TMJ stands for temporomandibular joint, the joint that connects our lower jaw called mandible to the temporal bone of the skull. However, TMJ is commonly used by many people to refer to a group of conditions that affect the temporomandibular joint itself. Some practitioners include dysfunctions of the neck in this group. Currently, more than 10 million people in the United States have TMJ disorders. Although not very common in seniors, the pain as well as eating and drinking difficulties significantly affect the over-all health and well-being of our senior loved ones.

Each side of our jaw has one temporomandibular joint. It can be felt by placing our fingers in front of the ears and feeling the joint as we open our mouth. Our TMJ is unique because of an articular disc which allows rotational (opening and closing) and translational (sliding) movements. However, this disc is prone to displacement. A "pop" is heard or felt when the mouth is opened or closed. Upon clenching, the nerves and blood vessels are compressed which results to pain and swelling.

Temporomandibular joint disorders are medical problems that cause dysfunction in the jaw joint and the muscles responsible for jaw movements. Symptoms include head and neck pain, and locked jaw or a jaw that is difficult to open. A popping, grating or clicking sound is often heard when the jaw joints move. Upper and lower teeth sometimes do not fit together. These all lead to limited jaw movements and may cause problems in biting, chewing, yawning or talking.

There are three major categories of TMJ disorders. Myofascial pain is pain or discomfort involving the jaw muscles. It is the most common TMJ disorder. The second major TMJ disorder is the internal derangement of the jaw joint. Examples are dislocated jaw, displaced disc or injury to the condyle (connects the lower jaw to the under-side of the disc). The third category is arthritis that involves the TMJ. Like any other joints, the jaw joint is also prone to arthritis.

A person can have a combination of these categories. TMJ disorders can also co-exist with other muscular conditions such as fibromyalgia (painful muscles and soft tissues) and chronic fatigue syndrome.

Causes and Risk Factors

Most cases of temporomandibular joint disorders simply start without any medical reason. There is also no scientific proof that orthodontic braces or a large, bad bite can trigger TMJ disorders. There is also no basis to link tooth grinding with the risks for developing TMJ disorders. However, certain events are believed to trigger TMJ problems. These include trauma which can change alignment of teeth. Injuries may also damage or dislocate the articular disc. TMJ often occurs in women than men. Senior age is not a significant risk factor; studies show that incidence decreases with age. However, senior loved ones are still at risk as degeneration and loss of cartilage occur due to normal process of aging.

Prognosis

Temporomandibular joint disorders generally have good prognosis. Pain and discomfort usually go away on its own. However, other cases of TMJ disorders worsen over time and require long term pain management and self-care at home.

Diagnosis and Treatment

There is no standard diagnosis and treatment for TMJ disorders. Physical assessment of the face, neck and head is made to note any tenderness or swelling. A detailed medical and dental history is taken and other medical conditions that cause facial and neck pain are ruled out before confirming TMJ.

There is no certified specialty in the field of medicine that specifically covers TMJ disorders. The treatment goal is mainly pain management and preventing further discomfort. Treatment includes pain medications, usually over-the-counter drugs. Nonsteroidal anti-inflammatory drugs such as ibuprofen may be used to temporarily relieve pain and discomfort. A bite guard, also known as stabilization splint, may also be prescribed. It is a plastic mouth appliance worn over the upper or lower teeth, also to temporarily relieve pain. This may also prevent teeth clenching and grinding at night.

Surgery may also be suggested. This includes surgically replacing the jaw joints with artificial implants. However, this procedure is very painful and implants often malfunction. Surgery is more often avoided than recommended.

Care Plan

Home care is important for people with temporomandibular joint disorders. Our loved ones may experience eating and drinking difficulties. Changing the consistency of their food may be useful for easier chewing and swallowing. Foods with soft consistency such as mashed or pureed foods are recommended. Due to limited jaw movements, your loved ones can use straw to aid them in sipping fluids in between meals. Advice loved ones not to chew gum or eat hard candies as these may cause further stress to jaw joints. Ice packs may be applied over affected jaw to relieve pain.

Consult with a physical therapist on proper jaw exercise. Regular jaw movements with enough rest may be beneficial. Examples are gentle mandible movements like opening and closing, and sliding the lower jaw sideways. If pain continues or worsens, consult your physician. A dentist or a specialist on oral and maxillofacial care may also be consulted.