and rotate. This enables us to chew foods. The increased versatility leads to more risk of problems, a little like our shoulder joints.
Who gets Jaw Joint and Muscle problems?
It is unusual for people to have jaw joint problems under the age of 10 but still possible. Most people start to develop problems during the teenage years. This can be a stressful time and can be associated with clenching the teeth together a lot. While conscious clenching can happen during the daytime, it is more common for people to do this while they are asleep at night. This is called parafunctional activity. In older people arthritis can be a problem with the jaw joints, or a history of trauma to the joint, such as while playing rugby or other contact sports. Wearing a mouth guard actually helps to protect, not just the teeth but also the jaw joints.
If the jaw joints or chewing muscles become painful then it can take some time for things to settle down. The most common causes are nocturnal or daytime clenching. The joints and muscles can become swollen and can even make it difficult to bite together properly. This can be exacerbated by chewing for long periods, such as with chewing gum, or high forces from eating foods, such as toffee or crusty breads. Reducing the amount of movement can help to reduce the symptoms but it does take time. Normally when joints and muscles become painful, the movements reduce and it becomes self limiting. If this doesn’t happen, then it is best to take a soft diet, stifle yawns, avoid playing with or rubbing the joints because this usually just makes things worse, even if short term relief is gained.
Will Braces Help?
We are sometimes asked if braces will help. The honest answer is that it is unlikely to help that much. The studies done on this have shown fairly clearly that symptoms might improve while the brace is on. This is more to do with the fact that braces make the teeth tender and so clenching is reduced. The symptoms normally return once the braces are removed. The other question we are asked is whether braces can cause joint problems. Again, this is very unlikely but studies have indicated that during treatment a few people will develop symptoms. These numbers are comparable to a non treatment control group. This tells us that the development of symptoms is more of a coincidence than being caused by the brace.
Sometimes types of treatment may help in that they act like a night guard. So appliances like Invisalign could help, to just keep the jaw joint slightly forward but would not be a reason to carry out treatment. It may just help in some cases, where teeth are being aligned but there is no evidence that using aligners treats jaw joint and muscle pain. There are plenty of people with perfect bites that have joint and muscle pain.
Times of stress are more likely to be linked, such as when taking examinations. But stress can happen at positive times as well, such as when planning a wedding or preparing for a holiday.
As well as taking a soft diet or avoiding clenching, sometimes taking anti inflammatory pain killers such as neurofen or aspirin can be of help, as long as you are able to take this kind of medication. Sometimes a night guard is of help but not in all cases, just like with jaw exercises, while they can help, sometimes they can make things worse. The more dramatic treatments such as steroid injections, botox or joint surgery are reserved for those with very unusual, severe cases, that don’t respond to other treatment. The long term side effects of these treatments can be as severe as the problem, so they are better left until all other treatments have failed.
In most cases, simple guidance is all that is needed.