TEMPOROMANDIBULAR JOINT DISORDERS

The Temporomandibular Joint (TMJ) is located in front of your ear. It is the joint between your lower jaw bone (mandible) and the base of the skull. . The joint allows the lower jaw to move and function.

A joint is where two bones meet. Joints allow movement and flexibility of various parts of the body. The movement of the bones is cased by muscles which pull on tendons and ligaments that are attached to bone. Cartilage covers the end of bones. In the jaw joint, there is also a cartilage disc within the joint. Inside the joint there is a small amount of thick fluid called synovial fluid. This fluid lubricates the joint which allows smooth movement between the bones. The TMJ joint moves each time you chew, talk ,yawn, laugh and each time you swallow .It is, therefore, one of the most frequently used of all joints of the body and one of the most complex.

Facial Pain { image missing}

Problems affecting this joint can be called TMJ disorders, TMJ dysfunction or TMJ pain. These disorders may affect the jaw joints, the muscles that control jaw movement and the dental occlusion (bite). TMJ disorders are disorders arising from an imbalance in the delicate working relationship of the jaw and skull with the muscles that move the jaw, as well as the nervous system associated with these systems. This imbalance results in muscle fatigue, spasm and/or joint dysfunction, and even changes in the teeth, which in turn cause a variety of symptoms, unique for each person. Temporomandibular joint dysfunction is ill-understood, but up to 10% of the population may be affected at some time in their life. It is important to realise that jaw joint problems, although a nuisance, are not serious and usually respond to relatively simple measures over a period of time. Patients themselves can manage most of these treatments.

The most common symptoms are:

• Joint noise – such as clicking, cracking, crunching, grating or popping. However clicks or noises can sometimes be heard coming from the jaw joint when you chew or move your mouth. These noises can be quite normal, so they are only relevant if you have other symptoms in the joint such as pain or reduced movement.
• Pain is usually a dull ache in and around the ear which may radiate along the cheekbone or downwards into the neck. However the pain may be sharp and searing, occurring each time you swallow, yawn, talk, or chew. It often causes spasms in the adjacent muscles that are attached to the bones of the skull, face, and jaws. Then, pain can be felt at the side of the head (the temple), the cheek, the ear, the lower jaw, and the teeth.
• Headache
• Reduced mouth opening. This may be a general tight feeling or a sensation of the jaw getting stuck. Very rarely, the jaw may get ‘locked’, causing difficulty in opening or closing the mouth.
• Most jaw joint problems are made worse by chewing and are aggravated at times of stress.

TMJ disorders are of two types:

• Problems related to the muscles working the joint, or problems in the joint itself. Muscle problems are usually the most common cause, especially in younger people.
• Problems in the joint itself are less common.

Muscular problems may be due to overactivity of the jaw muscles. This may occur if you clench your jaw a lot during sleep, which is quite common. Another cause of muscle-type problems is when the muscles around the jaw joint become more sensitive to pain. Psychological factors and stress can increase TMJ joint symptoms.
Joint problems may be caused by normal wear and tear of the joint, or of the cartilage disc inside the joint. This tends to affect older people.
Arthritis, which means joint inflammation, may also cause problems. Rarely, the jaw joint can dislocate (meaning the bone slips out of its normal place in the joint).

Diagnosis.

A thorough medical history and examination is critical in diagnosing TMJ disorders.Often, no tests are necessary if you are healthy and have symptoms that are typical of a TMJ disorder x-rays are usually required and in specific cases patients are referred for an MRI.

Treatment

Treatment is aimed at trying to reduce the workload of the muscles so allowing the disc of cartilage to return to a normal position in the joint. Most problems in the jaw joint can be helped with simple treatments and advice on how to rest the joint.

• You can rest the joint by eating soft food and not using chewing gum. A soft diet that requires little chewing allows over-worked muscles to rest.
• Avoid opening the mouth very wide – so don’t do too much singing, and try not to yawn too widely
• Identifying and stopping any habits, such as clenching or grinding. These may be “subconscious”, i.e. you may not be aware of them. Splints or ‘bite guards’, which cover the teeth at night may be beneficial where teeth grinding are problematic.
• Reducing stress by relaxation therapy and learning techniques to control tension and stress
• Massaging the muscles and applying warmth (warm water in a hot water bottle wrapped in a towel applied to the side of the face) may help.
• Jaw exercises can help the jaw muscles to work better so that there is less strain on the jaw joint area. The exercises that are best for you will have been discussed in clinic.

Painkillers such as paracetamol, ibuprofen or codeine may help. Sometimes a small dose of an antidepressant medication is prescribed for a few days. The anti depressant medication acts as a muscle relaxant and reduces the spasm of the muscles surrounding the jaw joint.

TMJ treatments:

If there is an underlying condition, for example, a type of arthritis which is contributing to the TMJ disorder, this may need treating in its own right. An injection of steroid into the joint may help.

Surgical treatment is only undertaken after very careful evaluation and trial of conservative treatment. This can involve manipulation of the joint whilst you are asleep or more rarely surgery carried out with a mini telescope. In extreme cases it may be necessary to open the joint and operate on the bones, cartilages and ligaments.

Most TMJ disorders improve over time It is very rare to get any complications with this condition. However, a small minority of patients are regrettably sufferers from chronic facial pain which is never really relieved to their satisfaction.