What are the main symptoms of TMJ disorders. How are TMJ disorders diagnosed. What are the most effective treatments for TMJ-related jaw problems. Can TMJ disorders be prevented. How does stress contribute to TMJ issues. What lifestyle changes can help manage TMJ symptoms. When should you seek medical help for jaw pain.

Understanding Temporomandibular Joint Disorders (TMJ/TMD)

Temporomandibular Joint Disorders, commonly referred to as TMJ or TMD, are a group of conditions affecting the jaw joint and surrounding muscles. These disorders can cause significant discomfort and interfere with daily activities such as eating, speaking, and even yawning. To better understand this complex issue, let’s delve into the intricacies of TMJ disorders.

What is the temporomandibular joint?

The temporomandibular joint is a hinge-like structure that connects your jaw to the temporal bones of your skull, located in front of each ear. This joint allows for various jaw movements, including up and down and side to side motions, essential for activities like talking, chewing, and yawning.

Common Causes of TMJ Disorders

While the exact causes of TMJ disorders are not always clear, several factors can contribute to their development:

• Jaw injury or trauma
• Teeth grinding or clenching (bruxism)
• Dislocation of the disc between the ball and socket of the joint
• Arthritis
• Chronic stress
• Misalignment of the jaw or teeth

Understanding these potential causes can help in prevention and treatment strategies. For instance, addressing stress-related teeth grinding through relaxation techniques or using a night guard can significantly reduce the risk of developing TMJ issues.

Recognizing TMJ Disorder Symptoms

TMJ disorders can manifest in various ways, and symptoms may vary from person to person. Some common signs include:

• Pain or tenderness in the face, jaw joint area, neck, and shoulders
• Difficulty opening the mouth wide
• Jaws that get “stuck” or “lock” in open or closed positions
• Clicking, popping, or grating sounds when moving the jaw
• Facial fatigue
• Difficulty chewing or sudden changes in bite alignment
• Swelling on the side of the face

Additionally, individuals with TMJ disorders may experience secondary symptoms such as headaches, earaches, dizziness, and tinnitus (ringing in the ears). It’s important to note that these symptoms can also be indicative of other health issues, making proper diagnosis crucial.

Diagnosing TMJ Disorders: A Comprehensive Approach

Accurately diagnosing TMJ disorders requires a thorough evaluation by a dental professional. The diagnostic process typically involves:

1. Detailed medical history review
2. Physical examination of the jaw and surrounding areas
3. Assessment of jaw movement and function
4. Evaluation of bite alignment
5. Imaging tests, such as X-rays, MRI, or CT scans

During the physical examination, dentists look for signs of tenderness, listen for joint sounds, and assess the range of motion in the jaw. Imaging tests can provide detailed views of the joint structure and help rule out other potential issues.

Why is proper diagnosis important?

Accurate diagnosis is crucial because TMJ symptoms can mimic other conditions, such as sinus problems, tooth decay, or even certain types of headaches. A precise diagnosis ensures that you receive the most appropriate and effective treatment for your specific condition.

Home Remedies and Self-Care for TMJ Relief

While professional treatment may be necessary for severe cases, there are several self-care strategies that can help alleviate TMJ symptoms:

• Apply moist heat or cold packs to the affected area
• Practice gentle jaw stretching exercises (as recommended by a professional)
• Adopt a soft food diet to reduce jaw strain
• Avoid extreme jaw movements and wide yawning
• Maintain good posture to reduce neck and facial pain
• Use over-the-counter pain relievers like ibuprofen or naproxen

Implementing these self-care techniques can often provide significant relief and may be sufficient for managing mild TMJ symptoms. However, it’s important to consult with a healthcare professional if symptoms persist or worsen.

Professional Treatment Options for TMJ Disorders

When self-care measures aren’t enough, various professional treatments can help manage TMJ disorders:

Conservative Treatments

• Prescription medications (muscle relaxants, anti-inflammatories)
• Custom-fitted oral appliances or night guards
• Physical therapy and jaw exercises
• Cognitive behavioral therapy for stress management

Advanced Treatments

• Botox injections to relax jaw muscles
• Corticosteroid injections for joint inflammation
• Arthrocentesis (joint fluid removal)
• Arthroscopy for joint repair

In rare cases where conservative treatments are ineffective, surgery may be considered. However, this is typically viewed as a last resort due to its invasive nature and potential risks.

