Jaw Joints And Facial Pain

Knowing the temporomandibular joint complex

This section emphases on the diagnosis and treatment of TMJ disorder, which is a condition affecting 1 in 10 people usually during their lifetime.

The temporomandibular is a small joint by the front of the ear, where the lower jaw and skull meet. The joint allows your jaw to move and as the image above shows, this is more than a simple ball and socket.
The joint can be damaged, as can the cartilage (articular disc) which acts as a cushion within the joint. Muscles and ligaments which assist the joint can contribute to temporomandibular joint (TMJ) disorder.

Diagnosing the disorders of jaw joints:

At CIMS we carry out a detailed oral examination under the supervision of our chief consultant Dr Mukherji. Panoramic x-rays, or other specialist imaging techniques may be helpful, to define the detail of your jaw, joints and soft tissues. Patient’s medical history, perhaps family medical history may be discussed, genetic factors can have a relationship with TMJ disorder.
Issues such as mouth sores, gum disease, sinus function, or unexplained toothache would be investigated. Along with any previous trauma to the face, or jaw, including biting hard, or unusually wide mouth opening. The jaw joints and nearby areas can be examined for pain, clicking, popping, or grating, event patients bite and facial muscle function is analyzed.

Temporomandibular joint pain dysfunction:

TMJ dysfunction occurs when the muscles and ligaments around your jaw joints become inflamed or irritated. The condition may be acute or chronic, and the resulting pain may be mild or severe.

Understanding TMJ PDS

Download our information booklet on JAW JOINT PROBLEMS

Causes & Symptoms

Trauma due to tooth grinding, or clenching or overloading the jaw, or your chewing muscles might be a contributor, one cause of damage to the articular disc.
External trauma can reduce the joint’s function, or nearby fractures have an indirect effect. Inflammation could arise from other medical conditions, or be related to arthritis that could be a form which develops quickly and leaves deposits on joints, or more prevalent conditions, such as rheumatoid arthritis, or degenerative osteoarthritis.
A TMJ disorder is likely to be a concern, with pain in the muscles, jaw joint, face, or neck. Jaw stiffness, or restricted movement, clicking, or popping sounds, more rarely swelling by the joint.
Although natural misalignment is not usually a root cause, how your upper and lower teeth come together can change due to joint dysfunction. Headaches, hearing loss, or tinnitus are other common side effects, the causes of temporomandibular joint problems can also be multi-factorial. An accurate assessment is critical for successful treatment to eliminate symptoms.
Treatment includes various non-surgical and surgical managements,

Causes & Symptoms

Transcutaneous electrical nerve stimulation (TENS). This therapy uses low-level electrical currents to reduce pain by relaxing your jaw joint and facial muscles. TENS can be completed at home or your healthcare provider’s office.

Ultrasound- This is a deep heat treatment that is applied to the TMJ to relieve soreness or improve joint movement.
Trigger-point injections.- Pain medication or anesthetic is injected into tender muscles of the face (called “trigger points”) to relieve pain.
Radio wave therapy. -Radio waves create a low-level electrical stimulation to the joint, which increases blood flow and provides TMJ relief.
Botulinum Toxin (Botox®). -These injections help reduce muscle mass and inflammation.

When should you consider TMJ surgery?

TMJ surgery should only be considered after all other treatment options have been tried and severe pain remains. While TMJ surgery is the best option for many people, it’s important to weigh your options and make an informed decision.
There are three types of TMJ surgery: arthrocentesis, arthroscopy and open-joint surgery. The type of surgery needed depends on the TMJ symptoms and the complexity of the problem.
Arthrocentesis. This minor procedure is executed in the minor ot, under local anesthesia. It’s often recommended when the jaw suddenly locks in the closed position. It can also help reduce inflammation in the TMJ. Needles filled with sterile fluids are inserted into the affected joint and the joint is washed out.

Arthroscopy:

This procedure is performed under general anesthesia. Your surgeon makes a small incision in front of the ear and inserts a small, thin instrument that contains a lens and light. This instrument is hooked up to a video screen, which allows your surgeon to examine the TMJ and surrounding area. Depending on the cause of your TMJ pain, your surgeon may remove inflamed tissue or realign the disc or another area of the TMJ and as arthroscopic surgery is performed through tiny incisions, there is less scarring, a shorter recovery time, less discomfort, and fewer complications compared with open-joint surgery.

Open-joint surgery:

Open surgery is the traditional procedure in which a long incision is made to insert instruments. Open-joint surgeries may be necessary if:
The bony structures that make up the jaw joint are wearing away.
There are tumors in or around TMJ.
There is severe scarring or bone chips in the joint.
Compared to arthrocentesis and arthroscopy, open-joint surgery results in a longer healing time plus has a greater chance of tissue scarring and nerve injury. Still, there are instances in which open-joint surgery is the best solution. Your healthcare provider can help you determine which approach is suitable for your unique needs.

