'
Health & Diving
Ears & Diving

Ears & Diving

Temporamandibular Joint Syndrome (TMJ)

Temporamandibular joint syndrome is pain in and around the temporomandibular joint caused by prolonged gripping of a mouthpiece from a snorkel or scuba regulator.


Statistics

It has been reported that TMJ occurs in 15-20 percent of snorkelers and scuba divers.

Mechanism

TMJ is a chronic inflammation of the jaw joint just in front of the ear. The pain can be great enough to make holding the mouthpiece between the teeth difficult. The condition is exacerbated by local factors such as joint laxity, anatomical factors, capsular or muscular inflammation, or the type of mouthpiece used.

Diving-associated TMJ is thought to result from the forward posturing of the mandible by an ill-fitting mouthpiece and clenching of the mouthpiece, especially with heavy regulators. Diving may aggravate preexisting TMJ. The pain is sometimes severe enough to cause divers to abort the dive. It can occur in novice divers who clench their teeth, sometimes with such intensity that they occasionally bite through the mouthpiece.

Manifestations

  • Pain in the TMJ and ears
  • TMJ clicking or crepitus (cracking or popping sound)
  • Trismus (inability to open mouth fully) and impaired TMJ mobility
  • Dizzy spells (could be hazardous should it occur underwater)
  • Masticatory muscle pain
  • Stuffy sensation in the ears
  • Eustachian tube dysfunction
  • Headache and facial pain

Management

While diving: Work to relax your bite while retaining the mouthpiece in place. If unsuccessful, safely end the dive, surface and consider alternative mouthpiece options.

Definitive treatment: If pain persists, a consultation with a specialist is suggested as solutions are highly individualized. Treatment includes bite adjustment, management of dental problems and the use of orthodontic mouthpieces. Heat and anti-inflammatory drugs are helpful.

Fitness to Dive

Return to diving is possible upon pain resolution. You must also be able to grip the mouthpiece without pain.

Prevention

Use only a mouthpiece that fits properly. Consider a customized mouthpiece. Correct contributing conditions such as dental problems, anxiety and teeth grinding (bruxism).

Further Reading

More Questions? Ask a DAN Medic