The temporomandibular joint
(TMJ) is a small joint located in front of
the ear where the skull and lower jaw meet, which allows the lower jaw
(mandible) to move and function.
TMJ disorders have a variety of symptoms. Patients may complain of
earaches, headaches and limited ability to open the mouth. They may also
complain of clicking or grating sounds in the joint and feel pain when
opening and closing the mouth. What must be determined, of course, is the
What Causes TMJ Disorders?
Arthritis is one cause of TMJ symptoms. It can result from an injury
or from grinding of the teeth at night. Another common cause involves
displacement or dislocation of the disc that is located between the
jawbone and the socket. A displaced disc may produce clicking or popping
sounds, limit jaw movement, and cause pain during opening and closing of
the mouth. There are also conditions such as trauma or rheumatoid
arthritis that can cause the parts of the TMJ to fuse, preventing jaw
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, 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. Constant grinding also causes pressure on the
TMJ. Bruxing can put pressure on the articular disc, squeezing
out synovial fluid and robbing it of lubrication.
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 is also a very common cause of the TMJ syndrome.
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. It is one of the most
frequent triggers of TMJ syndrome. Malocclusoin, even on a
minute scale can trigger the spasm of muscles, resulting in pain.
Sometimes The Joint Itself Is The Problem
Stress may trigger pain in the jaw muscles that is very similar to
that caused by TMJ problems. Such patients frequently clench or grind
their teeth at night causing painful spasms in the muscles and difficulty
in jaw movement. Patients may also have a combination of muscle and joint
problems. That is why diagnosing TMJ disorders can be complex and may
require different diagnostic procedures.
Determining the cause of a TMJ problem is important, because it is the
cause that guides the treatment.
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. In addition, viral infections can cause damage to
the surfaces of the TMJ.
The 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 conylar
head are injured, the disc can slip out of place can can no longer
server as a normal cushion between the lower and upper parts of the
jaw. Typically, the disc is pulled forward. Mild
displacements can cause a clicking or popping sound in the joint and
sometimes can be painful. Permanent damage may result from the
Role Of The Oral And Maxillofacial Surgeon
When symptoms of TMJ trouble appear, an oral and maxillofacial surgeon
should be consulted. A specialist in the areas of the mouth, teeth and
jaws, the oral and maxillofacial surgeon is in a good position to
correctly diagnose the problem. Special imaging studies of the joints may
be ordered and appropriate referral to other dental or medical specialists
or a physical therapist may be made.
Range Of Possible Treatment
The oral and maxillofacial surgeonís treatment may range from
conservative dental and medical care to complex surgery. Depending on the
diagnosis, treatment may include short-term medications for pain and
muscle relaxation, bite plate or splint therapy, and even stress
Generally, if nonsurgical treatment is unsuccessful or if there is clear
joint damage, surgery may be indicated. Surgery can involve either
arthroscopy (the method identical to the orthopaedic procedures used to
inspect and treat larger joints such as the knee) or repair of damaged
tissue by a direct surgical approach.
Once TMJ disorders are correctly diagnosed, appropriate treatment can be