Hello my wonderful TMJoiners! I’m Priya Mistry the TMJ doc and today I’m going
to talk to you about the specific signs and symptoms that come along with TMJ Disorders.
These symptoms can be really vast and varied and they can kind of just be all over the place.. and
so a lot my patients have been on a really long journey before they even get to my office. I
really wanted to make a video to clarify these different signs and symptoms, what they are,
how they come about, etcetera. By the end of the video, you should know the most common signs and
symptoms that come along with TMJ Disorders! That being said, if you’re looking for more information
on TMJD, then this is the YouTube channel for you. Be sure to hit that Subscribe button as
I post a new informational video every Friday for people who are suffering from TMJ Disorders.
For those of you who don’t know me, I’m a general dentist with a practice in Vancouver, Washington
where we are dedicated to taking care of patients with TMJ disorders. Please check
out the links below if you want to hang out with me on my other social media platforms.
I post quite frequently - especially on Instagram - about TMJ Disorders, just useful tips, trivia,
general information, so if you're looking to nerd out on TMJ information like I like to do,
please check out the links below!
So let’s get right into it! I’ll list off the most common signs and symptoms and then I'll kind of
circle back around and go over each one in more detail. So - headaches, ear pain, neck pain, jaw
pain, specific tooth pain, shoulder pain, numbness or tingling in the face or fingertips, changes
in the bite or occlusion, jaw joint noises, and episodes of the jaw actually locking or catching.
Let’s go back to the top of the list - Headaches. Headaches are the NUMBER ONE reason people walk
through my office door. And really, any type of headache - migraines, ice pick hadaches,
tension headaches, cluster headaches, hemicrania continua and more. And I’m truly NOT trying to
minimize what anybody is going through or what anybody has experienced in terms of headaches.
I'm not trying to clump them all in one category, I'm simply saying that people with all types of
headaches have come to see me. I have seen firsthand how debilitating many of these
headaches can be for my patients. Having said that, ALL headaches are mediated through the Fifth
Cranial Nerve - the Trigeminal Nerve. And if we can bring down the threshold of excitation
of that nerve, then we can bring down the severity and the frequency of those headaches.
Next up is ear-related concerns. These include ear pain - dull or sharp - vertigo, tinnitus,
hearing loss, and stuffy ears or that clogged up sensation in your ears.
So for more specific information on the ear related concerns,
I do have two videos where I delve deep into that. One is called “Tinnitus and TMJD” and the other
is called “Stuffy Ears, Vertigo, and Ear Pain Explained". I have linked both above.
So neck pain is next on the list. The neck and the jaw are intimately related,
and it makes sense because they're literally right next to each other. Many of our patients
have had neck pain for years, and they don't really realize until they come in here
that it's linked to their jaw pain, so for more information on
this, I did make a video called “Neck Pain and TMJD” which I’ve also linked above.
Jaw pain is also something we commonly see in our patients. So that jaw pain can be in the actual
masseter, kind of down here. OR it can be further up - people commonly point here or here. This
further back area is typically associated with a dysfunctional muscle called lateral pterygoid
muscle and the pain is associated with that muscle going into dysfunction. Further forward,
that pain is typically associated with the temporalis tendon insertion - where the big
fan-shaped temporalis muscle attaches to the jaw bone. That muscle is also a key player
in clenching and grinding activity, as is the lateral pterygoid muscle. So those areas can get
really flared up in people who chronically clench and grind their teeth and can be a big source of
pain. Another area that people commonly point to is right behind the angle of the jaw, and pain
here is typically associated with dysfunction of a muscle called the posterior digastric muscle
OR it's due to the damage of a specific ligament called the stylomandibular ligament. If the
stylomandibular ligament is damaged, that can be linked to a syndrome called Ernest Syndrome.
Specific tooth pain is something that we see very commonly. Many people come
in with pain that they believe is coming from a tooth and it hurts so badly,
that these people believe they need a root canal, that they have an infection and they
need a tooth extracted - when actually it's an angry, dysfunctional muscle. A muscle that's in
spasm referring pain to the tooth. The two muscles that do this most commonly are the
lateral pterygoid muscle and the deep portion of the masseter muscle. Because it feels so
much like it's coming from the tooth, thought, it can be very confusing for the patients of course,
but the practitioners as well to try tp figure out the source of the pain. So many of my patients
have had multiple root canals or multiple teeth extracted to no avail. The pain doesn't go away
after these procedures. Shoulder pain is another common symptom in many of my patients. Many have
had rotator cuff injuries which have then fed up and affected the neck and the jaw. The shoulder,
neck, and jaw are all connected so any tight or damaged or injured muscles
in the shoulder can feed up and cause tension or pain in the neck or the jaw and vice versa.
