TMJ/TMD

Temporomandibular joint and muscle disorders, commonly called "TMJ," are a group of conditions that cause pain and dysfunction in the jaw joint and the muscles that control jaw movement.  There are two jaw joints that function in opening, closing, talking and chewing. Their designed function is very specialized and when trauma is inflicted on the joint(s) the damage can be severe.  TMD stands for Temporomandibular Disorder.  We use this term to describe the pain that patients experience in the head and neck, because until we have a diagnosis we do not know if the source of the pain is truly the joint (s) or something else.  TMJ treatment refers to specific management of a popping jaw and TMD management usually refers to management of facial pain, jaw pain and neck pain. Many people have TMJ disorders, estimates suggest that over 10 million Americans are affected by this disorder. This condition appears to be more common in women than men.

What is the temporomandibular joint?

The jaw joint is located just in front of the ear canal, and it joins the jaw bone (mandible) to the skull near to the temple. The jaw joint is also called the temporomandibular joint (TMJ). Problems affecting this joint are usually known as TMJ disorders. However, there are various other terms for for this condition - TMJ dysfunction, TMJ pain and myofascial pain disorder.

Understanding the jaw joint

A joint is where two bones meet. Joints allow movement and flexibility between two bones. The jaw joint allows movement between the jawbone (mandible) and the skull. Muscles attached to the skull and jawbone cause the jawbone to move as the mouth is opened and closed.

What are TMJ disorders?

Temporomandibular joint disorders are problems which affect the jaw, jaw joint and surrounding facial muscles that control chewing and moving the jaw. TMJ is characterized by severe headaches, jaw pain of varying degrees, grinding teeth, and an intermittent ringing in the ears. The vast majority of TMJ sufferers are unaware that the root cause of these problems is something that a dentist can effectively treat.

Common TMJ Causes and Disorders

The following are contributing factors to TMJ disorders:

  • Whiplash: causes the muscles of the neck to be jarred and pulled violently, often resulting in ligament tears, stretching of structures to their limits and discal tearing.  All can lead to the development of TMJ symptoms.
  • Bruxism/Clenching: bruxism , the grinding of teeth, usually occurs during sleep.  Clenching can occur throughout the day or night.  Both can be directly related to TMJ, either as a trigger for muscle spasms or as a result of malocclusion.
  • Loss of Teeth: When a tooth is lost, the teeth around it tend to shift to fill the space.  This change can alter the way the teeth gear in relation to the joint, causing symptoms to develop.
  • Malocclusion:  Malocclusion is the abnormal contact of opposing teeth with respect to the temporomandibular joint that interferes with the efficient movement of the jaw during mastication.
  • Systemic Diseases: The TMJ, like any other joint , is susceptible to any of the systemic diseases.  Immune disorders such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis and systemic lupus erythematosus and electrolyte imbalances can produce inflammation and muscle cramping in the TMJ.
  • Disc Displacement: The jaw joint, in addition to being a ball and socket joint, glides forward and backward.  When functioning correctly, the articular cartilage lies between the condyle head of the mandible and the roof of the joint.  It normally follows the condylar head in its forward and backward movement.  If the ligaments that hold the disc to the condylar head are injured, the disc can slip out of place and can no longer serve as a normal cushion between the lower azd upper parts of the jaw.

What are the symptoms and signs?

  • Pain in the facial muscles and jaw joints may radiate to the neck or shoulders. Joints may be overstretched. You may experience muscle spasms from TMJ syndrome. You may feel pain every time you talk, chew, or yawn. Pain usually appears in the joint itself, in front of the ear, but it may move elsewhere in the skull, face, or jaw and lead to headaches, dizziness, and even migraines.
  • TMJ may cause ear pain, ringing in the ears (tinnitus), and hearing loss. Sometimes people mistake TMJ pain for an ear problem, such as an ear infection, when the ear is not the problem at all.
  • When the joints move, you may hear sounds, such as clicking, grating, and/or popping. Others may also be able to hear the sounds. Clicking and popping are common. This means the disc may be in an abnormal position. Sometimes no treatment is needed if the sounds give you no pain.

Signs

  • Your face and mouth may swell on the affected side.
  • The jaw may lock wide open (then it is dislocated), or it may not open fully at all. Also, upon opening, the lower jaw may deviate to one side. You may find yourself favoring one painful side or the other by opening your jaw awkwardly. These changes could be sudden. Your teeth may not fit properly together, and your bite may feel odd.
  • You may have trouble swallowing because of the muscle spasms.
  • Headache and dizziness may be caused by TMJ. You may feel nauseous or vomit.

How are TMJ disorders diagnosed?

A proper diagnosis always begins with a thorough examination by Dr. Kay.  A medical history is needed in diagnosing your jaw problem, Dr. Kay may ask the following questions:

  • What kind of pain do you have?
  • Is it an ache, a throbbing pain, or a sharp stabbing pain?
  • Is the pain continuous or intermittent?
  • Can you outline the area of pain on your face with your finger?
  • What helps to alleviate the pain? What aggravates the pain?
  • Do you grind or clench your teeth? Do you bite your nails or chew on any objects, such as pens or pencils?
  • Do you hold the telephone with your shoulder against your ear for a long time?
  • Do you chew gum often? For how long?
  • Do you have any oral habits that you have not mentioned?
  • Physical examination: During the physical examination, Dr Kay will examine your head, neck, face, and temporomandibular joints, noting any of the following:
    • tenderness (pain) and its location;
    • sounds, such as clicking, popping, grating;
    • the mandible (lower jaw) range of motion and whether it is easy to open and close and can move from side to side and forward-backward without any pain;
    • your assessment of pain on a scale from 0 (no pain) to 10;
    • wear and tear on the buccal cusps of the mandibular teeth, especially the canine teeth;
    • the rigidity and or tenderness of the chewing muscles;
    • how your teeth fit together: normal, open bite, crossbite, overbite, dental restorations, or skeletal deformity.
  • ImagingX-rays may be taken of the mouth and jaw during the examination.