We all encounter patients with signs and symptoms that we diagnose as a TMJ disorder. Assigning a specific diagnosis under the broad umbrella of TMJ disorders is, therefore, the next and essential step if we are to adequately educate and plan effective care for those seeking our help.
As the most common TM disorders are present due to some level of orthopedic injury to the muscles of mastication and or TM joints, there is a multitude of potential diagnoses that can be chosen. They are based upon the patient’s medical/dental profile, the history of symptom emergence, the actual symptoms, the clinical examination findings, and imaging.
One common diagnosis made by orthopedists is a joint sprain. The common definition of a joint sprain is “a stretching or tearing of ligaments – the tough bands of fibrous tissue that connect two bones together in your joints.” The temporomandibular joints can clearly suffer this fate and therefore, require evaluation and treatment.
TM Joint Sprains Occur For A Whole Host Of Reasons
Joint sprains can, of course, occur with variable levels of severity, and therefore, the chosen paths of treatment, the duration of treatment needed, and the ultimate outcomes – are different as well. Over time I have seen sprained TM joints for a whole host of reasons presenting with clear cut stories as to why this occurred, but at other times existing with a puzzling history.
Eating injuries are one of the more common histories. Not a month goes by without a patient arriving at my practice describing the moment when something slipped, popped, or shifted in one of their jaw joints while eating a toasted bagel, a crispy Flagel, a piece of fruit, a large sandwich, or some food substance that turned out to be harder than anticipated . Just about all of these events are accompanied by pain, immediate restriction of jaw movement, and only sometimes a sense of a profound bite change. Histories of traumatic yawning events, intimacy, vomiting during an illness or as part of an eating disorder, or accidental jaw impacts during sports, bicycle falls, motor vehicle accidents, and other random events are also common themes.
Sprains associated with intubations during a general anesthetic procedure are seen several times a year with a bewildering yet common denial from the medical providers that the joint compromise was not a result of the reported procedure. And sprains do occur at times as a consequence of dental and/or oral surgery procedures that required extended periods of keeping the mouth open or wide-opening efforts that compromised the restraining ligaments of the joints. From an overall perspective, however, I am actually surprised that more sprains do not occur from surgical and dental procedures. That may be a testament to the resiliency of the intraarticular structures of the TM joints.
Also, periods of aggressive tooth grinding while sleeping has been implicated by patients whose stories speak of challenging life events or uncontrollable personal struggles. On the light-hearted side of this discussion, there have been more than a few patients in my office with sprained TM joints who report restless sleep and uncontrollable tooth grinding – due to the current political environment in this country.
Treating A TM Joint Sprain
When a patient presents with a joint sprain, it is typically after a few weeks or months of self-care home remedies that have fallen short. The standard first-line therapies are dietary caution, limitation of mouth opening, ice application, and anti-inflammatory medication use by those that are prompted to do so by their PCP or general dentist. If insufficient healing has resulted, pain is usually the motivator to seek care in my office, along with distressing joint noises, locking events, or bite unevenness.
An evaluation will shed some light on the severity of the sprain with the primary goal of pain elimination. More consistent use of non-steroidal anti-inflammatory medications at higher doses or for more extended periods may be required along with oral appliance use to prevent full condylar seating for short periods. Oral steroids may also be considered, particularly if bite changes have lingered. However, in many cases, the fastest route to manage these persistent problems definitively is with an intraarticular steroid injection followed by supportive therapies inclusive of physical therapy.
As I mentioned above, pain relief is the number one goal with the knowledge that joint noises and minor bite discrepancies may remain due to structural compromises of the joint tissues. At times, the compromised ligaments cannot support a normal disc position and leads to jaw motion problems and functional pain as a residual concern. These scenarios may require an MRI and procedures such as a joint arthrocentesis or arthroscopic surgery procedure.
Recognition that TMJ sprains are common and do occur will hopefully lead to earlier intervention and more predictable treatment outcomes.