TMJ injury leading to condylar fracture:

Condylar fractures of the mandible or the lower jaw can limit the functional movements of the TMJ causing limited mouth opening and pain on joint region, if these symptoms are not addressed can lead to TMJ dysfunction if not properly treated.

Internal derangement of Jaw Joint:

The term “internal derangements” refers to conditions with the joint disc which gets displaced from its original position on the mandibular condyle or the head of the lower jaw. Internal derangements are not uncommon. However, they are usually self-limiting and respond well to conservative, inexpensive care. In rare cases, surgical intervention may be indicated, but only in the presence of significant pain and/or dysfunction, despite skillful conservative treatment.

When the joint stops moving – Ankylosis:

Temporomandibular joint (TMJ) ankyloses is a pathologic condition where the mandible is fused to the fossa by bony or fibrotic tissues. This interferes with mastication, speech, oral hygiene, and normal life activities, and can be potentially life threatening when struggling to acquire an airway in an emergency.

TMJ replacement surgery:

TMJ replacement surgery, or total temporomandibular joint replacement is a relatively new surgical procedure that involves replacing the joints between the lower jaw and the base of the skull with custom-made prosthetic joints.

TMJ treatment (jaw replacement surgery) is usually required in patients who have:

Jaw damage through osteoarthritis
Damage due to an accident
Had part of the jaw bone removed due to a cancerous tumour, bone infection, rheumatoid or psoriatic arthritis.

In TMJ joint replacement surgery, the knuckle of the joint has to be cut off and a titanium replacement installed. A little of the bone at the base of the skull is sometimes removed, and replaced with a high-density type of plastic that screws onto the side of the skull. The titanium knuckle sits into the plastic and allows the jaw its full range of movements.

Dr. Srijon Mukherji happens to be some the few consultants in the India and the eastern region who are well experienced to offer it at CIMS.

Treatment at CIMS:

When a temporomandibular joint disorder is the primary issue, you will receive excellent care, with your treatment focused on minimum intervention for maximum effect.
We understand that the loss of function and pain that a TMJ disorders can bring and issues that are not often confined to the jaw itself, discomfort can be wider and core functions such as eating, or speaking are affected.
Seeing a leading maxillofacial consultant is a sound first step. There may be causal, symptomatic, or separate oral conditions to be addressed. These can be accurately diagnosed and treated
A Good oral function is an essential part of enjoying a healthy, pleasant life. If our center can help you, please get in touch with our friendly team.

Trigeminal neuralgia:

Trigeminal neuralgia is a condition that causes painful sensations similar to an electric shock on one side of the face. This chronic pain condition affects the trigeminal nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain.

You may initially experience short, mild attacks. But trigeminal neuralgia can progress and cause longer, more-frequent bouts of searing pain.
Trigeminal neuralgia affects women more often than men, and it’s more likely to occur in people who are older or in late middle ages, because of the variety of treatment options available, having trigeminal neuralgia doesn’t necessarily mean that you’re hopeless to a life of pain. Doctors usually can effectively manage trigeminal neuralgia with medications, injections or surgery.

Diagnosing facial pain:

If your face hurts without a clear cause, it could be atypical facial pain (AFP). AFP is unexplained, chronic (ongoing) pain in your face. It might affect your teeth, jaw, cheek or ear. AFP can be hard to diagnose. Depression, stress or anxiety can make AFP worse.
At CIMS the consultants may perform tests to rule out other conditions that could make your face hurt.

Tests may include:

Dental exams: A dentist carefully examines your oral cavity where they may do dental X-rays to check for cavities, infections, impacted molars or other dental problems.
Imaging exams: An MRI or CT scan can detect problems in your head, neck or face. It is advised to rule out the possibility of a facial fracture, tumor or blood vessel problem.

Neurological tests: The consultant uses neurological testing to check the nerves in your face. They check your ability to smile, frown and move your lips. They may also touch different areas of your face to check for pain or numbness.
Psychological tests: The consultant may ask questions about your mood, behavior and interactions with other people. Problems like depression, stress or anxiety may trigger pain or make it worse.

Once the symptoms successfully rules out the diagnosis, this usually can improve with proper medication or psychological therapy. Atypical facial pain is difficult to diagnose. The symptoms are similar to those of many other facial pain syndromes. Your healthcare provider will do a physical exam, review your medical history and evaluate your symptoms.

Migraines:

A migraine is a headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.
For some people, a warning symptom known as an aura occurs before or with the headache. An aura can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling on one side of the face or in an arm or leg and difficulty speaking.
Migraines are often undiagnosed and untreated. If you regularly have signs and symptoms of migraine, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches.
Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.
See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which could indicate a more serious medical problem:
An abrupt, severe headache like a clap of thunder
Headache with fever, stiff neck, confusion, seizures, double vision, numbness or weakness in any part of the body, which could be a sign of a stroke