1 Facial pain.
2. Clicking jaw joints.
3.
Restriction of mouth opening
Pain
is usually felt in or around the ears , extending upwards
towards the side of the head , and downwards towards the side of
the jaw. The character of the pain is dull, and the pain can last for hours or
even days. It is often made worse by movement of the jaw such as during
eating or talking. Specially so when the mouth is kept open for a long
time such as for general anaesthetic or for dental treatment.
Some people who grind
or clench their teeth during the night wake up with the pain . In such
patients the pain improves during the day. With others the pain gets
progressively worse during the day if there is increase in stress .
It sometimes associated with ear ache and headache and discomfort in the
throat.
Clicking
of the jaw joints usually implies malfunction .It is
not a sign of arthritis. In order to understand the origin of
joint noises a brief explanation of the anatomy may be
helpful.
The jaw joint is a very
sophisticated joint and connects the lower jaw to the base of the skull. It is
capable not only of rotational movement, but also of sliding
movement such as occurs when one sticks the jaw forward.
In normal
function, the mouth opening and disc movement take place together
harmoniously . If for any reason there is muscle spasm, then the disc
is pulled forward earlier than it should and so get trapped in front of
the head of the jaw (condyle). This can occasionally lock the jaw joint.
Usually however the disc snaps back into position and this is heard as a
click
In
some patients there is no click as the anatomy of the joint is flat.
Restriction
of the mouth opening. This
is due to combined effect of jaw muscle spasm and interference with
movement of the disc in the joint.
Causes The most common cause of muscle spasm in adults is increase
in muscle tone. This may be the result of having a demanding job, preparing for
an examination, or even being "on ones toes too long" .The muscles
tends to initiate a ' vicious circle'. The spasm produces pain and the
pain produces more spasm.
Other
important factors which unmask tendency for the jaw muscles to go into
spasm is interference with subtle jaws function. Keeping the mouth open
for general anaesthetic , for removal of wisdom teeth , or other
dental treatment .Having to avoid certain parts of the mouth whilst chewing can
also place extra stress on the joints. This could because by such factors as a recent
high dental filling , or by worn down dentures. In young people .infection at
the back of the jaw such as from impacted wisdom teeth can also contribute the
pain and irritation can cause muscle spasm.
DIAGNOSIS
is made from history of the complaints, examination of the
jaws and the joints, and finding of tender jaw muscles. Occasionally
special tests such as x-rays help us to make a diagnosis. (Ordinary
x-rays however do not show the position of the disc.)
TREATMENT
The most important
aspect of treatment is to understand what causes the disorder. If this is
understood, then action can be taken to reduce initiating factors and carry out
procedures which improve it. The initial treatment is usually conservative. You
should treat your facial muscles like any bruised, strained muscle . Massage
them as much as you can. I suggest that you to do a series of relaxation jaw
exercises (see the exercise section) . Additionally application of warmth to improve the
circulation in the affected area is recommended. Many patients also have a
model made of their teeth. This enables the technician to make a thin
plastic cover to be worn over the teeth . This is known as a bite raising
appliance or occlusal splint and is similar to a gum shield . We advise
that you wear this at night to rest your jaws.
Occasionally
patients benefit from injection of the tender spots with long acting
local anaesthetic . This is with the aim of making the
muscles relax for a while to get rid of the vicious circle. Suitable
joints can be injected with cortisone. This is particularly helpful
in those which have a rough surface.
Medications Most
patients benefit from medicines like Neurofen or paracetamol . However those
patients with significant muscle spasms require additional tablets to relax the
muscles and reduce the pain. The main groups of medication used for Myofascial
pain dysfunction syndrome are also used for depression. Most of our patients
however are not depressed. So please realize that this is yet a different use
of these type of medicines . For their pain reduction effect they are used at
smaller doses. Their initial side effect is to make you sleepy and have a dry
mouth. Therefore we usually advise that these tablets are taken at night and
the treatment is started at a weekend . Full benefits are not seen for at least
three weeks.
Other Treatment
As muscle spasm is the key culprit in this
condition, physiotherapy and general relaxation classes and yoga are most
helpful.
Application of warmth to improve the circulation in the affected area is
recommended. Many patients also have a model made of their teeth. This enables
the technician to make a thin plastic cover to be worn over the teeth .
This is known as a bite raising appliance ( BRA) and is similar to a gum shield . We advise that you wear this at
night to rest your jaws.
Rarely arthroscopy is carried out. That is under
general anaesthetic the tip of a small instrument with a tiny camera lens is
introduced into the joint and any scarring reduced and the joint washed .Rarely
cases in which the joint disc is badly displaced , it may require surgery
If you suffer from facial
pain, earache and headache, consider the possibility that you are
suffering from Temporomandibular Joint
Dysfunction and see your Dentist .
Other types of pain Facial exercises
