In The Wizard of Oz, Dorothy and the Scarecrow discover a Tin Man who's rusted solid. After a few moments of squeaking gibberish, they realize he's asking them to apply oil to the hinge connecting his jaw and head. Dorothy applies the oil, the joint loosens, and he can comfortably speak.
Clinically speaking, the Tin Man was actually suffering from a syndrome of the temporomandibular joint, or TMJ. It was his TMJ that was rusted shut. Unfortunately, for people suffering from TMJ pain, the treatment isn't as simple as adding a little oil.
What is TMJ?
The TMJ is a ball and socket hinge located at the back of the jaw. A bony bump at the front of the socket called the articular eminence (AE) prevents the jaw from slipping out of place.
"For most of us, the jaw can slip back and forth without any issue,"says Eric Granquist, DMD, MD, director of the Center for Temporomandibular Joint Disease. "But in some people, this bony bump is low enough to allow the jaw to slip forward, but is just high enough to prevent it from slipping back into place. This makes it very painful – or impossible – for a person to voluntarily shut their mouth."
This type of TMJ is considered acute. The jaw may slip back onto place on its own, but may require the jaw to be manually pushed back into place by a physician in an emergency room.
The chronic form of TMJ, which isn't as common, is much more serious.
"The concern with chronic TMJ dislocation is that eventually the tendons, muscles, cartilage and the AE become damaged, leading to arthritis, nerve damage and possibly, permanent dislocation," says Dr. Granquist.
People with chronic TMJ dislocation are probably predisposed to the condition. "Something in the anatomy of the joint or its surrounding bones makes it much more likely to slip out of place," says Dr. Granquist. "It's a very painful and embarrassing condition, and over time, it can cause permanent damage to the TMJ."
The TMJ sits right behind a major nerve in the face, which is at the center of a network of nerves that cross and connect throughout the face, head and neck. So when the TMJ is affected, pain can spread throughout the eyes, ears, mouth, forehead, cheeks, tongue, teeth and throat. Even the muscles of the neck and upper back can become involved.
Minor TMJ discomfort will usually go away without treatment. However, anyone with the following TMJ symptoms should consider an evaluation to prevent or avoid future issues:
- Constant or repeated episodes of pain or tenderness at the TMJ or in and around the ear
- Discomfort or pain while chewing
- "Locking" of the joint in either the open or closed position
- Chronic pain in other parts of the face lacking an obvious cause
- A clicking or grinding noise when the jaw is opened or during chewing accompanied by discomfort or limitation of movement
Diagnosis and Treatment for TMJ Disorders
Treatment for TMJ disorders starts where the pain starts.
"Once we know what's causing the pain, we can treat it," Dr. Granquist says. In addition to in-office evaluations, diagnostic tools include Panorex (an x-ray that encircles the jaws), CT scan and MRI.
Many milder forms of TMJ discomfort can be treated with a combination of medications for inflammation and pain (such as NSAIDs) and non-medical therapies.
"Sometimes, the issue can be as simple as stress causing jaw clenching or grinding of the teeth," Dr Granquist says. "Many of these patients can be helped by night guards, cold or hot therapy, and relaxation techniques."
People who have rare acute TMJ dislocations that correct themselves also have little to worry about. "But these events can serve as a warning of trouble down the road," Dr. Granquist says, and should be discussed with a primary care physician.
For patients with severe and chronic TMJ, the Penn TMJ Center offers a number of surgical approaches.
"Most patients won't need TMJ surgery," Dr. Granquist explains. "But for the few that do, it can have a profound benefit for quality of life."
The Tin Man couldn't have said it better.