TMJ Disorders (Temporomandibular Joint Disorders)
Temporomandibular joint disorders are a group of problems related to the temporomandibular joint (TMJ). Often times referred to as simply TMJ, these problems can take many forms including headache, pain, limited opening, popping or clicking of the joint, and occasionally locking of the jaw in an open or closed position.
The TMJ is a complex joint and problems can arise from a single or usually multiple sources. Problems can arise from the musculature, the occlusion (bite), or the internal components of the joint itself (ligaments, cartilage, bone).
The muscles of the lower jaw are the muscles of mastication (chewing). These muscles have multiple attachments to the jaws, facial skeleton, and skull. When functioning in harmony, these muscles allow us to chew and speak comfortably. Problems can arise if the musculature becomes stressed, injured, or overworked. Clenching of teeth (bruxism), usually due to stress, while awake or during sleep is a common factor in TMJ disorders. This habit will place undue strain on the muscles and the joint itself resulting in symptoms and accelerated wear on the teeth. Repetitive function (chewing gum), dietary preferences, and even posture can place additional stress and strain on the TMJ complex.
The occlusion (your bite) is the relationship of the upper teeth to the lower teeth. Malocclusion, or misalignment of the teeth, can disrupt the posture of the TMJ and result in symptoms. Malocclusions can be due to crowded teeth, broken down non-restored teeth, or misalignment of the jaws.
Trauma can also be a major factor in causing TMJ symptoms. Direct trauma to the head, face or jaws can result in bruising, inflammation, damage to teeth, dislocations of the joint or fractures to the jaws and facial bones. Trauma can result in permanent changes to the TMJ complex. Indirect trauma, namely deceleration injuries (falls, motor vehicle accidents, whiplash) can also cause injury to the TMJ and related structures.
The TMJ is a complex sliding "ball and socket" joint with multiple components. The inside of the TMJ consists of the socket (fossa) in the base of the temporal bone of the skull, the ball (condyle) of the lower jaw (mandible), ligaments, muscles, and shock absorbing disc of fibrous cartilage between the condyle and fossa. Problems or changes to any of these structures can result in pain, noise, or limited mobility. The TMJ is subject to degenerative changes (arthritis), compressive forces (bruxism), displacement or wear of the disc, and inflammation.
Diagnosis and treatment of TMJ problems can be challenging. Coordination with other health care providers, general dentists, orthodontists, physical therapists, and medical physicians is often indicated. The diagnosis of TMJ disorders may involve a thorough history, examination, and radiographic studies. Radiographs (xrays), CT scans, or magnetic resonance imaging MRI, may be utilized to assist in confirming a diagnosis. Dental models may be fabricated to analyze the occlusion, or fabricate splints for therapy.
Treatment of TMJ disorders can also be challenging. Since the causes of problems can be from multiple sources, the treatment may be multifaceted as well. The majority of TMJ issues are musculature in nature so treatment may involve medications (analgesics, anti inflammatory medication, muscle relaxants, even antidepressants). Dietary changes, stress management, and behavior modification are often utilized to treat patients dealing with TMJ symptoms. Warm or cold compresses, massage, jaw exercises, or other physical therapy may also be recommended. Splint therapy (wearing a mouth guard) is often utilized to treat patients with TMJ disorders. These splints can be used to protect the teeth and the joint from the forces of clenching (bruxism) or to help reposition the TMJ to a more favorable less painful position. Malocclusion is best evaluated with your general dentist and orthodontist. Restoration of teeth into a functional occlusion is an important consideration when treating TMJ symptoms. Evaluation by an orthodontist and appropriate treatment (braces) will properly align crowded or malpositioned teeth into an ideal occlusion. If the upper jaw (maxilla) and lower jaw (mandible) are functionally malpositioned, surgery is sometimes indicated to properly realign the jaws. Trauma to the facial bones and dental anatomy can be evaluated and treated by oral and maxillofacial surgeons. Occasionally surgery with in the TMJ is indicated, fortunately for most patients this is a rare event. Oral and maxillofacial surgeons, in coordination with other dental and medical specialists, can assist in formulating a treatment plan to treat TMJ disorders.