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A PAIN IN THE JAW

Q: My right jaw came out of place a couple of months ago. I am unable to get it back in. I'm also having a lot of earaches, which I never had before. What can I do?

-- D.C.

A: I presume that your jaw on the right side didn't become completely dislocated and stay that way for so long. But misalignment can occur and remain long periods of time.

When someone's jaw makes a cracking sound when they move it, almost always that sound is coming from the TMJ (temporomandibular joint). Sometimes the sound is soft enough that only the person can hear it, but sometime it can be heard across a room.

The TMJ is located on each side of the face where the jawbone (mandible) connects with a bone of the face (the temporal bone). A piece of cartilage between the two bones keeps them from rubbing together. Ligaments, tendons and muscles support the joint and are responsible for jaw movement.

The muscles, connective tissue and boney joints all work together. So a problem with any one can result in TMJ dysfunction or disorder. This disorder is really several disorders, depending on which and how much each of the components are involved.

Symptoms of TMJ dysfunction include stiffness, headaches, pain in the face and ears, bite problems, clicking or cracking sounds, and locked jaws.

TMJ dysfunction is most common in adult women. Fortunately, 80 percent of people with this disorder get better in six months or so, often without treatment.

The causes of TMJ dysfunction fall into two categories: tight muscles and damaged joints. Anything that causes the jaw muscles to tighten up can cause TMJ dysfunction, including stress and dental disease.

Damage to the TMJ joint can result from trauma or diseases such as arthritis. Less common causes of joint problems include fusion of bones or calcification of ligaments (ankylosis), looseness of the jaw caused by stretched ligaments, and birth abnormalities.

Treatment is based on cause. If the TMJ dysfunction is found to result from stress, a person may be urged to use stress-management techniques such as biofeedback and relaxation exercises, as well as to participate in support groups.

Treatment may include wearing a mouthpiece to reduce clenching and prevent damage to teeth. The mouthpiece fits over upper and lower teeth to position the jaw properly. A new technique increases the effectiveness of mouthpieces in treating TMJ. It uses a TENS (transcutaneous electrical nerve stimulator) device to relax jaw muscles and allow a better-fitting splint.

If misalignment of the bones or cartilage in the TMJ is the cause, as in your case, a dentist may attempt to manually realign the joint. If joint tissues are injured, physical therapy help reduce pain and swelling, as well aid muscle relaxation.

Bad alignment of the teeth may require an orthodontist or oral surgeon to do major restorative dental work. If osteoarthritis or rheumatoid arthritis is the cause of the TMJ trouble, it may be necessary to restrict joint use and to use nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce swelling.

Write to Allen Douma in care of Tribune Media Services, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y. 14207.