The Role of Lifestyle Changes in Managing TMJ Disorders

Long-term management of TMJ disorders often involves making certain lifestyle adjustments:

• Stress reduction techniques (meditation, yoga, deep breathing exercises)
• Improving sleep hygiene to reduce nighttime teeth grinding
• Ergonomic adjustments to reduce neck and shoulder strain
• Dietary modifications to avoid hard or chewy foods
• Regular exercise to improve overall muscle tone and reduce tension

These lifestyle changes can significantly contribute to symptom relief and prevent the recurrence of TMJ issues. Incorporating these habits into your daily routine can lead to long-term improvements in jaw health and overall well-being.

Preventing TMJ Disorders: Proactive Measures

While not all cases of TMJ disorders can be prevented, certain steps can reduce your risk:

• Practice good posture to reduce strain on the jaw and neck
• Avoid chewing gum excessively
• Be mindful of jaw clenching during stressful situations
• Use proper form when exercising, especially during activities that involve the head and neck
• Address dental issues promptly to maintain proper bite alignment
• Learn and practice stress management techniques

By being proactive about jaw health and overall well-being, you can potentially reduce the likelihood of developing TMJ disorders or minimize their impact if they do occur.

Is TMJ disorder a chronic condition?

TMJ disorders can be either acute (short-term) or chronic (long-term). Some individuals may experience temporary symptoms that resolve on their own or with minimal intervention. However, for others, TMJ disorders can become a chronic condition requiring ongoing management. The duration and severity of symptoms can vary widely among individuals, emphasizing the importance of personalized treatment approaches.

The Impact of TMJ Disorders on Quality of Life

TMJ disorders can significantly affect an individual’s quality of life, influencing various aspects of daily functioning:

• Difficulty eating and enjoying meals
• Challenges in verbal communication
• Sleep disturbances due to pain or discomfort
• Emotional stress and anxiety related to chronic pain
• Limitations in social interactions and activities

Understanding these potential impacts underscores the importance of seeking timely treatment and developing effective coping strategies. Many individuals find that a combination of medical intervention and lifestyle adjustments can greatly improve their overall quality of life when dealing with TMJ disorders.

How does TMJ affect sleep quality?

TMJ disorders can significantly impact sleep quality in several ways. The pain and discomfort associated with TMJ can make it difficult to find a comfortable sleeping position, leading to frequent nighttime awakenings. Additionally, teeth grinding or clenching during sleep (nocturnal bruxism) is common in individuals with TMJ disorders, further disrupting sleep patterns. Poor sleep quality can, in turn, exacerbate TMJ symptoms, creating a cycle of discomfort and sleep disturbance.

Exploring the Connection Between TMJ and Headaches

Many individuals with TMJ disorders experience frequent headaches, leading researchers to investigate the relationship between these two conditions:

• Tension headaches: TMJ-related muscle tension can trigger tension headaches
• Referred pain: Jaw pain can radiate to surrounding areas, causing headaches
• Migraine correlation: Some studies suggest a higher prevalence of migraines in individuals with TMJ disorders
• Bruxism impact: Nighttime teeth grinding can lead to morning headaches

Understanding this connection is crucial for developing comprehensive treatment plans that address both TMJ symptoms and associated headaches. In many cases, treating the underlying TMJ disorder can lead to a reduction in headache frequency and severity.

Can TMJ disorders cause ear problems?

Yes, TMJ disorders can indeed cause or contribute to various ear-related symptoms. The close proximity of the temporomandibular joint to the ear structures can result in referred pain and other issues. Some ear-related problems associated with TMJ disorders include:

• Ear pain or aching
• Tinnitus (ringing in the ears)
• A feeling of fullness or pressure in the ears
• Vertigo or dizziness
• Hearing changes or muffled hearing

These symptoms can sometimes be mistaken for primary ear problems, highlighting the importance of a thorough evaluation to determine their true cause. Addressing the underlying TMJ disorder often leads to improvement in these ear-related symptoms.

The Future of TMJ Disorder Treatment: Emerging Therapies and Research

As our understanding of TMJ disorders continues to evolve, researchers and medical professionals are exploring new treatment modalities and approaches:

• Regenerative medicine: Stem cell therapies and platelet-rich plasma injections for joint repair
• Advanced imaging techniques: Improved diagnostic accuracy through high-resolution MRI and 3D imaging
• Customized 3D-printed splints: Tailored devices for more effective bite correction
• Neurofeedback therapy: Training patients to control muscle tension through brain-computer interfaces
• Gene therapy: Targeting specific genetic factors that may contribute to TMJ disorders

While many of these approaches are still in the experimental stages, they offer hope for more effective and personalized treatments in the future. Continued research in this field may lead to breakthroughs that significantly improve the management of TMJ disorders and enhance the quality of life for those affected.

How do hormones influence TMJ disorders?

