Less Is Best When Treating TMJ Disorder

January 1, 2015

EDITOR’S NOTE: This article uses research from several resources including the National Institute of Dental and Craniofacial Research at the National Institutes of Health (www.nidcr.nih.gov). The AFM urges musicians to seek professional medical advice when dealing with health issues.

If you are a musician suffering from temporomandibular joint (TMJ) pain and/or dysfunction you are not alone. One study showed that 75% of the population experiences one or more TMJ disorder symptom in their lifetime and those numbers are even higher among musicians.

The TMJ connects the lower jaw, called the mandible, to the temporal bone at the side of the head. If you place your fingers just in front of your ears and open your mouth you will feel the joints. These joints are flexible, allowing the jaw to move smoothly up and down and side to side for speech, singing, chewing, and yawning.

When the mouth is open, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. They slide back to their original position when the mouth is closed. A soft disc lies between the condyle and the temporal bone to absorb shock. This combination of hinge and sliding motions makes the TMJ among the most complex joints in the body.

There are three basic types of TMJ disorders—myofacial pain (discomfort in the muscles that control jaw function), internal derangement of the joint (displaced disc, dislocated jaw, or condyle injury), and arthritis. You may suffer from more than one of these conditions at the same time.

Any musician could be affected by TMJ disorders, but violists, violinists, wind instrumentalists, and singers, seem to be more susceptible due to the stress they put on the TMJ. Other musicians may develop TMJ disorder because of poor posture or anxiety, especially if they tend to clench their jaw or grind their teeth at night. Other causes of TMJ disorder include arthritis, jaw injury, or muscle fatigue.

There is a wide range of TMJ disorder symptoms, which include radiating pain in the face, jaw, or neck; jaw stiffness; limited jaw movement or locking jaw; painful clicking or popping when opening and closing the jaw; or a change in the way the upper and lower teeth fit together. Some of these symptoms overlap with those of other conditions, such as sinus and ear infections or toothache, making TMJ difficult to diagnose. A health care provider may use X-rays or MRI images, in combination with medical and dental history, for proper diagnosis.

There is no certified medical TMJ specialty, so finding the right care can be difficult. Look for a health care provider who understands musculoskeletal disorders (affecting muscle, bone, and joints) and who is trained in treating pain conditions and able to understand your special needs and stresses as a performing musician. Performance Arts Clinics are often a good source of advice, particularly when pain continues over time and interferes with your career.

Complex cases, marked by prolonged, persistent, and severe pain; jaw dysfunction; coexisting conditions; and diminished ability to work, may require a team of experts from various fields, such as neurology, rheumatology, pain management, and others, for diagnosis and treatment.

For most people, TMJ problems will go away on their own. So, it is best to start with conservative treatments. Patients may be advised to make it a habit to take frequent breaks while rehearsing, relax facial and jaw muscles frequently during the day, avoid chewing hard foods and gum, apply ice packs, avoid extreme jaw movements (for example, yawning or loud singing), and learn relaxation techniques.

Even for persistent TMJ, most people do not require aggressive treatment. Short-term use of over-the-counter pain medicines or nonsteroidal anti-inflammatory drugs (NSAIDS), may provide temporary relief. When necessary, your physician can prescribe stronger medications to ease the symptoms.

Your doctor or dentist may recommend a stabilization splint or bite guard, especially if nighttime teeth grinding is suspected. These plastic guards fit over the upper or lower teeth and should only be used for a short period of time and should not cause pain.

Other irreversible treatments, such as orthodontics to change the bite, surgery, and implants are controversial and should be avoided. If your doctor recommends them, be sure to seek a second opinion.

For more information on TMJ disorders and support visit the TMJ Association website (www.tmj.org).