Thanks to Reagan Davis, MPAS, PA-C, Physician Assistant in the Department of Otolaryngology, for contributing this month’s feature on TMJ!
The temporomandibular joints (TMJ or "jaw joints") are hinge-like joints located on each side of the face, in front of the ears. These joints connect the lower jaw to the skull and are frequently used in routine functions such as eating, chewing, and speaking. TMJ dysfunction can cause localized pain to the joints, referred pain to the ears, and to the muscles that control movement of the jaw. It can also cause reduced range of motion or trismus to the mouth. The causes are multifactorial, and can include genetics, arthritis, facial/jaw trauma or injuries, and teeth clenching or grinding (bruxism).
Upon initial evaluation, I try to identify triggers or causes for the TMJ dysfunction. Most TMJ patients come to see me for ear pain or ear fullness, in which, majority of the time, their ears are unremarkable; however, they do typically have some exam findings of jaw clicking or pain when palpating. I counsel all of my patients on the importance of stress reduction since stress and anxiety can contribute to various chronic pain syndromes. For some, stress and anxiety manifests as muscle tension in the upper part of their neck, face and jaw. I never underestimate the value of a good deep tissue massage and/or facial. Patients typically like hearing that recommendation in their treatment plan as well!
The treatment approach of TMJ Disorders typically begins conservatively with the use of dental night guards, warm and cold compresses, and a soft food diet. Dental night guards can help not only with TMJ dysfunction, but also protect from further dental attrition. Patients should also avoid excessive chewing or biting, including chewing gum. This disorder is chronic but acute episodes or flare ups can wax and wane, so it is important to adhere to preventative measures for optimal pain control. Non-steroidal anti-inflammatory drugs such as Ibuprofen or Naproxen (if tolerated, and not contraindicated) are the recommended acute treatment for TMJD. For patients who are unable to take NSAIDs by mouth, topical NSAIDs like Diclofenac gel can be used by massaging into the skin over the joints. Muscle relaxants, like Cyclobenzaprine, may also be helpful pharmacologic agents. In the event of failed medical therapy, I then re-evaluate the patient and determine if they are a good candidate for alternative treatments like Botox injections or if they may require surgical and/or physical therapy referrals.
While Botulinum toxin (or "Botox") is not FDA approved for the treatment of TMJ disorders, it is a good therapeutic option for patients with chronic myofascial pain and tension-like headaches, symptoms that are commonly associated with TMJ dysfunction. I offer Botox injections to patients who fail to respond to conservative therapies mentioned above. The dose varies from patient to patient, dependent upon their pain severity and anatomy, but typically patients receive these injections every three months into the temporalis and masseter muscles. I'm pleased to say that the majority of my patients who have undergone Botox injections report great benefit in regard to their pain management.
As someone who has personally suffered with TMJD for many years, I began my career in ENT with the hope of providing compassionate care and effective treatment options for patients who, like me, have had to frequently replace their dental night guards and keep Ibuprofen in stock in the medicine cabinet. With a referral to Otolaryngology, I'd be delighted to evaluate and manage your patients whom you suspect are suffering from TMJ dysfunction as well.
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