Hormonal factors appear to play a role in TMJ disorders, which may partly explain why these conditions are more common in women, especially during reproductive years. Estrogen receptors have been found in the temporomandibular joint, suggesting that fluctuations in estrogen levels could influence joint health and pain perception. Some research indicates that TMJ symptoms may worsen during certain phases of the menstrual cycle or during pregnancy. Additionally, the use of oral contraceptives and hormone replacement therapy has been associated with an increased risk of developing TMJ disorders in some studies. While the exact mechanisms are not fully understood, this hormonal connection highlights the complex nature of TMJ disorders and the need for individualized treatment approaches that consider hormonal factors.

Integrating TMJ Care into Overall Health Management

Managing TMJ disorders effectively often requires a holistic approach that considers overall health and wellness:

• Nutritional considerations: Anti-inflammatory diets may help reduce joint inflammation
• Sleep hygiene: Improving sleep quality can reduce pain sensitivity and promote healing
• Mental health support: Addressing anxiety and depression that may accompany chronic pain
• Physical activity: Gentle exercises to improve overall muscle tone and reduce tension
• Complementary therapies: Exploring options like acupuncture or massage therapy

By adopting a comprehensive approach to health, individuals with TMJ disorders can often achieve better outcomes and improved quality of life. This integrated strategy recognizes the interconnectedness of various bodily systems and the impact of lifestyle factors on jaw health.

How does posture affect TMJ health?

Posture plays a significant role in TMJ health, often in ways that may not be immediately apparent. Poor posture, particularly forward head posture, can place additional stress on the jaw joint and surrounding muscles. When the head is positioned forward of its ideal alignment, it can alter the resting position of the jaw, leading to increased tension in the facial and neck muscles. This misalignment can contribute to or exacerbate TMJ disorders. Improving posture through ergonomic adjustments, targeted exercises, and increased body awareness can help reduce strain on the temporomandibular joint and alleviate associated symptoms. Many TMJ treatment plans now incorporate posture correction as a key component, recognizing its importance in overall jaw health and function.

Temporomandibular Joint Disorders (TMJ & TMD): Overview

Written by WebMD Editorial Contributors

Medically Reviewed by Evan Frisbee, DMD on October 31, 2021

• What Causes TMD?
• What Are the Symptoms?
• How Is TMD Diagnosed?
• Home Treatments for TMD
• Traditional Treatments
• Other Treatments
• Surgery for TMD
• More

Your temporomandibular joint is a hinge that connects your jaw to the temporal bones of your skull, which are in front of each ear. It lets you move your jaw up and down and side to side, so you can talk, chew, and yawn.

Problems with your jaw and the muscles in your face that control it are known as temporomandibular disorders (TMD). But you may hear it wrongly called TMJ, after the joint.

We don’t know what causes TMD. Dentists believe symptoms arise from problems with the muscles of your jaw or with the parts of the joint itself.

Injury to your jaw, the joint, or the muscles of your head and neck — like from a heavy blow or whiplash — can lead to TMD. Other causes include:

• Grinding or clenching your teeth, which puts a lot of pressure on the joint
• Movement of the soft cushion or disc between the ball and socket of the joint
• Arthritis in the joint
• Stress, which can cause you to tighten facial and jaw muscles or clench the teeth

TMD often causes severe pain and discomfort. It can be temporary or last many years. It might affect one or both sides of your face. More women than men have it, and it’s most common among people between the ages of 20 and 40.

Common symptoms include:

• Pain or tenderness in your face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide
• Problems when you try to open your mouth wide
• Jaws that get “stuck” or “lock” in the open- or closed-mouth position
• Clicking, popping, or grating sounds in the jaw joint when you open or close your mouth or chew. This may or may not be painful.
• A tired feeling in your face
• Trouble chewing or a sudden uncomfortable bite — as if the upper and lower teeth are not fitting together properly. Learn more about the pros and cons of teeth alignment surgery.
• Swelling on the side of your face

You may also have toothaches, headaches, neck aches, dizziness, earaches, hearing problems, upper shoulder pain, and ringing in the ears (tinnitus).

Many other conditions cause similar symptoms — like tooth decay, sinus problems, arthritis, or gum disease. To figure out what’s causing yours, the dentist will ask about your health history and conduct a physical exam.

They’ll check your jaw joints for pain or tenderness and listen for clicks, pops, or grating sounds when you move them. They’ll also make sure your jaw works like it should and doesn’t lock when you open or close your mouth. Plus they’ll test your bite and check for problems with your facial muscles.

