Help for TMJ Disorder

Get TMJ (Temporomandibular Joint) Support

Anti-defamation leagues have difficulty gaining attention these days. That's probably because they overdid it and the public grew tired of the pitches: "we're a minority" ... "we've been abused" ... "we demand special treatment" ... "and consideration" ... "and compensation." Every untenable group, many with less substance, sought the limelight. Many received it. Many who didn't deserve any attention flaunted their concerns in the gazettes and on the telly.

No Laughing Matter 
But if anti-defamation leagues were still in vogue, there would probably be one for temporomandibular joint disorder (TMJD). This syndrome leaves its hapless victims struggling with something as simple as opening and closing their jaws without pain and/or clicking noises. Sometimes they need to suffer wearing a splint or even a harness. They have to put up with the indignities of uncontrollable clicks, pops and grating noises when they try to eat a meal or perhaps when they talk. There are many stories about clicking TMJD sufferers who have been asked to leave the restaurant so as to discontinue disturbing the other diners. Is it right for society to insult, belittle and ostracize them when they go out in public or venture into a restaurant? It's no laughing matter! Jaw pride ... No more apologies ... Out with our splints and up with our clicks!

Do You Have TMJ Disorder? 
Seriously, nearly 10 million Americans are agonized by this syndrome, a principal part of which can be a degenerative osteoarthritis of the temporomandibular joint. Every day, you use it countless numbers of times. It is where the lower jaw (mandible) joins the temporal bone, just in front of the ears on each side of your head. Every time you talk, swallow, bite or chew, you move it. Its importance is stressed by the fact that it is one of the most-used joints in your body.

Technically, TMJD is a syndrome that involves muscle as well as bone. TMJD can develop for many reasons. It's possible that you may be tightening your jaw muscles, stressing your TMJ, or even clenching or grinding your teeth. Previous injuries can also cause TMJ problems. TMJD can be a clinical manifestation of osteoarthritis or rheumatoid arthritis. Consequences can include pain, a misaligned bite, and clicking or rubbing noises when you open your mouth, among other dysfunctional and aggravating symptoms. You may even have trouble opening your mouth. Here's a check list to assess whether you may have TMJ syndrome:

  • Do you have chronic headaches or experience pain about the jaw, behind the eyes, in the ears, or even down the neck into the shoulders?
  • Do you have pain when chewing or biting?
  • Is it difficult or painful to open your mouth or yawn?
  • Does your jaw click, pop, grate, catch, or lock when you open your mouth?
  • Do you grind or clench your teeth?
  • Do you have pain when you clench your teeth?
  • Does stress make your clenching and pain worse?
  • Are your teeth sensitive, loose, broken or worn?
  • Do your teeth no longer touch when you bite?
  • Do your teeth meet differently from time to time?
  • Is it hard to use your front teeth to bite or tear food?
  • Any history of injuries of the neck, head or jaws?
  • Do you have problems (such as arthritis) with other joints?
If your answer is "yes" to several of these, the chances are good that you suffer from TMJ syndrome, a principal part of which can be associated with degenerative osteoarthritis of the temporomandibular joint. You'll be glad to know that there is a growing understanding of what can be done about it and one of the primary routes to resolving the problem is the right kind of supplementation. For a problem that's estimated to cost upwards to $30 billion per year and that wastes the equivalent of 550 million total days of labor, it's surprising that solutions have not been more forthcoming. Not surprisingly, many people are driven by their family members to seek remedies because they are the most bothered by the TMJ noises.

Fifty subjects (ages 16-80 with a median age of 41 years) of which 4 were males and 46 females participated in the study. All had various temporomandibular disorders and were given glucosamine hydrochloride (1,600 mg twice daily) and a mixture of chondroitin sulfate-4 and chondroitin sulfate-6 (1,200 mg twice daily) along with ascorbic acid (1,000 mg twice daily) as calcium ascorbate (buffered vitamin C). They were instructed to take all three supplements together and at approximately the same time each day. To be selected for this study, the subjects had to meet certain criteria:New Studies on Glucosamine and Chondroitin for TMJ Disorder 

Recent studies are reporting that the problems of TMJD stem from internal derangements resulting from various causes, but not uncommonly from osteoarthritis. TMJD from this cause can be addressed with chondroitin and glucosamine.1 These two nutrients have been used for years in veterinarian medicine to treat symptoms of animal osteoarthritis. It hasn't taken long for human beings to discover the benefits for themselves. And recently, the use of glucosamine and chondroitin sulfates has been applied to other forms of arthritis. Noticing these benefits after the administration of therapeutic doses of these supplements has sparked an interest in their possible use in the treatment of TMJD. Especially encouraging have been reports of decreased joint noises, lessened pain and reduced swelling for arthritis of the jaw. The first study to tackle the problem of TMJD head-on, is a very recent publication.2 As its author, Wesley Shankland, DDS, MS, PhD admits, the research is not rigorously conducted, and will not pass muster at a refereed journal. However, the supplements that his study investigates are well researched for other osteoarthritic uses [see Chondroitin & Glucosamine: New Forms Stand Up to Arthritis - May 99]. Plus, the side effects are very few and innocuous.

