What is TMJ/TMD?
Temporomandibular disorder (TMD) is a condition that affects the functioning of the joint that connects the jaw to the skull at the ear. The temporomandibular joint (TMJ) runs along each side of the face in front of the ear connecting the mandible (lower jawbone) to the skull. It is considered to be the most complicated joint in the body because of its dual action movement. In order to open the mouth wide, the joint must be able to slide and pivot. This is achieved when the condyle (top part of the lower jawbone) moves along a groove in the maxilla (upper jawbone). The condyle has a ball type end to help it function and move smoothly in the socket of the maxilla. When closing the mouth, the condyle shifts back to its original position. During this movement, the articular disc (comprised of elastic cartilage) between the condyle and the maxilla act as a cushion to make the movement smooth and protect the working parts. The temporomandibular joints are also aided by a network of muscles belonging to the neuromuscular system as well as ligaments which prevent or extend range of motion of the entire jaw. Since there are two temporomandibular joints, muscles and ligaments help them to work in synchrony. The disorder is referred to as TMJ since it affects the joint.
What are TMJ Disorders?
The disorder starts when the cartilage discs begin to wear and shift out of place during normal movement. The discs will then pop back into place as the jaw is closing. The lack of cartilage also causes nerves to be more sensitive and cause pain. The joint itself can also become inflamed for a number of reasons. TMJ can range from a mild discomfort to extremely painful. The best type of doctor to consult is a dentist who may also direct a patient to see a neurologist. Although affecting twice as many women than men, the disorder has many causes.
Causes of TMJ
Repetitive movements such as chewing, biting (especially on hard foods) or bending of the head can be harmful. Stress cannot be the sole cause of TMJ, however, if someone is at risk for the disorder, stress will make the person more vulnerable. Opening of the mouth too wide will put someone at risk for TMJ. Misalignment of the teeth or lack of an overbite may also cause problems with positioning of the bones in the jaw causing the disorder and orthodontia is also the cause of many cases Many people clench their jaw or grind their teeth at night which is also a large cause. Cars crashes or any type of impact in the jaw area can also easily precipitate TMJ. Lastly, any type of arthritis will contribute to the development of the disorder.
Symptoms of TMJ
Pain when opening the mouth is the most common symptom of TMJ since this is when joints and cartilage are over-stretched. A popping type noise is often heard when opening the mouth to the point of over-extension. Any type of pain in the face or ears including headaches or earaches is a possible indicator of a TMJ inflammation as well. Since the temporomandibular joints are used when speaking and eating, any discomfort during this act may be a sign. Given that the joints also affect the alignment of teeth, a sign of the disorder may be a shift in dental alignment, worn teeth, grinding of teeth at night or loose teeth. The locking of the jaw into place is also a tell-tale warning of TMJ.
Eating/Pain Reduction Instructions for TMJ
Some simple home remedies may make a large difference in pain management of TMJ. The first step recommended by dentists is to take an anti-inflammatory medication. Over the counter drugs are sufficient such as Tylenol, Motrin or Advil. This will reduce the swelling of the joint and increase the patient’s comfort. Eating a diet of small sized and soft foods is a must. Because the temporomandibular joint is so sensitive to opening and pressure, any reduction in stress is important. Also, applying a warm compress on the painful area three to five times a day for up to twenty minutes will help the entire area glide more easily. Reducing stress levels and making sure that the neck, back and shoulders are well stretched will help as well.
Pain Disorders That Are Confused with TMJ
Since the temporomandibular joint involves the musculoskeletal system, the nervous system, the circulatory system and also crosses between the two medical disciplines of neurology and dentistry, a thorough investigation of the patient’s symptoms is required. A similar diagnosis to TMJ could include but is not limited to the following:
Fibromyalgia is an arthritis related syndrome that affects joints and muscles and presents itself as amplified pain. It can present itself as tender spots which could easily be thought as TMJ.
Ernest Syndrome is a facial disease in which the stylomandibular ligament, connecting the jaw bone to behind the ear, becomes severely inflamed and causes irritation in the back of the neck. It affects movement of the jaw and can very easily be mistaken for TMJ.
Temporal Tendinitis imitates the pain and symptoms of a migraine and suffers can also have facial, ear, tooth, neck and shoulder pain. Many times it is invoked by a car accident.
Trigeminal Neuralgia is an extremely painful disease that involves the nerve delivering sensation to the face and the surface of one eye. With acute pain that lasts for several seconds at a time, even chewing, brushing teeth, being touched etc., is all very painful.