Your dentist may take full face X-rays so they can view your jaws, temporomandibular joints, and teeth to rule out other problems. They may need to do other tests, like Magnetic resonance imaging (MRI) or computer tomography (CT). The MRI can show if the TMJ disc is in the proper position as your jaw moves. A CT scan shows the bony detail of the joint.

You may get referred to an oral surgeon (also called an oral and maxillofacial surgeon) for further care and treatment. This doctor specializes in surgery in and around the entire face, mouth, and jaw area. You may also see an orthodontist to ensure your teeth, muscles, and joints work like they should.

There are things you can do on your own to help relieve TMD symptoms. Your doctor may suggest you try some of these remedies together.

Take over-the-counter medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), like naproxen or ibuprofen, can relieve muscle pain and swelling.

Use moist heat or cold packs. Apply an ice pack to the side of your face and temple area for about 10 minutes. Do a few simple jaw stretches (if your dentist or physical therapist OKs them). When you’re done, hold a warm towel or washcloth to the side of your face for about 5 minutes. Perform this routine a few times each day.

Eat soft foods. Add yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans, and grains to your menu. Cut foods into small pieces so you chew less. Skip hard, crunchy foods (like pretzels and raw carrots), chewy foods (like caramels and taffy), and thick or large bites that require you to open wide.

Avoid extreme jaw movements. Keep yawning and chewing (especially gum or ice) to a minimum and don’t yell, sing, or do anything that forces you to open wide.

Don’t rest your chin on your hand. Don’t hold the phone between your shoulder and ear. Practice good posture to reduce neck and facial pain.

Keep your teeth slightly apart as often as you can. This will relieve pressure on your jaw. Put your tongue between your teeth to control clenching or grinding during the day.

Learn relaxation techniques to help loosen up your jaw. Ask your dentist if you need physical therapy or massage. Consider stress reduction therapy as well as biofeedback.

Talk to your dentist about these tried-and-true treatments for TMD:

Medications. Your dentist can prescribe higher doses of NSAIDs if you need them for pain and swelling. They might suggest a muscle relaxer to relax your jaw if you grind or clench your teeth. Or an anti-anxiety medication to relieve stress, which may bring on TMD. In low doses they can also help reduce or control pain. Muscle relaxants, anti-anxiety drugs, and antidepressants are available by prescription only.

A splint or night guard. These plastic mouthpieces fit over your upper and lower teeth so they don’t touch. They lessen the effects of clenching or grinding and correct your bite by putting your teeth in a more correct position. What’s the difference between them? You wear night guards while you sleep. You use a splint all the time. Your dentist will tell you which type you need.

Dental work. Your dentist can replace missing teeth and use crowns, bridges, or braces to balance the biting surfaces of your teeth or to correct a bite problem. Learn more about what causes an overbite, as well as when an overbite is considered normal.

If the treatments listed above don’t help, your dentist may suggest one or more of the following:

Transcutaneous electrical nerve stimulation (TENS). This therapy uses low-level electrical currents to provide pain relief by relaxing your jaw joint and facial muscles. It can be done at the dentist’s office or at home.

Ultrasound. Deep heat applied to the joint can relieve soreness or improve mobility.

Trigger-point injections. Pain medication or anesthesia is injected into tender facial muscles called “trigger points” to give relief.

Radio wave therapy. Radio waves stimulate the joint, which increases blood flow and eases pain.

Low-level laser therapy. This lowers pain and inflammation and helps you move your neck more freely and open your mouth wider.

If other treatments can’t help you, surgery is an option. Once it’s done, it can’t be undone, so get a second or even third opinion from other dentists.

There are three types of surgery for TMD. The type you need depends on the problem.

Arthrocentesis is used if you have no major history of TMJ but your jaws are locked. It’s a minor procedure that your dentist can do in their office. They’ll give you general anesthesia, then insert needles into the joint and wash it out. They may use a special tool to get rid of damaged tissue or dislodge a disc stuck in the joint, or to unstick the joint itself.

Arthroscopyis surgery done with an arthroscope. This special tool has a lens and a light on it. It lets your doctor see inside your joint. You’ll get general anesthesia, then the doctor will make a small cut in front of your ear and insert the tool. It’ll be hooked up to a video screen, so they can examine your joint and the area around it. They may remove inflamed tissue or realign the disc or joint. This type of surgery, known as minimally invasive, leaves a smaller scar, has fewer complications, and requires a shorter recovery time than a major operation.

Open-joint surgery. Depending on the cause of the TMD, arthroscopy may not be possible. You may need this type of surgery if:

• The bony structures in your jaw joint are wearing down
• You have tumors in or around the joint
• Your joint is scarred or full of bone chips

You’ll get general anesthesia, then the doctor will open up the entire area around the joint so they can get a full view and better access. You’ll need longer to heal after open-joint surgery, and there is a greater chance of scarring and nerve injury.