Let's move on to numbness or tingling in the face or the fingertips. So this is a symptom
I don’t hear as commonly, but I stillDO hear it. Dysfunctional muscles in the head,
neck and jaw become swollen. They become edematous and those swollen muscles can then put pressure
on the trigeminal nerve, and if pressure is put on that nerve, it can lead to that
tingly and sometimes even burning sensation in the face. With TMJ Disorders, many of the muscles of
the head, neck, and jaw can go into spasm. These spastic muscles can then pinch different nerves,
nerves that go down the arms causing the numbness or that tingling sensation in fingertips.
Let’s go on to the bite changing. The most common reason the bite actually changes is when the jaw
is locked closed, a very painful condition in during which people can't open more than
one or two finger widths. When the jaw is locked closed, the jaw bone - the whole mandible here,
this bone - actually sits a little differently than it did when the jaw is NOT locked closed.
That being said, this whole jaw bone houses all of the lower teeth, so if it's sitting in
a different orientation, it's not going to contact the upper teeth the same way
leading to the bite changing or feeling off. A less common but still possible way for the bite
to change is when the muscles of the head, neck, and jaw become so dysfunctional - so swollen,
so edematous, and so spastic - that they actually cause the mandible - this whole
jaw bone - to sit in a different orientation in three dimensional space. So again, if the jaw
bone is in a slightly different orientation - the jaw bone houses all of the lower teeth - and so
the way the lower teeth contact the upper teeth will be different, thereby changing the bite.
Now let's talk about joint noises - clicking, popping, crackling, or snapping.
Clicking and Popping are essentially the same thing in terms of what’s going on
anatomically inside the joint. Inside of our jaw joints is a little cartilaginous disc called the
articular disc. When that disc comes in and out of alignment, it will click and it will pop as
this animation shows. The animation shows the disc in blue. What a lot of people don't know is that
the disc is actually out of alignment when we are closed. So you can see in this animation, they're
closed and the disc is too far forward. It should be further back, between the bony components of
the joints. When we go to open, we can get back on the disc - we can recapture the disc. CLICK.
And then when we go to close, we get back off of it with a reciprocal click or pop. Each time
the disc comes in and out of alignment, it can be felt, or heard, or both. Crackling noises are due
to compression of that same disc within the joint. Crackling noises usually indicate a more advanced
stage of degeneration within the joint and those crackling noises typically start after many many
years of chronic clenching and grinding activity which compresses that disc even more. People don’t
present with the snapping noise as commonly as they do with the clicking, popping, or crackling
noises. The snapping is usually just a one time incident. So typically somebody will say, "I was
yawning" or "[I was] biting into a big sandwich" or, "I just bit at an awkward angle and I heard a
loud SNAP!". And that snap is typically followed by pain. It can also be followed by clicking or
popping that was not there before or even the jaw locking. What that one time snap usually indicates
is straining or overstretching of a ligament inside the joint and those ligaments hold the disc
in alignment. So if that ligament is strained or snapped or stretched, that disc can get in
and out of alignment leading to sudden clicking and popping that may not have been there before.
Next and last is episodes of the jaw locking or catching. When the jaw locks closed,
what happens is that little disc of cartilaginous tissue becomes displaced but it's not able
to get back in alignment. So it's too far forward, but when the patient goes to open,
it doesn't get back in alignment. It just stays there, as a barrier to opening.
So this is a condition during which the patient can't open more than one or two fingerwidths
and it's usually pretty painful. It's also the most difficult to treat successfully.
This animation shows the little disc too far forward, and when the patient goes to open,
they can't get back on it so it's serving as a barrier to opening and it's pretty painful.
So there you have it my friends. These are the most common signs and symptoms
associated with TMJ Disorders. Sometimes people will present with ear pain, vertigo, and jaw pain.
But the jaw pain is mild, so they focus on the first two. With the ear pain and the vertigo,
these people will go to their Primary Care Physician and then their ENT,
trying to figure out what's going on. Other people will present with only specific tooth pain, but
it's really severe. These people of course will go to their dentist, endodontist, oral surgeon trying
to figure it all out. They're thinking they need a root canal or a tooth extracted when it’s actually
a muscle referring pain to the tooth. Still other patients will suffer from only headaches,
but these headaches are debilitating. They have no other symptoms - it's just the headaches.
These patients will go on quite the journey with their neurologists trying to find the source
of the headaches or a successful treatment, often involving oral medications and Botox.
I can’t tell you the number of patients that make it to my office only AFTER seeing ENTs, multiple
dentists, physical therapists, neurologists, or having multiple teeth root canaled or extracted,
only to realize it was TMJD all this time. So this is the reason I made this video - it's to
bring awareness to the wide variety of signs and symptoms that can present with TMJ Disorders. And
these signs and symptoms can present with just a few or people can have kind of all of them.
And I've just seen everything across the board so I want to make you all very aware of that.
So that’s really it my friends. If you like what you heard or learned something new,
click “Like” below, Subscribe to my channel. As always, questions and comments are always welcome.
I try my best to answer them all. And remember, my friends, you can never have TMI about TMJ!