A woman in her early 40's came to me with a complaint of pain and soreness in front of her ears and near the temples every morning. She said that it felt like a dull headache, which would disappear as the day progressed. On further case taking it became apparent that she was under a great deal of tension. Her husband had observed that lately she has been grinding her teeth in her sleep. This grinding is medically known as Bruxism. I diagnosed her as suffering from Temporomandibular joint disorder or TMJ.

WHERE IS YOUR TEMPOROMANDIBULAR JOINT LOCATED?

Your TMJ is located in the area right in front of your ears on either side. This is where the upper jaw and lower jaw meet. It is a hinge joint with a small disc of cartilage separating the two bony surfaces which prevents one bone from rubbing against the other. We use this joint numerous times a day for chewing food, yawning, talking, biting. There are a number of muscles, tendons involved in these movements and together with the joint it enables us to perform all these tasks. Normally all these components are functioning well and there is no pain but if you are experiencing discomfort, pain, headaches, clicking sounds, or locked jaw then you have TMJ disorder.

WHAT ARE THE CAUSES OF TMJ DISORDERS?

There are many different causes for developing a TMJ disorder. Here are a few of the common ones.

1. BRUXISM - teeth clenching or grinding subconsciously causes a wear and tear on the disc of cartilage between the two bony surfaces. Usually the person is completely unaware of this and is noticed by someone else. Sometimes the only way it is found out is when your dentist notices the wear and tear effect on the teeth. Grinding of teeth or jaw clenching is a sign of tension and anxiety leading to overuse of the muscles. Myofascial Pain Syndrome is caused by nocturnal bruxism. In Homoeopathy we have a special remedy known as Chamomilla which helps in such cases of Bruxism especially when the child is highly irritable and clenches his teeth subconciously giving rise to pain which he cannot bear.

2. TRAUMA OR INJURY TO THE TMJ - if there is any history of fracture or trauma to the TMJ then this can cause immobility or limitation in movements. For such traumatic injuries Arnica would help the patient a great deal.

3. DENTAL PROBLEMS - people who have a misalignment of teeth suffer from TMJ problems. If the person experiences difficulty in finding a comfortable bite or the way the teeth fit together then they should get a dental check up. Sometimes chewing excessively only on one side of the jaw can cause TMJ disorder.

4. ARTHRITIS - various different types of arthritis can affect the TM joint. Infectious arthritis is not very common but can occur when a blood borne infection localizes in the joint or it can happen as a direct extension of an adjacent infection. The area gets inflamed, there is tenderness, and restriction of movement. Traumatic arthritis can set in after an injury or fracture of the TMJ. Osteoarthritis can affect the TMJ too. It is usually seen in older people. They complaint of stiffness, mild pain while eating, cracking sounds. This is all due to wear and tear of the joint and its cartilage. Rheumatoid arthritis of the TMJ is encountered in adults and children who are suffering from RA in more than 50% of the cases. Pain, swelling, inflammation are the common findings.

5. HABITUAL GUM CHEWING OR NAIL BITING

6. OCCUPATIONAL HAZARDS - telephone operators use to suffer from this earlier as they had the habit of holding the phone between the head and shoulder.

WHAT ARE THE SIGNS AND SYMPTOMS OF A TMJ DISORDER?

The signs and symptoms depend on the cause of the problem but there are a few which are common to almost all the causes.

1. Tenderness of your jaw muscles. There may be soreness when you wake up in the morning or after movement of the jaw.
2. Headache is one of the most common complaints experienced. Facial pain is another. Moving the joint while opening and closing the jaw causes pain. Facial pain can also be aggravated by cold weather or the draft of the air condition as this causes the muscle to contract.
3. A clicking, crunching, popping or grinding sound is a symptom of TMJ disorder which a lot of people experience.
4. If Ear pain is present inspite of there being no infection in the ears or sinuses then TMJ should be strongly suspected especially if the pain is situated in front the ear.
5. Limitation of movement and locking of the jaw occur in some TMJ disorders. This makes it difficult to open and close the mouth while eating, talking, yawning.
6. Some patients do complaint of dizziness though this is not very common with TMJ disorders. The dizziness is vague and there is a slight sense of imbalance. It is very different from the dizziness felt in vertigo.