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TMJ (Temporomandibular Joint) Disorders: Symptoms and More

The temporomandibular joint (TMJ) is the joint that connects your mandible (lower jaw) to your skull. The joint can be found on both sides of your head in front of your ears. It allows your jaw to open and close, letting you to speak and eat.

The abbreviation “TMJ” has also been used to refer to a group of health conditions related to your jaw. However, this is becoming more commonly abbreviated as “TMD” or “TMJD” to distinguish the temporomandibular joint itself from TMJ disorders.

These disorders can cause:

• tenderness at the joint
• facial pain
• difficulty moving the joint

According to the National Institute of Dental and Craniofacial Research, as many as 10 million Americans suffer from TMJ disorders. They are more common among women than men.

These disorders are treatable, but they have many different possible causes. This can make diagnosis difficult.

Keep reading to learn more about TMJ disorders. You should discuss any concerns with your doctor.

The symptoms of TMJ disorders depend on the severity and cause of your condition. The most common symptom of TMJ disorders is pain in the jaw and surrounding muscles.

According to 2021 research, other symptoms typically associated with these disorders include:

• pain that can be felt in the face or neck
• stiffness in the muscles of the jaw
• limited movement of the jaw
• locking of the jaw
• clicking or popping sound from the TMJ site
• dental issues, such as the wearing down of teeth
• tinnitus (ringing in the ear)
• vertigo
• headaches
• shift in the jaw, changing the way that the upper and lower teeth align (called malocclusion)

Symptoms may show up on just one side of the face or both.

Because TMJ disorders can have a variety of causes, there are also a variety of ways to treat them.

Physicians will typically advise starting with home treatments first. This is because many of the more complicated treatments still need more studies to prove their efficiency.

Home treatments

In a lot of cases, the symptoms of TMJ disorders can be treated with self-care practices at home. To ease the symptoms of TMJ at home, you can:

• Eat soft foods.
• Use ice to reduce swelling.
• Reduce jaw movements.
• Avoid chewing gum and tough foods (like beef jerky).
• Take measures to reduce stress.
• Use jaw-stretching exercises to help improve jaw movement.

Medication

If you find that your TMJ is not eased by using home treatments, some medications — both over-the-counter and prescribed by a doctor — may provide more relief.

Some of these medications include:

• nonsteroidal anti-inflammatory drugs (NSAIDs)
• corticosteroids
• muscle relaxers
• antidepressants
• local anesthetics

Your doctor will help you decide which medication is best for you, based on your personal condition and health history.

Therapies

Occasionally, your doctor may recommend physical therapy. Depending on the area that needs attention, your therapy could include:

• heat therapy
• cooling therapy
• acupuncture
• tissue mobilization
• resistance exercises
• stretches

If you and your doctor believe your TMJ disorder may be caused by stress, talk therapy or stress management exercises are additional options.

Surgery or other procedures

If your symptoms don’t improve with the methods listed above, your doctor may decide that your condition requires serious treatment.

Botox injections are one such treatment. Typically, these injections are done for painful trigger points or chronic teeth grinding. The evidence behind this treatment is still lacking, however.

In very rare cases, your doctor may recommend surgery to treat your condition. Procedures can include:

• corrective dental treatment to improve your bite and align your teeth
• arthrocentesis, which removes fluid and debris from the joint
• surgery to replace the joint

Procedures used to treat this condition may, in some cases, make your symptoms worse. Talk with your doctor about the potential risks of these procedures.

In many cases, it’s not known what causes TMJ disorders. Trauma to the jaw or joint may play a role. There are also other health conditions that may contribute to the development of TMJ disorders.

These include:

• arthritis
• erosion (wearing away) of the joint
• habitual grinding or clenching of the teeth
• structural jaw issues present at birth
• growth disorders

Risk factors

While there are some factors that are often associated with the development of TMJ disorders, they haven’t been proven to be a direct cause.

Some of these include:

• female hormones (it’s theorized that estrogen may play a role in the development of TMJ)
• poor posture that strains the muscles of the neck and face
• prolonged stress
• joint hypermobility

TMJ disorders can be difficult to diagnose. There are no standard tests to diagnose most of the disorders that fall under that title. A doctor may refer you to a dentist, or an ear, nose, and throat (ENT) specialist to diagnose your condition.

A healthcare professional may examine your to see if there is swelling or tenderness. They may also use several different imaging tests.

