A painful popping and clicking sound when you open and close your mouth. A pesky ringing in your ear began a month ago and has progressively gotten worse. Acetaminophen and ibuprofen have become your “go-to” daily. Unfortunately, these symptoms are quite common and they are signs of temporomandibular joint disorders (TMD).
TMJ disorder may be caused by any problem that disrupts the intricate system of muscles, bones, and joints. Many risk factors, including various types of arthritis, such as rheumatoid, long-term teeth grinding and occlusal issues, to name a few. TMJ disorder may be treated with a variety of therapeutic methods, as discussed further in this article.
TMJ disorder has multiple signs and symptoms. Pain in the face, jaw, neck, and shoulders, as well as the ears when the mouth opens or closes, when speaking or when chewing. Often patients have difficulties when opening their mouth or a sudden, unpleasant feeling when their top and the bottom teeth do not fit together properly. In addition, clicking, snapping, or gritting noises in your jaw as you open or close your mouth or chew is associated. Swelling of the face is also a TMJ disorder indicator. Typically, TMD causes inflammation, pain in muscles, tendon and
ligament stretching, and disc abnormalities. TMJ issues are also influenced by genetics, gender (women are more likely to be afflicted), and age. Stress, both physical and emotional, may also play a role.
As dental professionals, we are responsible for presenting treatment options for TMJ disorder. Treatment options often include physical therapy with jaw exercises that may enhance muscles, increase flexibility and movement range. Sometimes doctors recommend warm, moist compresses and removing hard or sticky food from the diet however this only treats the symptoms.
The American Aligner Society recognizes occlusal aligners as one of the most commonly utilized treatment options to relieve TMJ discomfort. An occlusal aligner, often called an occlusal splint, is a removable dental appliance that covers several or all of the upper or lower teeth. Typically constructed in a lab, aligners are fabricated from the mold of the impression of the teeth. After the aligner is made, the dentist will instruct patients to wear it at recommended times during the day (all day, only at night, both). If an aligner is recommended, it should not cause permanent changes in the bite. If an aligner causes or increases pain, the American Aligner Society recommends that the patient should stop wearing it and seek advice from the provider who made the aligner. The aligner is intended to provide relief from pain and improve jaw function so it can move smoothly.
There are several distinct types of TMJ aligners, a stabilization or flat plane, an anterior bite plane, a NTI (Nociceptive Trigeminal Inhibition Tension Suppression System), and a repositioning aligner. A stabilization or flat plane aligner covers all the upper teeth. Its flat surface is intended to help reduce teeth grinding and to relax sore jaw muscles. However, it does not prevent teeth clenching because the lower teeth can still contact it. Therefore, in some patients, their condition can be aggravated by the aligner. An anterior bite plane aligner fits on the upper jaw and
makes contact with only the six lower front teeth. It keeps the back teeth from touching and prevents both clenching and grinding. It is generally worn only at night because constant wear may allow the posterior teeth to shift. An aligner fits on the upper front teeth and is designed to prevent teeth clenching and grinding. However, because it fits on only a few teeth, it places a great deal of stress on them and that can be harmful. Also, because of its small size, if it comes off during the night, there is danger that it could be swallowed or aspirated. A repositioning aligner
is used to move the lower jaw forward or backward, assists a displaced (clicking) disc or establishes a “better” jaw position. Prolonged use raises the risk of permanent changes in the bite that can be extremely harmful.
Typical occlusal aligners can cost hundreds, even thousands of dollars. It is typical for patients to have multiple appointments scheduled for initial and follow-up examinations. Due to the lack of scientific evidence verifying safety and effectiveness of occlusal aligner appliances, medical nor dental insurance often do not cover this treatment. However, there are more affordable and convenient options for patients. An American Aligner Society endorsed company, Forever Aligned Club,
offers these aligners as a product with their affordable membership club discount.
The severity of temporomandibular dysfunction/disorder has several adverse effects on a patient’s quality of life that coincides with joint and muscle symptoms. Thus, appropriate measures should be taken to ensure the patient’s health and well being. The next time you have a little pop in your jaw or a ring in your ear, don’t let it go untreated. Most importantly, never try to treat symptoms yourself or with over the counter “boil and bite” products.