WHAT IS THE TREATMENT FOR TMJ DISORDERS?

Treatment is usually determined by the cause of the problem. Along with medication there are a number of ways in which the person can take care of her or his TMJ. Here are a few self-care tips given below.

a. Stress is one of the main risk factors for developing TMJ. It causes excessive grinding of the teeth and the person is not even aware as it is usually present during sleep. Women seem to suffer from this more than men and especially during their early 20's or during perimenopause. Dealing with this stress, tension or anxiety is essential. You can effectively cope with stress by doing simple things like deep breathing, meditation, Yoga, relaxation of the muscles by certain exercises, dancing, playing sports, art etc…

b. Taking care of what you eat is essential. Stay away from hard, chewy, crunchy food. No chewing gum or eating hard sweets and chocolates. Raw vegetables like carrots, radish, cucumber, fruits like apple, pear all should be either chopped or grated and eaten.

c. Ask your dentist to check your bite and give you something called a Biteplate (also called a splint). This is needed if your jaws are wrongly aligned.

d. If you are in the habit of grinding your teeth at night you should get a little device known as a night guard. You have to insert it over your teeth so that they are protected from wear and tear.

e. When the pain is acute then ICE therapy will give tremendous relief. The ice helps to reduce the inflammation and pain. Sometimes doctors advise alternate Ice and Heat therapy as it helps to reduce the muscle tension and spasm.

HOMOEOPATHIC TREATMENT

As a homoeopathic physician we always first try to ascertain what is the cause of the symptoms that the patient is suffering from. Is it just mechanical like an injury or chewing gum continuously or is there a deep seated underlying cause. The patient's personality and nature are extremely important, is she the anxious, nervous kind who gets tense easily which causes the grinding at night. Here are a few remedies which have given great results in TMJ disorders.

BELLADONNA

A 40 year old woman came to me complaining of severe throbbing headaches. She felt as if someone was hammering her head and could not bear to be touched. Even the slightest noise brings on the terrible pain. Her husband added that her nature had changed drastically. She was normally a very jovial, happy person but now extremely irritable and even violent sometimes.
Another point he made was that she had started grinding her teeth at night which she was not aware of. On further case taking she told me that she was going through lot of stress and emotional problems. This was the cause of the grinding of teeth leading to terrible headaches.
She was only better by pressure and sitting semi-erect. Eating or chewing is painful and worsens the pain.

This woman's symptoms matched those of Belladonna and she was given Belladonna 200, 5 pills four times a day which gave her tremendous physical and mental relief.

HECLA LAVA

This remedy works wonders on the affections of the Jaws especially if the problem is caused by an injury to the bone. Hecla lava also is a remedy for necrosis and caries of the jaw bone. The TMJ area is very sensitive and painful. The Hecla lava patient will not allow the area to be touched.
There is normally a swelling along with the pain. Hecla lava is also extremely useful in abscesses of the gums, gum boils, toothache.

5 pills of Hecla Lava 200, fours times a day will give great relief.

RHUSTOX

Rhustox has a great affinity for affections of all joints in the body including the temporomandibular joint. All the pains are worse at night-time. The patient complaints of severe tearing, shooting pains which are worse from touch. The first movement of the joint is especially painful but the pain gradually reduces on subsequent movement.
There is also a cracking sound on chewing or moving the jaws. These patients are affected by cold, wet weather and drafts of air.
They get relief by heat and rubbing the area. Rhustox is one of the remedies for different types of arthritis and other affections of the bones, tendons, ligaments and joints.

Rhustox 200, 5 pills four times a day should be given to cure the patient.

CINA

A mother brought her 5 year old boy to me saying that her son was complaining of headaches especially after getting up in the morning. At first she thought it was an excuse to miss school but even on holidays he would say the same thing. She also added that he constantly itches his anus and picks at his nose. The boy was cranky and constantly tugging at his mother to carry him. When asked about his appetite the mother said he ate very well and was constantly hungry though he had not put on too much weight. This child was suffering from worms which causes grinding of the teeth in some people.

I prescribed Cina 200, 5 pills four times a day and also advised the mother about hygiene, boiling water and not to give raw uncooked food to the child.