The temporomandibular joint, or TMJ, is a small joint located in front of the ear where the skull and lower jaw meet. This joint allows the lower jaw (mandible) to move and function and is the most constantly used joint in the body. The TMJ is a “ball and socket” joint, and the round end, or “ball” is called the condyle; the “socket” is called the fossa. Between the condyle and the fossa is a disc made of cartilage that acts as a cushion to absorb stress and allows the condyle to easily move when the mouth opens and closes.
Ligaments hold the disc and condyle in place, and muscles surrounding the TMJ help stabilize the joint as well as move the lower jaw during chewing speaking and other functions.
The teeth themselves are also important for proper TMJ function, because if they don’t fit together properly, stresses can be generated that can displace the condyle and damage the disc, ligaments and muscles. Trauma can also damage the TMJ and inhibit proper function.
What are TMJ Disorders?
TMJ disorders can be relatively minor, or they can be extremely painful and potentially debilitating. Emotional stress, with attendant habits such as grinding or clenching the teeth, can trigger TMJ symptoms as well as muscle spasms around the joint and jaws. Malpositioned jaws also may produce TMJ problems and, in some cases, arthritis may be the cause of TMJ disorders. Injury, such as a blow to the chin or jaw, can displace the condyle or disc, this causing problems.
In some cases the TMJ disorder the disc is displaced to the front of the joint which interferes with its ability to properly interface between the “ball” and “socket”. This front displacement of the disc to make a clicking sound when the joint functions, and joint uses sensitive soft tissue to function on as opposed to smooth cartilage. In some cases the disc may move so far forward that the mouth cannot be widely opened. This can cause a condition known as degenerative joint disease.
Signs and Symptoms
TMJ sufferers can display a variety of symptoms, and certain signs may indicate the potential for TMJ disorders to develop. Following are signs and symptoms that are possible in patients with TMJ problems:
- Painful clicks or pops in the joint when opening or closing the mouth
- A habit of tooth grinding or clenching
- Sore jaw muscles when awakening
- Difficulty opening the mouth fully
- Frequent headaches or neckaches
- Pain in the TMJ area
- Locking of the jaw
Because the disorder has many boundaries between several health-care disciplines—in particular, dentistry and neurology—there are a variety of treatment approaches.
Non-surgical Treatment Options for TMJ Disorders
In the treatment of TMJ disorders you will be working in partnership with your surgeon and in some cases your orthodontist and restorative dentist. It is important to know that most types of TMJ disorders can be treated, in whole or at least in part by “conservative therapy” or self care. Other problems require more extensive therapy, sometimes including surgery. The following are treatment options that will be reviewed with you by Dr. Abbey to determine the specific treatment needed in your case:
In almost all cases it is important to rest the jaw by keeping the teeth apart for periods of time and to practice good posture. It may be necessary to avoid hard foods that strain the jaw when chewing. Just as resting the jaw can be beneficial, proper exercise of the jaw may also be helpful at appropriate times. Exercises can help restore normal range of motion in cases where jaw movement is restricted by a TMJ disorder. These exercises should consist of gentle opening and closing movements to avoid stressing the joint. Moist heat can be used to help relax muscles of mastication. You may be prescribed medications such as muscle relaxants and/or anti-inflammatory drugs that can help relieve discomfort, reduce inflammation, and break the cycle of pain.
We may recommend the construction of a nightguard device, or occlusal splint to be worn for varying amounts of time, depending on the nature of your TMJ problem. There are many types of splints to help reposition the jaw, prevent clenching and grinding of the teeth, rest the jaws, and help relax the jaw muscles. Orthodontic treatment or dental treatment such as restorations to correct a defective bite may be necessary and potentially therapeutic as they restore proper harmony between the teeth, muscles, and joint.
If the position of the jaws is incorrect, corrective jaw surgery to reposition the upper and/or lower jaw may be indicated to restore balance and be potentially helpful in resolving the disorder.
Surgical Treatment Options for TMJ Disorders
In cases where the diagnosis indicates a specific problem with the TMJ or where several attempts at non surgical intervention have failed, joint surgery may be an appropriate treatment. TMJ surgery is designed to treat and fix a specific problem including removal of scar tissue, repair and reposition of the disc, alter the anatomy of a joint, remove pathology or degenerative tissue.