These can include:

• X-rays. X-rays of the jaw and teeth usually involve you biting down on a small mouthpiece as your dentist moves an imaging machine around your head. These X-rays will allow your dentist to see the bones in and around your jaw, as well as your teeth placement.
• CT scan. A CT scan of the jaw allows your doctor to see the bones and joint tissues in a more advanced way than a regular X-ray.
• MRI. An MRI of the jaw will reveal if there are problems with the structure of the jaw. An MRI, or magnetic resonance imaging scan, uses a magnetic field to show detailed images of organs and tissues.

You may not be able to prevent TMJ disorder from developing, but you might be able to reduce symptoms by lowering your stress levels, employing physical therapy and exercises, and working with a dentist or doctor if you often grind your teeth at night.

Possible solutions for teeth grinding include wearing a mouth guard at night and occasionally taking muscle relaxants.

Can TMJ disorder be cured?

TMJ can be caused by a variety of issues, such as trauma to the jaw or persistent stress, so curing the symptoms is directly connected to curing, or easing, the condition that caused them.

However, many individuals find that their TMJ symptoms improve or even go away on their own within weeks or months if home remedies are employed.

Are TMJ disorders serious?

While many people find their TMJ symptoms go away on their own after addressing the root cause, other individuals may deal with more serious symptoms that can affect their quality of life.

Even when someone is dealing with a more serious case of TMJ disorder, it’s recommended to avoid aggressive treatments such as surgery whenever possible, because there is still not enough evidence to show that these irreversible methods work.

There are a wide variety of treatments available for TMJ disorders. If one doesn’t work for you right away, work with your doctor to find one that does.

What will happen if TMJ disorder is not treated?

TMJ isn’t life threatening, but if it’s not treated, it can cause pretty persistent discomfort and tension in and around your jaw. It’s also possible that the affected joints could become inflamed, and there may even be damage to your teeth.

You don’t have to deal with the pain and discomfort of TMJ alone. Talk with your doctor or dentist about your symptoms.

The outlook for TMJ disorders depends on the cause of the condition. TMJ disorders can be successfully treated in many people with at-home remedies, such as changing posture or reducing stress.

If your condition is caused by a chronic (long-term) disease such as arthritis, lifestyle changes may not be enough. Arthritis can wear down the joint over time and increase pain. There are, however, many treatments to help with the symptoms of arthritis itself.

Most cases of TMJ disorder warrant changes in lifestyle habits, possibly combined with medications to ease pain and discomfort. Aggressive treatments are rarely needed.

Talk with your doctor about your options to determine what treatment is right for you.

Temporomandibular joint dysfunction (TMJ)

The temporomandibular joint is a paired organ that connects the lower jaw to the base of the skull. As you know, the lower jaw is the only movable bone that is capable of performing complex movements of the jaw in space. The most simple and understandable movements are opening and closing the mouth (up / down). But, we also know how to move the jaw to the right to the left, back and forth and an infinite number of combinations, when the movements occur simultaneously in all directions of the three-dimensional coordinate system. The movement vector is set by four pairs of the main masticatory muscles: masteterial (right and left), temporal (right and left), medial pterygoid and lateral pterygoid muscles of the right and left sides. Thanks to them, we open and close our mouths, bite and chew food, swallow, make sounds when talking, play musical instruments, bite our nails, bite walnuts, open beer bottles, kiss and much more. The jaw joint provides the possibility of such movements, while maintaining a strong and stable connection between the lower jaw (M/N) and the fixed bones of the entire skull.

Anatomy of the jaw joint

Describing the detailed anatomy of a joint in the format of a popular presentation is not so easy. We will try to do this without going into details, but by addressing important defining questions.

The articular part of the lower jaw is called the condyle. The condyle articulates with the articular fossa. The surfaces of these formations are incongruent and the sliding of the condyle along the surface of the fossa would be impossible if it were not for the intraarticular disc, which is a cartilaginous lining. Its upper surface is adapted to the shape of the fossa, while the lower surface is adapted to the shape of the condyle. This property eliminates incongruity.

When opening the mouth, the condyle (pos. 4), and with it the entire lower jaw, performs two types of movement:

• translational movement from the hole (pos.1) to the top of the hillock (pos.2)
• rotational movement (counterclockwise. arrows).

Simultaneously with the movement of the condyle, the articular disc also moves (pos. 3). And this is one of the easiest movements to describe. Many movements are much more complex and intricate.

In order for the joint to work in a normal mode, it is necessary to coordinate the work of all masticatory muscles, ligaments firmly attached to the condyle and the ligamentous apparatus holding the intraarticular disc.

What does TMJ dysfunction mean?

