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Easing the grind for busiest joint

By TOM VALEO
Published April 26, 2005

Considering how much we talk and chew, it should come as no surprise that the joint linking the jaw to the skull is one of the busiest. It's also one of the most complex. It's the only joint that, in addition to acting like a hinge, slides forward and backward, and moves side to side.

Ironically, the joint that enables us to talk has a name difficult to pronounce - temporomandibular. The temporomandibular joint can be temperamental, causing pain, stiffness and an array of clicking and popping noises.

All of those problems are grouped under an umbrella term - Temporomandibular Joint Syndrome, or TMJ Syndrome.

The causes are as varied as the symptoms, but the treatment is the same for most: rest, relaxation and anti-inflammatory drugs such as aspirin and ibuprofen.

Most problems that plague the body appear more frequently with age, but TMJ is an exception. TMJ problems "are most prevalent in women of childbearing age," said Dr. John Kusiak, program director at the National Institute of Dental and Craniofacial Research at the National Institutes of Health in Maryland. "It's not clear why, but it's likely that sex hormones, especially estrogen, may play a role."

TMJ can strike at any age. Even babies are sometimes born with TMJ problems. Sometimes the problem stems from a malformed TMJ, the result of an injury or a congenital defect.

The most common cause of TMJ discomfort, however, seems to be muscle tightness around the jaw, usually from overuse. Unlike other joints, which suffer the most stress when you're awake and active, the TMJ can suffer the most damage when you're asleep. That's when you're most likely to clench and grind your teeth, a problem known as bruxism. During sleep, a person can clench and grind the teeth much harder than while awake, causing damage to the teeth as well as to the TMJ.

While people associate bruxism with stress, research hasn't established a solid link between the two, though the circumstantial evidence is strong.

"Certain antidepressants reduce the pain of chronic TMJ," Kusiak said. "That suggests that reducing stress might help."

Among older people, the most common TMJ problem is arthritis, which affects the pad of cartilage that cushions the spot where the jawbone meets the skull.

Like cartilage in all joints, that pad becomes thinner and harder with age and prone to inflammation. The result is pain and stiffness. Some people with severe TMJ arthritis have trouble opening their mouths, chewing and talking.

Because so much remains unknown about TMJ, most doctors advocate cautious, reversible treatment, especially since most TMJ problems eventually just go away.

For starters, rest the joint. Don't chew gum, and try applying hot compresses to relax the jaw muscles. For pain, consult your doctor, who may recommend aspirin or ibuprofen before moving to a prescription pain reliever or muscle relaxant.

If it hurts to eat, switch to soft foods for a while. If you grind your teeth at night, ask your dentist for a bite plate - a soft, plastic device that protects your teeth and cushions the pressure exerted by your jaw muscles.

And if a doctor or a dentist recommends surgery, be extremely cautious.

"We prefer conservative treatments that don't change anything permanently," Kusiak said. "We discourage anything that changes the architecture of the joint, and we consider surgery a last resort."

Since stress seems to play a role in at least some TMJ cases, relaxation techniques, such as deep breathing, mediation or yoga, may help. Some people even use biofeedback to learn how to keep their jaw muscles relaxed.

And if relaxation techniques don't help your jaw, they still may improve your life.

- Tom Valeo is a freelancer who writes about medical and health issues. Write to him c/o Seniority, the St. Petersburg Times, P.O. Box 1121, St. Petersburg, FL 33731 or e-mail features@sptimes.com

For a good overview of TMJ problems, log on to http://arthritis.about.com/od/tmj/

Information from the National Institute of Dental and Craniofacial Research is available at www.nidcr.nih.gov/HealthInformation/OralHealthInformationIndex/TMDTMJ/Tmd.htm

[Last modified April 22, 2005, 08:50:04]