Temporomandibular
Joint (TMJ) Disorders There are mllions of people the world
over who suffer from such seemingly disparate symptoms as headaches,
earaches, tenderness of the jaw muscles, or dull, aching facial
pain often share a common problem. They all suffer from TMJ. The
term "TMJ" Disorder is the acronym for "Temporomandibular
Joint". This is the ball and socket joint that allows the lower
jaw to open, close and move sideways when chewing and speaking.
Everyone, of course, has two of them, and they are located about
one centimeter in front of the ears. They are the only joints in
the head. These disorders can have a variety of causes and are believed
to result when either one or both of them - the chewing muscles
and jaw joints - do not work together correctly. In many cases,
TMJ disorders can be successfully treated
The TMJ is typical of the type of joint called a "ball
and socket". The ball is the rounded eminence visible in the
detail to the right and is technically known as the "condyle"
of the joint. The ball rotates in a cuplike depression (the socket)
technically known as the "fossa". Although the joint looks
like it is attached directly to the sinuses, it is actually separated
from them by soft tissue ligaments that entirely enclose the joint,
but are not visible on an x-ray. Also not visible is the meniscus,
which is a disk of cartilage that lives in the space between the
condyle and the fossa and is capable of moving forward and backward
as the jaw opens and closes. The condyle and the fossa are each
covered with a thin layer of non movable cartilage of their own.
All three layers of cartilage help to provide smooth, frictionless
surfaces for comfortable joint operation.
HOW THE CHEWING MUSCLES AND JAW JOINTS WORK
The structures that make it possible to open and close the mouth are
very specialized and work together when you chew, speak and swallow.
These structures include the muscles, ligaments, bones and joints
of the jaw. There are five pairs of muscles that allow you to open
and close your mouth. They also control forward, backward, and side-to-side
movements of the lower jaw, in which temporomandibular joints are
involved providing functional movements. Each of these important joints
has two sections, connected by a disk, that make possible the hinge
and gliding actions needed to open the mouth widely.
Any problem that prevents this complex system of muscles, ligaments,
bones, and joints from working together properly may result in a TMJ
disorder. There are a multitude of factors that contribute to TMJ.
Body alignment problems could be one, but there are also other factors.
These are:
The hereditary connective tissue disorder called
Ehlers-Danlos syndrome. TMJ is common in people with Ehlers-Danlos
syndrome, Marfan syndrome or other connective tissue disorders. Besides
TMJ, other common features of connective tissue disorders are mitral
valve prolapse, hypermobile joints (also called being double jointed),
myopia (nearsightedness), irritable bowel syndrome, fibromyalgia,
pectus excavatum (sunken chests), scoliosis, hearing problems, anxiety
disorders, heart palpitations, poor wound healing and bleeding problems.
Some people, especially women, with connective tissue disorders have
what is called a Marfan habitus or mitral valve prolapse syndrome.
They are tall and thin with long arms and legs, scoliosis and/or a
chest deformity such as pectus excavatum or pectus carinatum.
When a dentist thinks of TMJ, he or she tends to think more globally
than just the anatomy of the joint. The joint is really a part of
the larger system that makes the jaws work. They include MPD (MyoFascial
Pain dysfunction), MFPDS (MyoFascial Pain dysfunction Syndrome), and
the more general TMD (TemperoMandibular Dysfunction).
SIGNS AND SYMPTOMS OF TMJ DISORDERS
TMJ disorders have many signs and symptoms. Some of the most common
include the following: • Pain in or around the ear. This
pain often spreads to the face. • Tenderness of the jaw
muscles. • Clicking/popping noises when one opens or closes
the mouth. • Difficulty in opening one's mouth. •
Jaws that get stuck, lock, or go out. • Pain brought on
by yawning, chewing, or opening the mouth widely. • Certain
types of headaches or neck aches.
Your dentist can determine the cause of your symptoms by conducting
a series of diagnostic tests. These may include a complete medical
history, a clinical examination, X-rays, and casts of your teeth.
Your dentist may refer you to a physician or to another dentist. This
procedure may seem time-consuming, but proper diagnosis is an important
step before treatment. It can save time and money by ensuring that
you receive the treatment appropriate for your particular problem.
CAUSES OF TMJ DISORDERS
TMJ disorders often result when the chewing muscles and the temporo-mandibular
joint do not work together correctly. When this occurs, the muscles
often cramp. This spasm can then become part of a cycle that results
in tissue damage, pain and muscle tender-ness.
Although accidents such as injuries to the jaw, head or neck, or diseases
such as arthritis, may result in some TMJ problems, factors relating
to the teeth and bite are also believed to be common causes of TMJ
disorders.
Among these factors are the following:
Oral habits such as clenching the teeth or grinding the teeth. These
habits can tire the muscles and cause them to go into spasm. The spasm
causes pain, which in turn causes more spasm. The end result of this
spasm-pain-spasm cycle may eventually be a TMJ disorder. Many people
unconsciously "clench" their teeth during the day, often
in response to unperceived environmental stressors.
Problems in the way the teeth fit together or bite. Improperly aligned
teeth can sometimes place the chewing muscles under stress and cause
them to go into spasm, thus setting off the harmful cycle described
above. Oral habits and problems with the bite often work together
to cause TMJ disorders.
In many cases, TMJ disorders stem from a condition called malocclusion,
which means having a “bad bite” or accidents and trauma.
Malocclusion means that your upper and lower teeth do not close together
in the correct way—they are misaligned. This includes underbite
and overbites. When the teeth are misaligned, they cannot provide
the support the muscles in the face need for chewing and swallowing.
