Symptoms
VARIETY - TMJ disorders can produce a wide variety of symptoms. The most common include facial pain, difficulty chewing and swallowing, limited mouth opening, unexplained (phantom) tooth pain, headaches (including common migraines), blocked eustachian tubes (stuffy ears), dizziness (vertigo), ringing or whooshing sounds in the ears (tinnitus), subjective hearing loss, and chronic neck and postural tension. All these symptoms rarely occur together in one patient, and most patients suffer from only a few of them. For example, some only experience headaches, some only experience facial pain, and some only experience ear problems. A few people also suffer from unusual visual disorders or idiopathic neurosensory disorders, like twitching or numbness, that seem connected and often respond to TMJ disorder treatment, although we don't understand the mechanisms involved. Even neurologic conditions of unknown etiology, like Tourette's syndrome and trigeminal neuralgia, are sometimes reportedly eliminated by TMJ treatment; but not by any particular type of TMJ treatment.
CHILDREN rarely suffer from serious TMJ disorder symptoms, because their extensive capacity for growth adaptation will change their facial structure to accommodate even extreme bite strain rather than allowing the strain to create tissue damage.
WOMEN - are much more commonly affected than men because of their more downward and backward facial growth pattern, which diverges from the average male facial growth pattern at puberty, when females start showing signs and symptoms of TMJ disorders. This difference in male and female adult facial growth patterns is illustrated in the file entiled CAUSES under the tab FOR DOCTORS.
ADAPTATION - eventually eliminates the acute symptoms, because TMJ disorders are self-limiting due to fibrosis of the retrodiskal (behind the disk) tissues, as described in MANAGING THE ARTHRITIC TMJ under the tab TMJ DISORDERS. This adaptation almost always succeeds by middle age. Older people may still have a bite that causes difficulty chewing (like operating a door off the hinges), chronic postural muscle tightness that includes the jaw muscles (myofascial pain), and some ear problems that have persisted from previous damage; but they are unlikely to develop persistent TMJ inflammation or acute pain unless they have an extremely strained bite or a systemic arthritic condition like rheumatoid arthritis that happens to attack the TMJs, and TMJ injuries respond quickly to simple treatment or even just time, despite the deterioration of the TMJs continuing on X-rays and MRI.
Adaptation is probably more successful in older people, because their diminished neuromuscular reactivity removes a key element from the symptom generating cycle; in which joint damage in a TMJ triggers reactive jaw muscle tightening, which causes more joint damage, which triggers more jaw muscle tightening, etc. These protective neuromuscular reflexes were designed to diminish with age, because, in the small number of our ancestors who got old, they could be triggered so frequently by the arthritic changes of normal aging that they could prevent basic function.
ACUTE TMJ PROBLEMS are usually accompanied by TMJ inflammation, which produces swelling that stretches the joint capsule and pushes the affected condyle down and away from the skull like an expanding bag of water under a table leg, thereby separating the back teeth on that side. In such cases, biting forcefully produces immediate pain, because it drives the condyle into the swollen joint capsule; and the pain can be relieved by biting forcefully on a small piece of leather, folded paper, or a wooden coffee stirrer placed between the second molars on the side of the inflammation.
JAW MUSCLE TENSION always accompanies TMJ inflammation, because muscles automatically tighten up to protect injured joints. When a TMJ is inflamed, the jaw muscles stay hypervigilant and can never fully relax. Their chronic low level tension inhibits resting circulation in their capillary beds and thereby prevents them from being able to adequately flush out their waste products. In this manner, the jaw muscle tension causes the pain, but the TMJ inflammation causes the jaw muscle tension. Treating the jaw muscles produces short term relief, because it helps flush waste products out of the capillary beds; but, if the cause of the muscle tightness is not addressed, the relief will not last.
In addition, after the jaw muscle tension has become chronic, the jaw muscles can shorten anatomically in a process known as contracture. Their diminished resting lengths then interfere with resting circulation, which can create little pockets of waste products that present clinically as trigger points - pea shaped nodes that are exquisitely sensitive to manual pressure. When compressed, they can cause pain in the teeth and at locations surprisingly far away in typical "pain referral" patterns, which can persist long after their original cause has been eliminated.
