Why does my jaw hurt so much? Part 2
Nearly all of us have had a door at home that just doesn’t want to stay shut. You close it, and it pops right back open, almost as if it’s mocking you (maybe the faint “creak” in the hinge is laughter). Anyhow, we usually ignore it until it becomes annoying enough that we decide to investigate. The problem is that the door latch (the springy metal cylinder that sticks out of the door) doesn’t engage in the catch (the hole in the door frame). Either due to faulty installation, humidity, or old age, the door latch is usually below the catch when the door is closed.
A proper fix would require time and tools, so the interim “solution” is just to yank up on the door and voila! The latch goes into the catch and the door stays closed! This workaround does the trick well enough, but the door and the hinges suffer the consequences. Each time the door is closed in this manner the bottom hinge gets pulled out, the top hinge gets pushed in, and the door rubs on the frame. Do this enough times and things start to loosen up, wear down, and eventually fall apart.
Enter the analogy: Your jaw works the same way in that the jaw joints function as hinges, the jaw bone represents the door, and the teeth represent the latch/catch system. When everything functions properly together, we say they are in ‘harmony.’ How do things get out of harmony? The problem almost always starts with the teeth.
The best way to simplify any complex problem is to remove, or neutralize, one of the factors. While I don’t advocate extracting teeth to solve jaw problems, luckily I already have a number of patients without teeth (lucky for me, maybe not them). And over the years I have found that, by and large, people without teeth do not have TMJ problems.
The hallmark treatment for TMJ problems is a rigid plastic device that fits over the teeth (top or bottom) called a nightguard. While nightguards do a good job of managing the symptoms, if you remove the appliance, the symptoms eventually come back. So maybe we should stop viewing nightguard appliances as solutions and more so as diagnostic tools and adjunct therapies.
Just like our door analogy where the hinges can loosen and the frame can wear down, the jaw/joint system can suffer damage from repeated trauma. In the early stages this is just inflammation or other reversible changes, and nightguards can be helpful in restoring the joint to a state of health, a condition which is necessary before any definitive treatment can begin. If the trauma continues, permanent damage can occur and treatment can be more complicated.
If you suffer from TMJ problems, remember that effective treatments are available and you can get relief. It is important to seek help right away, before the symptoms become intolerable. A good option for immediate relief is a boil-and-bite product available at the drug store. Avoid chewy foods and gum. The natural rest position for your jaw is where your teeth are slightly apart and your tongue is on the roof of the mouth. Practice this. A lot. Throw in some active jaw stretching (don’t use your hand to pull or push the jaw) and apply a warm, moist towel when you can.
Schedule an appointment with your dentist for an evaluation and make sure you understand the treatment plan. Treatment will likely involve an appliance of some kind to get the symptoms under control and reduce inflammation. If there is permanent damage, treatment can still be effective but it may take longer and involve more modalities.
Remember that the jaw/joint/teeth system is fundamentally a mechanical system, and any treatment plan that ignores the mechanics is missing the forest for the trees. Your treatment plan should include a thorough evaluation of your teeth and bite; only then can the primary cause of most TMJ problems be identified and remedied.
Dr. McGann
