Dental Procedures: TMJ Disorder

Normal TMJ

Thinning and compressed disc

Severe Damage TMJ
Severe compression and damage to the disc and articular surfaces of the TMJ

For sufferers of TMJ (temporomandibular joint) pain, an all-too-common disorder, a proper diagnosis is the first step toward relief - that's where our health care team can help.

Over 10 million Americans suffer from TMJ Disorder. This large group includes people of all ages - pre-teens, teens, young adults, the middle aged and seniors. The words "TMJ Disorder" are often a catch-all term used to describe dysfunction of the jaw muscles and joints. It can be as minor as slight clicking or popping sensations when the mouth is opened and closed, or as serious a persistent pain extending into the face, neck and shoulders affecting posture and even mobility.

The temporomandibular joints connect the jaw bone to the skull and are located just in front of each ear. They are sliding "ball and socket" joints and dependent upon proper alignment to work smoothly. These are also the most complex and frequently-used joints in your body, cycling over 2,000 times per day. You can feel the joints work by placing your fingers on them while opening and closing your mouth.

What are the signs of TMJ Disorder?
When the joints are not working properly, you may experience any of these symptoms:

Pronounced noises associated with movement in the TM joints (clicking, popping or crunching)
Pain when the jaw is opened fully
Limited range of opening
Clenching or grinding teeth
Facial pain and sense of facial muscle fatigue
Ear pain not related to ear infections
Occasional "locking" when the jaw seems to "stick open" temporarily
Ringing in the ears (tinnitus)
Frequent headaches

What causes TMJ Disorder?
A good understanding of what causes TMJ Disorder begins with a basic knowledge of how the TM joints work. Both joints consist of a "ball", known as the condyle, located on the lower jaw (mandible) and the "socket" or fossa on each side of the skull. In between the two bone surfaces a "disc" acts as a shock absorber to allow a smooth, gliding action for the joint. The disc is held in place against the back of the joint by ligaments and connective tissue containing blood vessels and nerves. Muscle groups attach directly to the jawbones to align, stabilize and control jaw movement.

A TMJ Disorder may develop for any number of reasons:

Lost or crooked teeth
Overbite
Teeth that fit together poorly
Degenerative arthritis
Various head or neck injuries including whiplash
Stress causing clenched teeth and muscle spasms

Any of these conditions can result in a misalignment or displacement of the jaw, which places stress on the nerves, blood vessels, muscles and connecting tissues of the TM joints. When the condition is prolonged, your body may begin to compensate by adapting an unnatural position involving the muscles or the neck, back or even the arms and pelvis.

How can our doctors and staff help?
We can serve as the key member of a health care team which could, depending on the cause of your TMJ Disorder, include an orthodontist, oral surgeon, your primary care physician, a physical therapist and even a psychologist. Because other types of pain have been shown to mimic TMJ Disorder, a careful and thorough dental and medical evaluation is essential to arrive at an accurate diagnosis. If your condition indicates causes other than dentition, we may refer you to another member of the health care team or a specialist for further diagnosis or treatment.

If your symptoms point to a dental problem, we will most likely take x-rays of your teeth and jaw. Dental casts may be required to check the fit (occlusion) of your upper and lower teeth and determine whether they come together correctly.

Treatment
If a malocclusion is detected, your teeth may require some restoration to improve the alignment of your "bite" and TM joints. This may include the addition of crowns or a "recontouring" of tooth surfaces to improve the "bite" or occlusion.

When bruxism, or "grinding" of the teeth is a persistent, unconscious reflex, an orthotic, sometimes called a "splint", may be custom-fitted to separate the upper and lower teeth slightly and align the bite. If an orthotic is prescribed, you may be instructed to wear it during the course of your day or only when sleeping.

In the short term, we may prescribe some treatments for immediate relief of pain and muscle spasm. These often include prescription muscle relaxers, pain killers, heat compresses or ice packs. The doctors may also suggest self-care techniques such as posture correction, specialized exercises to improve jaw muscle flexibility and strength, and a diet which excludes hard or tough foods like carrots or steak.

To relieve stress and anxiety, biofeedback, relaxation techniques or psychological counseling are often employed. Physical therapy can include ultrasound, postural training, mobilization and jaw exercises.

Only in rare cases is surgery required to correct a TMJ Disorder. Arthroscopy or arthrocentesis utilizing tiny instruments and needles to flush the joint and introduce anti-inflammatory medication can provide relief. Soft tissue repair is usually required when the disc must be repositioned or to release a "locked jaw".

When arthritis causes severe degeneration of the joints, various procedures are performed to repair or replace severed or perforated discs and smooth bone surfaces. Surgery, however, for TMJ Disorders is generally considered appropriate only after all other therapies have been fully explored.

A Final Word
If you suffer pain or discomfort you believe may be related to you TM joints, please ask us for help. The successful treatment of many TMJ Disorder sufferers begins with gentle, experienced care - right here in the dental office.