JAW PAIN and Osteopathic Manipulative Treatment

FAMILY MEDICINE® COLUMN
By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER’S JAW PAIN CAN PROBABLY BE TREATED WITHOUT SURGERY

Question: A few weeks ago I began having pain in my left ear. I thought it was an ear infection, and I went to the doctor. He said I had a TMJ disorder. Could you tell me what causes this and what I can do to get better? My doctor is sending me to an oral surgeon. Will I need surgery?

Answer: Temporomandibular joint (TMJ) syndrome is a painful condition that causes inflammation in the joint created by the temporal bone in the skull and the lower jaw bone (or mandible). As you can see, the term “temporomandibular” comes from combining “temporal” and “mandible” to make an adjective. Therefore, the abbreviation "TMJ" literally refers to the joint itself, although it is often used to refer to the disorder rather than the joint.

There are many things that can cause this problem. Teeth that don’t align properly -- “malocclusion” in medical lingo -- is a very common cause. Some people grind their teeth -- a condition called bruxism. This usually occurs at night and can lead to pain in the TMJ. Injury to the jaw or the side of the head can also cause TMJ syndrome. And, you can get arthritis in the TMJ, just like any other joint in the body.

The primary symptom is pain with opening and closing the mouth. This pain is usually worse in the morning and is just in front of the ear. This pain can radiate to the ear, cheek, neck or shoulder. Some people also complain that their jaw catches when they open their mouth. Some people have a grating or clicking sound in their TMJ when they eat.

Your doctor probably made the diagnosis of TMJ syndrome by feeling this joint with his fingers while you opened and closed your mouth. This is a technique we call palpation. He may have felt clicking or deviation of the jaw to one side when you opened your mouth. Also, he may have noted that you couldn’t open your mouth as wide as normal. You may have indicated that you felt pain when he applied slight pressure as he palpated the joint. And, depending on the results of this physical examination, he may have asked for an X-ray or MRI to aid in the diagnosis of your condition.

In most cases, TMJ syndrome can be treated with dietary modifications to eliminate very chewy foods, gum chewing and ice eating. Non-steroidal antiinflammatory drugs (NSAIDs) like ibuprofen are also very helpful as is moist heat to the area a couple of times a day for 10-15 minutes. Some people who grind their teeth or have pronounced malocclusion benefit from a dental appliance that prevents the jaw from closing completely. This has been shown to relieve the symptoms in over 70 percent of patients with TMJ problems. Some cases of TMJ syndrome respond very well to osteopathic manipulative treatment; so, if your physician is a D.O., you might ask if this manual medicine technique might be effective in your case. Fortunately, the odds are you probably won’t need surgery. Statistically, the need for this is rare; it is indicated in less than 5 percent of cases.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.