Any discoordination of the work of the elements of the joint is called dysfunction. The more pronounced violations of the interaction, the rougher the symptoms of arthritis or arthrosis coming in response to dysfunction.

The initial signs may be slight pain and appearing noises, clicks, crackling and crunching with various movements of the lower jaw.

As problems worsen, the abnormal sounds increase and the free and smooth movement of the mandible is disturbed. The opening of the mouth may occur unevenly, with a shift to the side or in a zigzag pattern. Pain can increase in intensity and capture or radiate to neighboring areas. Sometimes people report general headaches.

In difficult cases, mouth opening is drastically reduced and patients cannot chew food.

Causes of dysfunction of the jaw joint

The causes of joint dysfunction in the global sense are overloads. These may be short-term exposures or the result of chronic fatigue accumulated over a long period of time.

Short-term stress is sometimes referred to as acute injury. For example, hit. As a result of injury, ruptures and sprains of the ligaments occur, after which some muscles will be in hypertonicity, and the ligamentous apparatus will be unable to hold the elements in the correct ratio in relation to each other.

Many patients suffer from bruxism, which is certainly a chronic injury to the TMJ. Hypertonicity of the masticatory muscles and keeping the jaws in the position of closed teeth leads to overloading of the joint elements, impaired blood circulation, and compression of the intraarticular disc.

Can teeth cause dysfunction? Yes, the condition of the teeth and the nature of the bite also affect the condition and functioning of the jaw joint. So the bruxism described by us in a few years will lead to pathological abrasion of the teeth. Reducing the height of the teeth will lead to a change in the intermaxillary distance (the height of the lower third of the face decreases), and this leads to an increase in the load on the articular surfaces.

Do braces and orthodontic treatment prevent jaw disease?

Braces can prevent TMJ problems (be preventive), it really is. So the task of orthodontic treatment is the formation of such a type of bite, when any movement in the joint will be protected by correct, functional occlusion. This means that with any chewing movements of the lower jaw, the teeth must be guiding and determining for the trajectory of the glide of the articular process. The joint is limited from complete freedom of movement, which prevents overloading of its structures.

Let’s take a simple example of the sagittal movements of the lower jaw. In the case of sliding the dentition back and forth (imitating the final part of biting off food), the movements of the joint will be synchronized with the sagittal incisal path of reference (the trajectory of contact of the lower incisors with the palatal surface of the upper incisors).

If the shape of the slope of the articular tubercle (on which the condyle and articular disc slide) and the palatal surface of the upper incisors (on which the lower incisors slide) are not synchronized, then either the joint will receive excessive loads or the teeth will collapse from excessive pressure.

Similarly, the joint must be protected from overload during lateral masticatory movements. Lateral displacements in the joint must also be protected: When moving to the right, the canines of the working side should provide the right canine path, while moving to the left, the left canine path works.

Braces cause joint problems

But in life there are so-called iatrogenic diseases, when the doctor or the treatment prescribed by him was the cause of the problems. Unfortunately, braces can cause joint dysfunction. In orthodontics, a pathological distal occlusion is often found, due to the underdevelopment of the lower jaw. These are cases in which the chin appears to be underdeveloped and the entire lower jaw appears small or disproportionately receding.

In such cases it is necessary to increase the size of the mandible. But this is a difficult path and orthodontists are looking for ways to get around the complexity. Many choose the pernicious way of stretching the jaw forward, for greater beauty and harmony of the face. For this, Herbst devices, “Forsus bite corrector”, functional devices with an inclined plane of the Twin-block type are used.

After using such techniques, the face really improves. But what happens to the joint? Normally, the articular head is in the middle of the articular fossa. But after such treatment, in quotation marks, the condylar process moves forward to the top of the tubercle. The new position is not functional, since the ratio of the elements of the joint is sharply disturbed: the ligaments are overstretched, the intraarticular disc is in an unstable position, unable to adapt the articular surfaces. Therefore, his movements are not systemic, not coordinated. If it shifts, slipping out from under the condyle, a click or crack occurs. This situation over time leads to the erasure of the articular disc, in severe cases to its perforation.

The general chain of pathological changes is changes in occlusion for the sake of dental signs of occlusion and improvement of facial proportions, resulting in severe joint damage.

The ideal orthodontic treatment is also ambiguous for the temporomandibular joint

Gnathology is not an easy discipline, but we agreed to consider the problems of the joint at a popular level that is understandable to the common man. Here is one of the facts of the structure of the dentoalveolar system.

The sagittal incisal path is synchronized with the movement of the condylar process along the slope of the articular tubercle. Therefore, the depth of the incisal overlap correlates with the height of the articular tubercle.

