Introduction
Temporomandibular joint (TMJ) syndrome is a disorder involving the two joints (one on each side) that attach the lower jaw to the skull. These two joints open and close the mouth and are located directly in front of each of the ears. In TMJ syndrome, the area around the temporomandibular joints becomes chronically tender and inflamed. Symptoms include pain in the temporomandibular joint; popping, clicking, or grating in the temporomandibular joint while eating and drinking; a sensation of the jaw “catching” or “locking” briefly, while attempting to open or close the mouth or while chewing; difficulty opening the mouth completely; pain in the jaw; facial pain; muscle pain or spasm in the area of the temporomandibular joint; headache; ear pain; and neck and shoulder pain.
TMJ syndrome often occurs in people who have had accidents or injuries involving the jaw, but many others have had no such incident. It is believed that grinding the teeth or clenching the jaw in response to stress may trigger the condition in many cases. Other possible causes include arthritis of the temporomandibular joint, facial bone defects or disorders, and misalignments of the jaw or of the bite.
The underlying cause of TMJ syndrome is not known. In most cases, the joint appears to be healthy, suggesting that it is the soft tissue around the joint rather than the joint itself that has the problem. However, some cases of TMJ syndrome may be caused by TMJ arthritis, TMJ dislocation, or other forms of true joint injury.
Treatment of TMJ includes stress management, avoidance of certain foods that trigger discomfort (such as gum or beef jerky), and anti-inflammatory medications. The older antidepressant drug amitriptyline, taken in low doses, and the muscle relaxant cyclobenzaprine also may help.
According to a few controlled trials, some people with more severe forms of TMJ may benefit from the use of a dental appliance. On rare occasions, surgery may be necessary.
Proposed Natural Treatments
The supplement glucosamine, taken alone or with chondroitin, has shown considerable promise for the treatment of osteoarthritis. Because osteoarthritis of the temporomandibular joint can play a role in some cases of TMJ syndrome, researchers have begun to investigate the potential role of these supplements in treating the condition. Promising results were seen in a double-blind study that compared glucosamine to ibuprofen in the treatment of forty-five people with TMJ arthritis. During the three-month study, the supplement proved equal in effectiveness to the drug. However, because this study lacked a placebo group, it cannot be taken as fully reliable. Another double-blind study, this one involving glucosamine without chondroitin, did have a placebo group, but too many participants dropped out to allow meaningful conclusions to be drawn.
Electromyograph (EMG) biofeedback is a form of biofeedback therapy that involves teaching a person to gain conscious control of muscle tension. A meta-analysis (formal statistical review) of published studies suggests that EMG biofeedback might be helpful for TMJ pain. However, the reviewers noted that the evidence is incomplete and that more (and better quality) research is needed.
Similarly, while preliminary controlled trials suggest that acupuncture may be helpful for TMJ syndrome, more research is needed. A preliminary study compared traditional Chinese medicine (TCM), which incorporates acupuncture among other treatments, and naturopathic medicine (NM) with care given by clinic staffed by TMJ specialists. Researchers found that both TCM and NM provided greater benefit among 128 women. Although subjects were randomized into the different groups, the study was not blinded, and practitioners were permitted to treat each subject in any way they saw fit.
A cream made from cayenne and other hot peppers (capsaicin cream) has shown promise for many painful conditions. However, one study failed to find capsaicin cream more effective than placebo cream for TMJ syndrome. Other treatments that are sometimes recommended for TMJ, but that lack reliable scientific support, include chiropractic, massage, and prolotherapy.
Bibliography
Herman, C. R., et al. “The Effectiveness of Adding Pharmacologic Treatment with Clonazepam or Cyclobenzaprine to Patient Education and Self-Care for the Treatment of Jaw Pain upon Awakening.” Journal of Orofacial Pain 16 (2002): 64-70.
Kuttila, M., et al. “Efficiency of Occlusal Appliance Therapy in Secondary Otalgia and Temporomandibular Disorders.” Acta Odontologica Scandinavica 60 (2002): 248-254.
La Touche, R., et al. “Effectiveness of Acupuncture in the Treatment of Temporomandibular Disorders of Muscular Origin.” Journal of Alternative and Complementary Medicine 16 (2010): 107-112.
Raphael, K. G., and J. J. Marbach. “Widespread Pain and the Effectiveness of Oral Splints in Myofascial Face Pain.” Journal of the American Dental Association 132 (2001): 305-316.
Ritenbaugh, C., et al. “A Pilot Whole Systems Clinical Trial of Traditional Chinese Medicine and Naturopathic Medicine for the Treatment of Temporomandibular Disorders.” Journal of Alternative and Complementary Medicine 14 (2008): 475-487.
Smith, P., et al. “The Efficacy of Acupuncture in the Treatment of Temporomandibular Joint Myofascial Pain.” Journal of Dentistry 35 (2007): 259-267.
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