The cause of the jaw muscle tightness in most cases is the strained bite maintained by a strained facial growth pattern that persists in adulthood. The strained bite restricts the range of motion of the mandible. Patients often report feeling like they cannot find a comfortable place for their mandible, like an arm that's enclosed in a box that prevents it from fully stretching out. In most TMJ disorder patients, the teeth form the box, and the overbite prevents the bone from access to the more comfortable position. Reactions vary. In more aggressive people, the muscles become hyperactive and react to the restricted range of motion by pushing on the box in various directions to try to achieve more freedom of movement. In more passive people, the muscles react by becoming hypoactive and undergoing atrophy.
HEADACHES are very common TMJ symptoms, and a wide variety of different types of headache often respond to TMJ treatment, but there is no way to know from your particular headaches if they are caused by a TMJ disorder. The jaw muscles attach all over the sides of the head, and they can apply significant pressure to it, resulting in sinus headaches, temporal headaches, occipital headaches, or common migraines. In monkeys, biting forcefully bends the whole skull and opens the sagittal suture along the top of the head. In humans, the jaw muscles are weaker, but the skull is thinner. Chewing has been shown to increase cranial circulation, and sustained pressure from jaw muscle tightness may disrupt cranial circulation.
EAR SYMPTOMS include dizziness and disorientation, tinnitus (ear ringing), stuffiness (blocked eustachian tubes), and frequent difficulty hearing what people say (subjective hearing loss). There are two common causes of these ear symptoms in TMJ disorders, and effective treatment depends on determining which needs to be addressed in each case.
One cause is tight jaw muscles. The two little ear muscles share the same motor root as the jaw muscles, so increased jaw muscle tonus is accompanied by increased ear muscle tonus. One of the ear muscles, the tensor tympani, tightens the ear drum; and when its resting tonus is disturbed, it is not ready to hear. As a result, you often feel like you are missing things that people say, even though your hearing tests show normal results. The other ear muscle, the tensor veli palatini muscles, pulls open the eustachian tube during swallowing; and disturbing its resting tonus can prevent the tube from equalizing pressure between the middle ear and the outside air, making your ear feel blocked or stuffy.
The second cause is fluid pressure from swelling of the TMJ capsule due to inflammation. The back ends of the TMJs, where most of the tissue bruising occurs, are located only 1.5 millimeters from the front of the middle ear, and increased fluid pressure from inflammation can easily cross the thin membrane bones separating them. The vertigo in balance disorders is associated with enlargement of the endolymphatic spaces, which seems to be a sign of increased fluid pressure.
BALANCE DISORDERS - are frequently caused by TMJ inflammation, because the body's balance mechanism is located in the inner ear, just behind the TMJs. This mechanism is connected somehow with our core sense of self. When it is severely damaged, it causes dizziness and vomiting. When it is recovering or only mildly damaged, the same system can produce feelings of disorientation, inability to concentrate, a tendency to bump into things, and "spaciness".
EUSTACHIAN TUBE BLOCKAGE - The eustachian tubes pass just behind the TMJs, where increased fluid pressure from TMJ inflammation can push them closed. If a tube is held pushed closed for long enough, it may become unable to open. If it is held partially closed, it may become narrowed in the area just behind the inflamed TMJ. Subsequently any swelling of the lining of the tube from a cold or an allergy can further narrow its lumen until it becomes blocked. The upper ends of the tubes are commonly replaced surgically, but the lower ends of the tubes are the sites of the blockage.
TINNITUS - (ringing, roaring, or buzzing sounds in the ears) can be caused by a TMJ disorder a blow to the head, a drug reaction, or a loud noise. Its presentation tells us nothing about its cause. In addition, the symptom can remain long after its cause has gone. Studies have shown that TMJ treatment can relieve tinnitus in 50% of TMJ disorder patients, which would be considered a poor response rate for most disorders; but for tinnitus it is considered signficant, because there are so few effective treatments.
INDICATOR SYMPTOMS
Whatever TMJ disorder symptoms you have usually generally move together in the same direction, but not at the same speed. Whatever makes your TMJ disorder worse will make them worse, and whatever makes your TMJ disorder better will make them better, but some symptoms respond faster than others. The more rapidly responding symptoms serve as indicator symptoms - they let us know if the treatment is on track. Pain is the best indicator symptom, even mild pain such as facial soreness. The ear symptoms are the worst indicator symptoms, because their response is more irregular. Tinnitus is the most irregular. It can even get worse before it gets better.
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