TMJ DISORDERS

The TMJ or temporomandibular joint is the small joint located directly in front of the ear. This joint allows for movement of the lower jaw during opening and closing. TMJ disorders, dysfunction, and TMD are terms that describe a malfunction or problem related to this joint and its associated components, mainly its muscles and ligaments.

As you open and close during chewing, speaking, and swallowing this complex joint and its associated muscles are put in function, When all the elements are in harmony this joint operates smoothly and without pain. However, an abnormality in this system may result in difficulty in opening, clicking, popping or grating noises, and in many cases moderate to severe pain.

Patients who suffer with these symptoms are diagnosed as having a TMJ disorder.

Temporomandibular Joint

The TMJ or temporomandibular joint is a ball and socket joint similar in many ways to other joints of the body. The ball portion known as the condyle and the socket is called the articular fossa. Between these two bony components is the joint disc or meniscus, which is made of cartilage. This disc allows for smooth function and aids as a cushion between the condyle and the articular fossa.

Normal TMJ	Disc Displacement	Degenerative Joint Disease or Arthritis

Ligaments support and stabilize the disc and condyle and together with the surrounding muscles allow for proper movement of the lower jaw during functions such as chewing, speaking and swallowing.

Symptoms of TMJ Disorders

TMJ disorders encompass a wide variety of symptoms ranging from mild muscle discomfort to a potentially debilitating condition. These varied symptoms are all due to an abnormality of the jaw joint and its surrounding structures. In many cases trauma to the joint due to grinding and clenching of the teeth is the cause. Frequently clenching and grinding is increased during periods of emotional stress. Trauma to the joint can also be the result of a blow to the chin during a motor vehicle accident or a sport related incident. Trauma regardless of its cause may result in displacement or tearing of the joint disc. This causes pain and an interference with normal jaw function. Patients who suffer from TMJ disorders exhibit a wide range of symptoms. The following symptoms and signs however are extremely common.

1. Discomfort of the facial region generally above and in front of the ear



2. Noise in the jaw joint on opening and closing that is described as a popping, clicking, or grating sound



3. Frequent headaches and neck aches



4. Locking of the jaw and or painful opening and closing



5. Habits such as grinding or clenching of the teeth



6. A history of direct trauma of the chin or jaw joint region

The presence of one or more of these symptoms does not confirm the diagnosis of a TMJ disorder. These symptoms are common in a wide variety of diseases. Proper clinical examination and appropriate testing are necessary to make a proper diagnosis.

TMJ Evaluation and Examination

When symptoms of a TMJ disorder begin patients generally seek the care of an oral and maxillofacial surgeon. An oral and maxillofacial surgeon is a specialist in the areas of the jaw and facial region and has the expertise to diagnose TMJ disorders. In order to make a proper diagnosis, information is obtained in three ways.

1. Medical History
2. Clinical Examination
3. Radiographic Examination

Following completion of a thorough medical history the oral and maxillofacial region is examined. This examination begins with a detailed review of the history of the presenting problem. This includes the onset, duration, location and character of the pain or dysfunction. A physical examination involving the head, neck and TMJ regions would follow to further evaluate the degree of dysfunction. In some cases it is necessary to order a specific test to confirm or eliminate a diagnosis of a TMJ disorder. These tests typically are x-rays, MRI or CAT scans.

Treatment Options

Treatment of TMJ dysfunction varies depending of the diagnosis and degree of dysfunction. They may include jaw exercises, cold or hot pack applications, medications, electrical stimulation, biofeedback, and others. The use of a night guard or occlusal splint is in many cases extremely effective in reducing pain and restoring normal function. In most cases non-surgical modalities are quite effective. Patients are generally able to regain normal function with the absence of pain.

In those cases where non-surgical modalities are ineffective surgical intervention may be indicated. Surgery in our office is only considered in those cases where the diagnosis indicates a specific problem involving the joint. Surgical procedures are performed in much the same way as in other joints of the body. In some cases an arthroscope or miniature camera is used to view the joint while performing the surgical procedure. In cases where arthroscopic surgery would be ineffective in correcting the problem an open joint procedure or Arthroplasty is performed. This procedure involves surgical exposure of the joint and surgery under direct vision. In extreme joint deterioration joint replacement surgery may be necessary.