These muscles are then forced into a strained position, resulting
in pain throughout the face, head, arms, shoulders, and back. Although
a person may have beautiful teeth or had orthodontics to line the
teeth up for aesthetic reasons, the muscles and joints may not be
comfortable.
Predisposing factors: Gender
TMD affects women more than it does men. This is due partly to the
differences in bone and muscle densities between the two sexes, and
partly to differences in psychological outlook and worldview.
Age
Like most natural phenomena, the occurrence of serious TMD happens
along a "bell shaped curve" with the vast majority of the
sufferers falling between the ages of 25 to 45. TMD is not forever.
This implies that it is associated with psychological and physiological
variables that change throughout life.
Posture
In a normal relaxed state, the lower jaw, affected by gravity, tends
to drop into eccentric positions away from the position in which the
upper and lower teeth would normally come together. This is especially
true in persons who tend to hold their heads so that their jaw line
is not parallel to the floor (perpendicular to the force of gravity).
Normally, this causes no problems, however persons who grind or clench
their teeth may grind in these unusual positions.
Occlusion It
is the way your upper and lower teeth come together.
Whenever something disturbs the way they come together, say a new
filling or a lost tooth, this can effect the relative positions of
the two TM Joints. Grinding or clenching in these eccentric positions
can cause muscle splinting (cramping) and joint problems.
Sleep disorders
Many people do not sleep well due to several physiologic factors like
snoring and sleep apnea). Nighttime muscle hyperactivity can lead
to bruxism (grinding and clenching) and thus waking with headaches,
neck aches, earaches and tooth sensitivity.
TREATMENT
FOR TMJ DISORDERS
Since the teeth, chewing muscles and temporomandibular joints all
can be involved in a TMJ disorder, treatments vary. If pain and other
symptoms persist, a more involved treatment, such as changing the
way your teeth fit together, or even surgery, may be needed. However,
surgery is recommended only when a precise cause of the disorder has
been pinpointed and usually should not be undertaken until more conservative
treatments of the disorder have been tried first.
Some common methods of treating TMJ disorders are listed below:
1. Elimination of Spasms and Pain - This can be done
by applying moist heat to the face, using prescribed muscle relaxants
or other medications, massaging the muscles, and eating soft, non-chewy
foods. These are especially helpful for acutely painful flares. Bite
plates or occlusal (bite) splints can also be made. This treatment
helps to eliminate the harmful effects of clenching or grinding the
teeth. Bite guards/splints are more helpful over time to prevent acute
flares.
2. Counseling or Biofeedback/Relaxation Training
- Many times counseling is used along with other forms of treatment.
If emotional stress is the factor that causes clenching or grinding
of the teeth, that stress should be reduced or eliminated. Biofeedback,
a relaxation technique that teaches people to control tension throughout
various parts of the body with the aid of an electronic monitoring
device, can also be helpful in reducing muscle tension in the jaw.
Such mind/body techniques as the Alexander Method can be helpful in
muscle re-education.
3. Correcting the Way the Teeth Fit Together - If
your bite is incorrect or uneven, it can be adjusted by selective
grinding of the teeth. Orthodontic appliances (braces) and other dental
procedures may also be used to reduce problems caused by improperly
aligned teeth.
4. Surgery - If muscle spasms have occurred for long
periods, the TMJ itself may become injured or arthritic. In addition
the bones and soft tissues of the TMJ may slip out of normal position
because of trauma such as a blow to the head, or some other cause.
Occasionally, in cases such as these, surgery may be needed to correct
the TMJ problem.
Deprogrammers: Another
device that has recently come onto the market is called the NTI (for
Nocireceptive Trigeminal Inhibition). It is a proprietary device,
which fits over the top front teeth and accomplishes the same thing
as the butterfly deprogrammer. For more details to go to the inventor's
site nti-tss.com.
In some cases, you may be required to wear a dental splint that is
designed to help you reduce grinding and clenching. This plastic device
fits over the top or bottom teeth and will not create any serious
disturbance to your daily routine. In extreme cases of TMJ disorder,
TMJ treatment may involve some form of surgery that can range from
tightening the TMJ joint ligament to restructuring the TMJ to replacing
the TMJ.
Depending on the type of TMJ disorder that you are suffering from
and the extent of the TMJ disorder, you will undergo TMJ treatment.
TMJ treatment includes an emphasis on jaw rest, the applications of
heat or ice to help relieve jaw pain, and the use of anti-inflammatory
medication. Additionally, your doctor may recommend physiotherapy
that emphasizes muscle stretching and relaxing exercises. In turn,
you will be expected to change aspects of your daily behavior to combat
your TMJ disorder. You will have to avoid: chewing gum, eating hard-to
chew-foods, and opening your mouth wide to ensure that you do not
worsen your TMJ condition.
Follow the recommendations dentist and other health professionals
give you and discuss with them any concerns you may have. Remember,
in many cases the pain, headaches, and other symptoms associated with
TMJ disorders can be successfully treated.
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Statutory Warning: The information is intended
to help you better understand dental conditions and procedures and should
not be construed as specific medical advice or recommendation. The general
information provided here is not a substitute for a consultation with the
dentists. Only personal discussion of your individual needs with a professionally
qualified doctor / dentist will determine the best method of treatment suitable
for you.
ABOUT US 
TMJ disorders have many signs and symptoms. Some of the most common
include the following:
It
is the way your upper and lower teeth come together.
Another
device that has recently come onto the market is called the NTI (for
Nocireceptive Trigeminal Inhibition). It is a proprietary device,
which fits over the top front teeth and accomplishes the same thing
as the butterfly deprogrammer. For more details to go to the inventor's
site nti-tss.com.