The temporomandibular joint (TMJ) is the joint located infront of the ears on either side of the face and connects the mandible to the skull bones.It is one of the most complicated joint of the human body ,providing not only rotational but also translational movements. These characteristics allow the mouth to open wide and move the jaw forward and towards right and left. There is a disc cartilage between mandible and skull bone similar to that of bones in neck and back.This disc serves as a shock absorber , protecting the bones from friction and injury. Also there are several muscles and ligaments which are attached to TMJ and these ligaments and disc are enclosed in a capsule.All these structures play an important role in maintaining the joint in healthy state.Any condition that affects the joint is known as Temporomandibular joint disorders (TMD).
 

Symptoms of TMD
1.Headache
2.Teeth that do not meet properly
3.Dizziness
4.Difficulty in chewing and swallowing
5.Ringing and stiffness in the ear
6.Pain or pressure behind the eyes
7.Shoulder stiffness
8. Facial pain
9. Restricted mouth opening
10.jaw clicking (noise  while opening and closing) pain
11.jaw going to one side while opening
12.Neck pain
13.Tingling and numbness in arms
14. Teeth sensitive to cold

WHAT CAN CAUSE TMD??
1.Trauma to the joint
2. Cartilage wear and tear
3.Dislocated disc
4.Clenching and grinding
5.Arthritis
6.Myofascial dysfunction
7.Road traffic accident.

TMJ pain or disorders are difficult to diagnose and treat which is why one should visit a dental surgeon who ha s been specially trained to treat these disorders.

When treating TMD patients one should have a thorough knowledge of TMJ , if not diagnosed properly the patients symptoms can worsen and things might get complicated because of wrong diagnosis.

EAR SYMPTOMS and TMJ..?

• Pain in ear
• Ringing in ear
• Dizziness/balance issue
• Clicking,piping noise in front of the ear
• Ear pressure and feeling of fullness
• jaw shifts to one side while opening
• Sore and tender muscles around the joint

If above symptoms are there then TMD could be one of the reason for the same.

 MANAGEMENT OF TMD THROUGH PHYSIOTHERAPY
The muscles of shoulder and neck are connected to the jaw and any stiffness or misalignment in these areas can potentially directly affect the functions of the jaw. For this reason physical therapy in association with dental treatment may be suggested for improving TMJ discomfort.
Physical therapy(PT) for TMJ improves overall  posture and joint mobility, decreases muscle tension and optimises neck and jaw functions.
A thorough examination of the area will help us to evaluate which muscle is involved and accordingly PT can be planned.
The aim of PT is to

• Increase joint mobility
• Strengthen and stabilize the new position of TMJ
• Strengthen upper back and neck
• Correct postural alignment
• Reduce forward head posture.

MYOFASCIAL PAIN
It refers to a musculoskeletal condition in which a single muscle or a group of muscles become painful.
It is a chronic condition that may vary in severity,location and duration.
Generally pressure on certain points on the muscles are known as TRIGGER POINTS and can cause or recreate the  muscle pain. 
Sometimes pressure on triggers points may also cause pain in other areas of the body , a phenomenon known as referred pain.

WHAT CAUSES MYOFASCIAL PAIN ?

• Constant muscle use of fatigue
•  Repetitive muscle motions
• Muscle injury
• Stress and anxiety.

HOW IS MYOFASCIAL PAIN TREATED?
A detailed histroy and examination of the area is required to locate the muscle or group of muscles involved , location, trigger points.
Also blood tests are required to known any underlying systemic cause  for the same eg anaemia, vitamin deficiencies, calcium deficiencies and any auto immune disorder . This will help in treatment of other conditions which trigger the MYOFASCIAL PAIN
General Treatment Modality:

• Trigger point injections
• Physical Therapy
• Muscle Relaxants
• Acupuncture
• Massage Therapy.

NON DENTAL TOOTH ACHES
Some people experience persistent tooth aches without having any apparent dental problems to explain the pain, such as a cracked tooth or tooth decay.
Non dental toothaches have an underlying cause which is usually difficult to detect.
To determine the cause of such pain following need to be considered:

•  Periodontal ligament pain
• Salivary gland dysfunction
• Referred muscle pain
• Psycological disturbances
• Trigeminal Neuralgia
• Neoplasm/ lesions of the head
• Neuropathic  pain
• Sinus/Nasal toothache
• Referred headache pains
• Cardiac toothache

Patients may visit to dentist or medical specialist in search  for a solution  and often go through Root canal treatment, extractions  and other procedures which are not required because the pain is not of dental origin. Regardless of the fact that the patient is having toothache making the cause difficult to identify and puzzling for the dentist and the patient.

WHAT PATIENTS EXPERIENCE
The pain from a toothache of non dental origin may present itself in different ways and varies from patient to patient.
The pain may range from 

• low grade to throbbing, sharp shooting pain
• Comes and goes or may be present all the time
• Felt in the teeth or in the surrounding areas
• localized pain or migrating pain
• persists for weeks or even years.

A thorough knowledge, proper examination , histroy will help in diagnosing and treating such non dental toothaches. It is essential to visit a knowledgeable  Oro fascial pain dentist.