Temporomandibular Joint Disorders

September 28, 2011

The National Institute of Dental and Craniofacial Research of the National Institutes of Health indicates that 10.8 million people in the United States suffer from temporomandibular joint (TMJ) problems at any given time. While both men and women experience Temporomandibular joint problems, 90% of those seeking treatment are women in their childbearing years.

Temporomandibular joint disorders (TMD) are one of the many causes of headache, facial pain, neck pain, and related symptoms. The Temporomandibular joint differs from any other joints in the body in that it has a hinge action similar to the movements of the knees, and a sliding action similar to movements of the wrists.

To locate the Temporomandibular joint, place your fingers on each side of your face, just in front of your ears and gently open and close your mouth. Upon opening the mouth, the rounded end of bone at the top of the lower jaw, known as the condyle, will glide along a groove in the bone on the temple area (known as the temporal bone). Upon closing the mouth, the condyle will slide back to its original position. This can be felt by holding the fingers over the Temporomandibular joint. A very thin soft disk lies between the condyle and the temporal bone. This disk acts as a shock absorber for the Temporomandibular joint during daily functions such as chewing, talking, and yawning. It is during these actions that the Temporomandibular joint and its surrounding muscles may be affected, resulting in any one of a number of uncomfortable conditions including Temporomandibular joint disorders.

Temporomandibular joint disorders generally falls into three main categories:

  1. Extracapsular (outside of the Temporomandibular joint) or myofascial (surrounding muscle) pain. This is the most common form of Temporomandibular joint disorders, which involves discomfort or pain in the muscles that control jaw function, as well as the neck and shoulder muscles. The pain involved stems from abnormalities in the tissues or muscles around the Temporomandibular joint.
  2. Intracapsular disorders or internal derangement of the Temporomandibular joint refer to disorders within the joint itself. There is an abnormal joint structure interfering with or restricting normal joint function during movement of the jaw (mandibular movement). This involves a dislocated jaw, displaced disk, or injury to the condyle.
  3. Degenerative joint disease. This includes disease of the bone in the jaw such as osteoarthritis or rheumatoid arthritis in the Temporomandibular joint.

SIGNS AND SYMPTOMS

  1. Pain or discomfort in front of the ears, in the ears, in or behind the eyes, at the base of the skull, in the temple areas, at the top of the head, or in the cheekbone area.
  2. Inability to chew hard or sticky foods, to talk for long periods of time, or to open the mouth very wide.
  3. Clicking, popping, or grating noises in the joint during movement.
  4. Inability to put the teeth together without pain, dislocation of the jaw, or locking of the jaw.
  5. Other symptoms that do not seem related such as dizziness, fatigue, or visual problems.

A physical examination will include taking a proper history of mouth-related problems. Palpation (hands-on physical examination of the joint by the practitioner) properly done is a very effective tool in detecting tender, uncomfortable, and painful areas. Further clinical investigation may include specialized diagnostic procedures such as making a model of the joint and x-ray (radiographic) analysis.

The clinician may find one or more of the following during physical examination:

  1. Facial asymmetry, such as different eye levels, deviation of the nose or chin to one side, too much or too little height in the lower third of the face.
  2. Limited or excessive range of mouth opening.
  3. Abnormal pattern of movement of the lower jaw on opening or closing.
  4. Malocclusion (bad bite), such as missing, shifted, rotated, or tipped teeth.
  5. Abnormal joint sounds such as clicking or cracking (crepitation).
  6. Muscle rigidity.
  7. 7. Radiographic (x-ray) findings such as displaced or poorly shaped condyles.
  8. 8. Soft tissue findings such as disk displacement.

A significant percentage of patients will respond to conservative noninvasive (nonsurgical) treatment that includes thorough patient education. Nonsurgical treatment options include physical therapy; biofeed-back with an occupational therapist; nonsteroidal anti-inflammatory medications; or a night guard, splint, or other mouth (orthotic) device that helps patients stop clenching or grinding their teeth while they sleep.

Dentists and specialists in the field of dentistry such as orthodontists, oral surgeons, and prosthodontists can be of great assistance in identifying and treating Temporomandibular joint disorderss.

See Also: Arthritis, Headache, Sleep disorders

Suggested Reading

  • Abdel- Fatteh, R. (1992). Evaluating Temporomandibular joint injuries. New York: Wiley.
  • Fricton, J. R., Koening, R. J., & Hathaway, K. M. (1998). Temporomandibular joint and craniofacial pain: Diagnosis and management. Philadelphia: W.B. Saunders.
  • Okeson, J. P. (1992). Management of temporomandibular disorders and occlusion (3rd ed.). St. Louis, MO: Mosby-Year Book.

 

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