The temporomandibular joint (TMJ) is the area directly in front of the ear on either side of the head where the upper jaw (maxilla) and lower jaw (mandible) meet. Within the TMJ, there are moving parts that allow the upper jaw to close on the lower jaw. The TMJ is used throughout the day to move the jaw, especially in biting and chewing, talking, and yawning. It is one of the most frequently used joints of the body. TMJ disorders are a group of complex problems of the jaw joint.

TMJ disorders are also sometimes referred to as myofacial pain dysfunction and Costen's syndrome. Some of patient’s behaviors or conditions such as teeth grinding and clenching, habitual gum chewing, malocclusion, fractures in the jaw or facial bones and/or occupational tasks such as holding the telephone between the head and shoulder may lead to TMJ disorders.

Symptoms of TMJ disorders tend to be chronic, and treatment is aimed at eliminating the precipitating factors. The following are common symptoms of TMJ disorder:

Headache: Pain is often made worse while opening and closing the jaw. Exposure to cold weather or air-conditioned air may increase muscle contraction and facial pain.

Ear pain: The ear pain is usually described as being in front of or below the ear. Often, patients are treated multiple times for a presumed ear infection

Sounds: Grinding, crunching, or popping sounds, medically termed crepitus, are common for patients with a TMJ disorder. These sounds may or may not be accompanied by increased pain.

Dizziness: many patients report a vague sense of dizziness or imbalance.

Fullness of the ear: patients describe here muffled, clogged, or full ears. They may notice ear fullness and pain during airplane takeoffs and landings.

Tinnitus: patients with a TMJ disorder experience noise or ringing in the ears.

The main treatment for acute TMJ pain include:

1. Jaw rest: it can be beneficial to keep the teeth apart as much as possible. Patients are advised to avoid chewing gum or eating hard, chewy, or crunchy foods such as raw vegetables, candy, or nuts. Foods that require opening the mouth widely, such as a big hamburger, are also not recommended.

2. Heat and ice therapy: these assist in reducing muscle tension and spasm. However, immediately after an injury to the TMJ, treatment with cold applications is best. Cold packs can be helpful for relieving pain.

3. Medications: anti-inflammatory medications such as aspirin, ibuprofen, naproxen, or steroids can help control inflammation. Muscle relaxants, such as diazepam, aid in decreasing muscle spasms.

4. Physical therapy: passively opening and closing the jaw, massage, and electrical stimulation help to decrease pain and increase the range of motion and strength of the joint.

5. Occlusal therapy: a custom-made acrylic appliance which fits over the teeth is commonly prescribed for night but may be required throughout the day. It acts to balance the bite and reduce or eliminate teeth grinding.

6. Correction of bite abnormalities: Corrective dental therapy, such as orthodontics, may be required to correct an abnormal bite. Dental restorations assist in creating a more stable bite. Adjustments of bridges or crowns ensure proper alignment of the teeth.

7. Surgery: Surgery is indicated in those situations in which medical therapy has failed. It is done as a last resort.

GLOSSARY
adjustments – korekta, regulacja 
appliance – urządzenie 
clenching – zaciskanie 
clogged – zatkany 
cold pack – zimny kompres 
complex – złożony 
contraction – skurcz 
crunching – chrupiący odgłos 
dysfunction – dysfunkcja 
ensure – zapewniać 
habitual – nałogowy 
immediately – natychmiast 
indicated – wskazany 
vague – niejasny, niewytłumaczalny 
last resort – ostateczność 
joint – staw
malocclusion – wada zgryzu 
mandible – dolna szczęka 
maxilla – górna szczęka 
muffled – stłumiony 
myofascial – (o bólu) mięśniowo-powięziowy 
popping – trzaskający 
presumed – domniemany 
teeth grinding – zgrzytanie zębami 
temporomandibular joint (TMJ) – staw skroniowo-żuchwowy
imbalance – brak równowagi
tend to – mają tendencję do
throughout – przez
tinnitus – szum w uszach
yawn - ziewać

Complete the sentences with words from the glossary section. One dash means one letter

‘I can’t stand this anymore. My ears are _ _ O _ _ _ D and I hear this ringing sound constantly.’ 
Teeth C _ _ _ _ _ _ _ _ and _ R _ _ _ _ _ G are connected with TMJ disorders.
H _ _ _ T _ _ _ gum chewing may lead to problems with temporomandibular _ _ I _ _. 
Malocclusion _ _ _ DS to worsen TMJ problems. 
Some acrylic appliances have to be worn mostly at night but some patients require their use T _ _ _ U _ _ _ _ T the day. 
_ _ _ _ _ _ _ S is a medical term which describes awkward sound in patient’s ears. 
Surgical procedure is for sure the last _ _ _ _ R _ in treatment of TMJ dysfunction.

Complete the patient’s testimony with words from the table:

‘I have suffered from problems with my TMJ since I was a child. When I was 10 years old, my mother used to complain of me "1. ___________ my teeth" on a spoon when I ate. The trouble is, my teeth never came near the spoon. The sound she heard came from my jaw popping. My jaw now 2._____________ constantly. I can't eat pizza or French bread, or even sing, without it locking. I wake up 3.____________times each night having to relocate my jaw. There is no pain just a jaw that can't seem to function normally. Brux guards do 4.____________. In fact, the only thing that seems to keep my jaw from popping and sticking is applying 5. ________ to the left TMJ. I have to sleep these days with a hard pillow 6._____________ against the joint, or it pops out 7. _____________. It's clear that something is keeping my jaw from 8._____________ properly, but no one seems to be able to help me fix it.’

Match term with its definition

1. COLD PACK
2. ANTI- INFLAMMATORY DRUG
3. MAXILLA
4. DYSFUNCTION
5. JOINT
6. YAWN
7. CONTRACTION
8. CLENCH
9. CUSTOM-MADE
10. MUSCLE RELAXANT

A. a jaw or jawbone, especially the upper.
B. the movable or fixed place or part where two bones join
C. an ice bag which applied to the body to reduce swelling, relieve pain, etc.
D. malfunctioning
E. medicine which reduces typical symptoms of inflammation such as swelling, pain etc.
F. a drug that reduces muscle contractility by blocking the transmission of nerve impulses
G. spasm
H. to close/ grasp tightly
I. to open the mouth involuntarily with a prolonged, deep inhalation and sighing or heavy exhalation, as from drowsiness or boredom.
J. made according to the specifications of an individual

Put words in order to make proper doctor’s questions

for/ you/ had /long/ have/pain/ how/ this/ = ……………………………………………
used/ have/ painkillers /you/ any = ……………………………………………………..
does/ radiate/ into/ the pain/ your/ jaw/ upper or lower = ………………………………
have/ consulted/ your/ this pain/ you/ about/ GP = …………………………………….
had / you/ have/ any/ procedures/ recently/dental = …………………

Lesson 19 answers