Temporomandibular Joint Disorders
Jaw Joint Disorders
Do You Have a TMJ Disorder?
- Are you aware of grinding or clenching your teeth?
- Do you wake up with sore, stiff muscles around your jaws?
- Do you have frequent headaches or neck aches?
- Does the pain get worse when you clench your teeth?
- Does stress make your clenching and pain worse?
- Does your jaw click, pop, grate, catch, or lock when you open your mouth?
- Is it difficult or painful to open your mouth, eat or yawn?
- Have you ever injured your neck, head or jaws?
- Have you had problems (such as arthritis) with other joints?
- Do you have teeth that no longer touch when you bite?
- Do your teeth meet differently from time to time?
- Is it hard to use your front teeth to bite or tear food?
- Are your teeth sensitive, loose, broken or worn?
The more times you answered “yes,” the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they’re treated.
Understanding TMJ disorders will also help you understand how they’re treated. The temporomandibular joint apparatus (jaw joint) is an integral part of the masticatory apparatus. It differs from other joints in several ways. First, it is a complex joint with an articular disc made of specialized fibrocartilage. It is capable of an unusual combination of hinging and gliding movements. Second, it is exceptional because of the spacial relationships of its component parts are influenced not only by muscular balance and structural anatomy, but also by occlusion (bite) and malocclusion (abnormal bites). Third, it is unique because the joints cannot operate independently; both operate as a single functional unit, but together. Any alteration in the activity of one side will therefore affect the other.
How Does the TMJ Work?
The temporomandibular joint (TMJ) consists of three major bony anatomical elements. The condyle is the “ball” that fits and hinges with the socket on the skull. It actually is football shaped and is typically smooth on the surface. The fossa is the “socket” located on the skull that accepts the condyle. In front of the fossa is ridge of bone called the “eminence“. This ridge is important and acts as a guiding plane during condylar function. So in fact, the TMJ functions more like a rolling pin on a breadboard as opposed to a ball-in-socket.
The TMJ also contains the disk, which is located between the condyle and the fossa padding the contact between these two bones. This fibrocartilagenous disk is somewhat similar to the meniscus located in the knee and can also be injured or displaced.
When opening the mouth to about the width of your thumb, the condyle will simply rotate in the fossa. To open wider though, the condyle is pulled out of the fossa (translated) by muscle and rises up onto the eminence. This also allows us to move our lower jaw forward and side-to-side for normal chewing. Displacement of the disk or degeneration on the surfaces of the bony components can cause pain and decreased range of motion. It can also be the origin of joint noises like clicks, pops, and grinding.
Trouble with Your Jaw?
TMJ (temporomandibular joint) disorders are a family of problems related to your complex jaw joint. If you have had symptoms like pain or a “clicking” sound, you’ll be glad to know that these problems are more easily diagnosed and treated than they were in the past. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important. No one treatment can necessarily resolve TMJ disorders completely and treatment takes time to be effective. Drs. Elias, Stephens and Verratti can help you have a healthier and more comfortable jaw.
TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. Or, you may have a damaged jaw joint due to injury or disease. Whatever the cause, the results may include a misaligned bite, pain, clicking or grating noises when you open your mouth, or trouble opening your mouth wide.
Treatment of TMJ Dysfunction
There are various treatment options that Drs. Elias, Stephens and Verratti can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder we will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care as well as professional care.
Proper diagnosis is tantamount to proper therapy. This is true in every aspect of our practice. Many modalities for diagnosis are currently available including sound clinical evaluation, plain film radiology and tomography, magnetic resonance imaging (MRI), CT imaging, and diagnostic arthroscopy. All of these modalities can aid in our understanding of a patient’s TMJ dysfunction.
Therapy can be divided into two categories, Non-surgical and Surgical therapy. These do not necessarily equate with conservative vs non-conservative therapy. Each has its place and time in patient care.
At The Pacific Coast Center for Oral, Facial and Cosmetic Surgery, correction of TMJ disorders is frequently oriented toward non-surgical therapy with the use of occlusal orthotics, physical therapy, stress reduction, and non-steroidal anti-inflammatories (NSAIDS). Each patient generally is placed on a non-surgical regime and reevaluated periodically to monitor their progress.
Those patients who do not respond well to non-surgical therapy are then re-evaluated for surgical care. Surgical care is generally provided through diagnostic and operative arthroscopy or arthrotomy and arthroplasty. Occasionally, total joint reconstruction is considered.
Frequently, many TMJ patients can be treated non-surgically. The fabrication and insertion of occlusal orthotics (bite splints) can relieve the stresses on the joint and relieve the frequent muscle spasms that are associated with TMJ dysfunction. Frequently, the use of these devises can relieve the pain associated with muscle spasms and effectively treat your pain.
Arthroscopy (surgery through an endoscope) is a minimally invasive procedure done on an out patient basis and in carefully selected patients, can provide excellent results with minimal postoperative discomfort. A small cannula is inserted into the superior or inferior joint space thus allowing the placement of a miniature video camera. The video picture is then projected on a video monitor in order to allow diagnostic evaluation and to visualize the operative site for manipulative procedures. A second cannula is then inserted which can be used to introduce operative instruments and to provide for lavage (rinsing) of the joint. Various operative and diagnostic procedures can then be performed, including laser surgery. This procedure is performed as an out patient under a general anesthetic for your comfort and safety.
Arthrotomy (open joint surgery) is usually reserved for those patients who have conditions not amenable to arthroscopy and have significant daily dysfunction and/or pain. Surgery is done through a very esthetic incision in front of the ear allowing access to the joint capsule and condylar apparatus. When disc replacement necessary, autogenous (natural) materials can be used. When condylar replacement is necessary, autogenous costochondral (rib) grafting or total joint replacement (prosthetic joint) may be recommended. Frequently, as with all joint surgery, care must be taken to avoid the initial etiologic (causative) factors by which the joint became diseased. Also, postoperative physical therapy is usually carried out for several months in order to achieve maximum range of motion and function.
We at The Pacific Coast Center for Oral, Facial and Cosmetic Surgery feel very comfortable treating all complexities of TMJ dysfunction. In addition, orthodontic care is sometimes recommended with potential surgical correction of skeletal malformation in order to normalize the biomechanical forces on the joint apparatus. Physical therapy and psychological counseling for stress relief are also important aspects of the total care of the TMJ dysfunction patient.
Ultimately, we must keep in mind that TMJ dysfunction is not life threatening but can greatly affect the quality of the patient’s life. Surgical correction of TMJ disorders is generally predictable and minimally disruptive to the patient’s life style.