  • Be new to TMJD therapy
  • Be diagnosed before the study began with either osteoarthritis or arthrosis (degenerative joint disorder)
  • Able to produce objective, audible sounds in one or both temporomandibular joints
  • Confirmed to have temporomandibular joints alterations or changes
  • To have reported joint swelling, warmth, and pain, especially after vigorous use of the temporomandibular joints
  • To have reported audible joint noise with mandibular movement
  • Not using any prescription anti-inflammatory medications at the time of the examination
Once the study began, the subjects were instructed not to take any other prescribed medication for pain management or joint inflammation, except for over-the-counter ibuprofen or aspirin. These could only be taken when their symptoms of joint pain and swelling interfered noticeably with their daily routines and activities.

All other therapies including physiotherapy in the form of ultrasound, EGS, iontophoresis or phonophoresis were prohibited. While several of the patients used the services of a chiropractic physician, temporomandibular joint manipulation was not allowed.

Over the course of the study (which lasted three months), the subjects were re-evaluated every two to three weeks when they were asked to quantify their TMJ noise by using the descriptors: "Same," "Improved," or "Better." There was no coaching nor were the subjects reminded of their initial or subsequent responses.

At the conclusion, 80% reported a decrease in TMJ noises with an associated decrease in joint pain and swelling. Of  the 40 subjects reporting a decrease in joint noises, several also reported decreases in TMJ pain and swelling, and also in other joints (mainly knees, hips and sacroiliac joints).

Typically, they said that they also "felt better" or "significantly better."

Decrease joint pain and swellingBenefits of Using Chondroitin and Glucosamine Together 
All joints, including the temporomandibular joint, have a protective covering called cartilage. Aging and damaged cartilage has lower water content which reduces the ability of the cartilage to absorb shock, withstand compression, and preserve a proper synovial fluid viscosity. Synovial fluid is a clear thick fluid which lubricates joints. When used together, glucosamine and chondroitin seem better able to:

  • Stimulate production and repair of cartilage
  • Improve the viscosity of the synovial fluid (the "shock absorber")
  • Hydrolyze the cartilaginous matrix (the "suspension system")
  • Inhibit release and subsequent activity of cartilage destroying enzymes
Along with the glucosamine and chondroitin sulfates, the Vitamin C (as calcium ascorbate) was included by the researchers because of its essential co-enzyme role in helping to enhance new collagen production.3

Other studies have found that all forms of Vitamin C are excellent anti-oxidants, helping to neutralize the free-radical formation which is a cause of osteoarthritis.4

Special Forms and Ratios of Chondroitin 
Another recent TMJD study investigated the correlation between TMJ disorders and the composition of glycosaminoglycan components in the synovial fluid (SF).5 Samples of synovial fluid were obtained from the TMJs of 28 women with a variety of joint problems throughout their bodies, including displaced disc with osteoarthritis or rheumatoid arthritis. Upon examination, the amounts of chondroitin 6-sulfate and chondroitin 4-sulfate were measured and the ratios calculated for the various the arthritic conditions. The results were statistically significant, from which the researchers concluded: the lower the ratio of chondroitin 4-sulfate to 6-sulfate, the greater the inflammation and cartilage breakdown in the synovial fluid of the TMJ. In other words, as cartilage degenerated and joint function declined, the percentage of chondroitin 6-sulfate increased while chondroitin 4-sulfate decreased. In young adulthood, the ratios find chondroitin 4-sulfate in greater abundance than chondroitin 6-sulfate. This is why most recent studies have used chondroitin in ratios consistent with more youthful levels. 

References

  1. Shankland WE 2nd. The effects of glucosamine and chondroitin sulfate on osteoarthritis of the TMJ: a preliminary report of 50 patients. Cranio.1998 Oct;16(4):230-235.
  2. Shankland W. The effects of glucosamine and chondroitin sulfate on osteoarthritis: a preliminary report of 50 patients. Submitted for publication. http://www.drshankland.com/glucos.html, April 29,1999.
  3. Vogel Z, Daniels MP, Chen T, Xi ZY, Bachar E, Ben-David L, Rosenberg N, Krause M, Duksin D, Kalcheim C. Ascorbate-like factor from embryonic brain. Role in collagen formation, basement membrane deposition, and acetylcholine receptor aggregation by muscle cells. Ann NY Acad Sci.1987;498:13-27.
  4. Schwartz ER, Oh W.H, Leveille CR. Experimentally induced osteoarthritis in guinea pigs. Metabolic responses in articular cartilage to developing pathology. Arthritis Rheum.1981;24(11):1345-1355.
  5. Shibata T.; Murakami K.-I.; Kubota E.; Maeda H. Glycosaminoglycan components in temporomandibular joint synovial fluid as markers of joint pathology. J Oral Maxillofac Surg.1998;56(2):209-213.