Pain Near the Ear - All About the TMJ — MY DENTAL FRIEND

Pain in the side of the face while

opening the mouth or pain in front of

the ear to the touch. These are just

some of the signs of TMJ problems. I’ll

explain what TMJ pain is and what can

be done.

Signs of TMJ problems

Pain just in front of your ear, or even in the ear when opening and closing the mouth or when chewing. Pain from pressing lightly on the skin just in front of the ear hurts while opening or closing the mouth. Also there is pain if a finger is placed in the ear while opening and closing.
There is a sound of clicking and popping near the ear when opening and closing the mouth.
Occasionally the jaw ‘locks’ open, particularly when yawning and it is difficult to close again. Perhaps you are experiencing difficulty in opening your mouth and you feel pain when you try to open further.
Just what is the TMJ?
It is the connection between the jaw and the head.
Where is the TMJ?
It is just in front of the ears. The TMJ is, in fact, a very delicate area and is prone to slipping out of place, meaning that the jaw and skull are no longer properly connected.
What is the most common cause of TMJ pain?
It usually results from anxiety. When suffering from stress, individuals tend to clench and grind their teeth tightly together in their sleep, often without even realizing it. Grinding of the teeth, called bruxing, causes inflammation in the space between the jaw and the head in front of the ear. That begins what is known was TMJ pain.
There is no specific medication
No medication is approved by the FDA (Food and Drug Administration) for TMJ problems, however, muscle relaxants, anti-depressants, and anxiolytics (to reduce anxiety) are commonly prescribed. Diazepam (Valium) is one such medication frequently prescribed in dental offices.

How does a dentist diagnose a TMJ problem?

The initial diagnosis is almost always made by a simple clinical exam. A patient has pain to the touch in front of the ears. The patient feels a ‘tired’ jaw and may have clicking sounds in the ear when opening and closing. On the rare occasion when it is necessary to investigate further, an MRI (magnetic resonance - a type of picture of the TMJ) might be ordered. The MRI is the ‘gold standard’ for diagnosing TMJ dysfunction. It gives a view of both hard and soft tissue (such as ligament) and helps to visualize changes in the shape of the TMJ due to stress (clenching of the jaws), and inflammation.

How often do dentists see TMJ patients in the office?

How often do these symptoms arise in adults? In one major study that reviewed over one thousand patients, sixteen years of age and older, it was found that approximately 20 percent had symptoms of TMJ. Interestingly the study also showed that a clicking sound by the ear was the most frequent symptom that caused patients to go to the dentist.

Two common treatments that have been shown to produce results include a plastic removable tray that fits over your teeth and is worn at night (a ‘night guard’ or ‘splint’) and physiotherapy:

**A ‘night guard’ or ‘splint’. For most mild TMJ cases, these plastic trays, worn at night, are very effective.**

The night guard is a plastic piece fitted over the teeth. It simply rests on your teeth and provides a constant reminder to stop clenching and grinding your teeth at night while sleeping. Stress related clenching of teeth is the most common reason for TMJ damage and pain. The night guard, made of either soft or hard plastic, is a subconscious reminder to not clench the teeth in your sleep.
My experience is that a great percentage of patients find quick relief from TMJ pain, and less stress in the muscles of the face after wearing a night guard for just a few weeks.
Physiotherapy includes massage, manipulation of the mouth and joint, and use of heat and cold. These techniques can be used along with a night guard.
Other techniques such as injection of corticosteroids or hyaluronic acid into the joint are believed to be effective, however, further studies need to be done before these techniques become mainstream.
It should be emphasized that the more conservative approaches, such as a night guard, should always be attempted first.

When surgery is needed:

For severe cases that are not resolved by simple treatments, more invasive surgeries might be needed.

Arthroscopic surgery: A small hole is made above the TMJ, (near the ear). A tube called a cannula is inserted, and through this tube tiny instruments will clean out scar tissue.
Open joint surgery: Through an incision, the joint can be visualized and scar tissue and bony pieces can be removed.

What is the key thought for you to take away about TMJ problems?

It is mostly a condition of emotional stress. We all feel stress in our lives and we all have challenges. The trick is to find a way to reduce this stress. Check out the section on anxiety in this My Dental Friend website. Relaxation means less stress in the joint and a reduced chance that you will ever need TMJ treatments.

Pain Near the Ear - All About the TMJ