Atypical trigeminal neuralgia is the same as the typical form of the disease except the pain shooting through the nerve is constant and increasing and decreasing in intensity. With trigger zones and dull aching areas, this is another agonizing disease that is similar to TMJ.
Osteonecrosis is a disease in which bone death occurs because of poor blood supply. It causes pain to transfer down the cranial nerve much like trigeminal neuralgia and again, mimics TMJ but is not the same disease.
A sinus infection although much less severe is a swelling of the sinuses in the nose. When fluid or mucus is present, bacteria can form and the pressure of the infection can cause pain all throughout the face and ears.
As indicated, there are many conditions that are easily confused with TMJ which is why it is so important for a medical practioner to examine a patient very carefully.
Evaluating your need for TMJ Treatment
More than several days of one or a set of symptoms is more than enough reason to see a medical practioner. The most noticeable of the guidelines for which to seek help are discomfort and inflammation of the jaw, aching pain in or around the ear area, discomfort when chewing, a popping sound when opening the mouth, a headache, uncomfortable bite and locking of the joint/jaw. Seeing a dentist when a patient has these symptoms is the best way to forestall the progression of TMJ.
Treatment Options for TMJ Disorders
Options for correction of the disorder range from mild to more involved including surgery. Before deciding on any treatment plan, a dentist or surgeon will take x-rays, a CT scan or an MRI depending upon the severity of the situation. Less involved remedies include taking an anti-inflammatory, using a warm compress on the joint, careful stretching of the muscles used by the jaw and the orthopedic splint. The orthopedic splint is used to correct a bite problem caused by misalignment of the jaws. A clear mouth piece is worn by the patient at all times and is solution for many. Dentists may also avoid the use of a splint and go directly for reconstructive dentistry or orthodontics for relief. In chronic instances, moderately invasive procedures to actual surgery is required.
Orthopedic Splint for TMJ
Since TMJ is an alignment issue of the bones, joints and muscles, a dentist will check to see if a patient has an overbite. A dentist will make a model of the upper and lower teeth so that he/she can see the exact alignment of the upper and lower jaws to then make a correction. From this a clear colored splint is fabricated to correct the bite pattern of the patient that he/she is usually directed to wear at all times. The outcome is overbite improvement, relaxed muscles in the local area and ability of the patient to move his/her jaw properly. It will also prevent any clenching of the jaw or teeth grinding at night. The largest advantage of the orthodontic splint is that it is a simple and non-invasive type of therapy and typically yields some sort of improvement.
What to Expect During TMJ Surgery
Arthrocentesis or temporomandibular joint irrigation is a procedure aimed at inflammation reduction. Performed using either local anesthesia to the joint or general anesthesia, the area is flushed with fluids to reduce the swelling. Steroids or anti-inflammatory medications may also be injected to help alleviate the problem. This is an innocuous procedure that requires no overnight hospitalization and may be very helpful.
Discectomy is a surgery that removes the articular discs that rest between the condyle and the maxilla. When discs are damaged, they usually pop back in forth into position providing no cushion for the condyle. Several weeks to months after the surgery, scar tissue forms in place of the disc and provides and new and improved cushion. When the surgeon performs a discectomy, he/she also removes many of the nerves in the surrounding area thereby reducing the pain. This is a highly successful surgery and can drastically improve the functioning of the temporomandibular joint and the patient’s range of motion.
Disc repositioning is a surgery when the articular discs are moved into the correct place after they have slipped. These slipped discs are what create a “popping” noise when opening the mouth and repositioning corrects this problem. This surgery is known to be very helpful, however, sometimes the discs do not remain in their new positions and the patient may be a better candidate for a discectomy.
Articular eminance recontouring is performed when the condyle pushes too deep into its socket which does not allow for the articular disc to carry out its function. A surgeon will reshape the condyle so that the clearance is adequate for proper function.
Temporomandibular joint replacement is a surgery aimed at the replacement of the actual TMJ. A partial replacement is in line when either the condyle, articular disc or maxilla is at fault for the symptoms. To add bone to the condyle in certain cases, bone is collected from another area of the body and added to the ball part of the condyle. A metal piece can also be used in place of the bone. If the maxilla portion is not smooth enough or irregularly shaped, a surgeon can carve the area. The disc can also be repaired. When not just components of the temporomandibular joint are replaced but all of them, a total joint replacement is called for. Both the condyle and the maxilla are replaced with metal parts and there is no real need for the articular disc. While a full joint replacement is a very involved surgery, it can help a patient recover fully.
The above surgeries require general anesthesia and an overnight stay in the hospital. They are all safe and effective treatments for TMJ.