In the case of a small incisal overlap, the articular tubercle is gentle and low

In the case of deep incisal overlap, the articular cusp is high and sheer.

It is this law of the structure of the dentoalveolar system that maintains the balance of forces, while maintaining the health of the joint and the integrity of the teeth. But how to be an orthodontist in each clinical case. After all, the final result of any treatment should be such that the depth of the incisal overlap is 2-3 mm. This means that the doctor is forced to neglect the structural features of the TMJ in order to meet the quality criteria.

Improvement in dental symptoms indicates quality treatment. But now the coordination of the work of the TMJ is broken.

Does your jaw move correctly?

Often, problems with teeth turn into a constant “headache”, and, in the truest sense of the word. A migraine, frequent discomfort when opening the jaw, eating, nighttime snoring settles in the life of a healthy person. For many, it remains a secret that the essence of the problem – dysfunction of the temporomandibular joint – is a consequence of malocclusion. We talked with Ramil Nailevich Gimadeev, chief physician of the City Dentistry dental complex on Vosstaniya, about how to find out that when such problems appear, you first need to go to the dentist.

How can TMJ problems be diagnosed?

Clicking, crunching in the jaw area, headaches, neck pain and the presence of snoring – all this can be associated with problems of the temporomandibular joint. The main difficulties that arise with the temporomandibular joint are associated with occlusion, in our understanding – bite. They lead to problems with the temporomandibular joint, so to speak, to its dysfunction. And dysfunction already leads to headaches, neck pain, and hearing loss.

Do I need to take any tests I have done to my doctor’s appointment? X-rays, for example?

To get started, you just need to come to the clinic and tell about your complaints. What research to do, the doctor decides on the spot. In this case, this is necessarily an x-ray examination, a computed tomogram, an orthopantomogram, a cephalometric image in a lateral, direct projection – this is again as necessary. We also need to make diagnostic models, on which we conduct a complete analysis of the state of bite today. There is no need to prepare pictures in advance, we will prompt and determine what is needed on the spot. But, of course, if any studies have already been carried out before, we can use them in our work, subsequently doing what we lack for a complete picture.

What are the pathologies of the TMJ?

The main problem is dysfunction, which includes an extended state and two more pathologies: arthritis and arthrosis. As we know, arthritis is a disease in which complaints of pain of varying intensity appear, ranging from a feeling of awkwardness, discomfort in the area of ​​the affected joint, and up to the complete shutdown of its function. One of the early and persistent symptoms of inflammatory arthritis is morning stiffness. Stiffness also occurs at other times of the day after a more or less long period of rest of the jaw. Arthrosis is a chronic dystrophic disease of the articular surfaces and meniscus of the temporomandibular joint, accompanied by pain in the masticatory muscles.

In any case, if you have the slightest manifestations of temporomandibular joint dysfunction or you are concerned about particular manifestations: someone snores heavily or grinds your teeth in your sleep, you can be advised to contact specialists who apply the technique of neuromuscular dentistry. And if your orthodontist, in addition to braces, uses methods to eliminate TMJ dysfunction, consider yourself lucky. An optimal bite will not only create a perfect smile and keep your teeth healthy, but also ensure proper posture and normal functioning of muscles and joints.

What methods of treatment of TMJ pathologies are used in the clinics of the City Dentistry network?

One of the methods of treatment of the temporomandibular joint is to achieve the correct occlusion, as we have already said – bite. To find the correct physiological state of the lower jaw in relation to the upper jaw, we use our diagnostic equipment that records the movement of the joint – this is gnathography, electromeography, selfography, it is by these parameters that we can diagnose the pathology of the TMJ – is there a perforation of the disc, some others changes, and from here a further treatment plan is already being built. In general, all ongoing activities are in any case an integrated approach that begins with sanitation – treatment of the entire oral cavity, orthodontics, if indicated, and leads, as a result, to the restoration of the lost bite height.

How long will it take to eliminate the existing TMJ pathology?

The minimum duration of treatment is from three to six months. But you need to understand that situations are different, so there are different methods of treatment and restoration of the physiological state of the TMJ. But, it is worth noting that the improvement in the quality of life comes much faster than the patient himself expects. Everything here depends on how quickly the diagnosis is carried out, and then the issue of restoring the final type of occlusion will be decided: this is the reconstruction of the bite or already orthodontics – the correction of various dentoalveolar anomalies using bracket systems of various functional effects.

One of the first to discover the connection between ear pain and impaired function of the temporomandibular joints was otolaryngologist Dr. James Costen, who worked in the 30s in the United States. He wrote a series of works in this direction, after some time, the term Costen’s syndrome was firmly established behind the problems associated with the TMJ joints.