A balance exists between how the teeth fit together, how the jaw joints function and how the muscles that move and support the jaw position function.  This relationship is either in balance or it may become compromise.  Researchers estimate that at least 35% of the people have some form of jaw joint problem, but most are unaware of the causes and/or the means to control these causes.  The condition appears to be more common in women than men. This may be related to the difference in scar tissue that occurs and this may be related to a difference in the body chemistry between men and women.  TMJ is referred to by different names such as TMD, TMJ disorder, and TMJ dysfunction.
 
For most people, pain in the area of the jaw joint or muscles is a sign of a serious problem.   The earlier these situations are discovered and addressed usually means the easier, and more simple and less costly they are to manage.  These situations do not self-correct, so professional intervention is usually required to intercept the problems in an early stage when conservative measures will be appropriate.  Left to degenerate, often these situations require extensive and expensive management steps to prevent long-term debilitation.

What is the temporomandibular joint?
What are TMJ disorders?
What causes TMJ disorders?
What are the signs and symptoms?
How are TMJ disorders diagnosed?
How are TMJ disorders treated?
Conservative Treatments 

Comprehensive Treatments

Long-term Management

What is the temporomandibular joint?

The temporomandibular joint is actually two joints in one.  There is a lower part of the joint which is the ball of the lower jaw and the disc.  The upper part of the joint is comprised of the disc and the joint socket (base of the skull).  The disc begins to develop around the time the permanent teeth erupt, so there is a relationship between the tooth position and function and the development of the disc.  The jaw joint is a actually held in place by muscles that move the jaw enabling us to talk, chew, and yawn. Muscles and ligaments control the jaw position and movement until the teeth contact.  Once the teeth contact the teeth determine the final position of the lower and upper jaw.
 
When we open our mouths, the rounded ends of the lower jaw, called condyles, turn (rotate) against the bottom side of the disc.  As we continue to open the disc glides along the front surface of the joint socket of the temporal bone. The condyles turn against the disc and the disc glides against the socket when we open and close our mouths. To keep this motion smooth, a lubricating solution (synovial fluid) is made by small membranes within the front and back of the joint.  This fluid is absorbed by the disc and serves to help keep these tissues alive and function properly as the disc absorbs shocks to the jaw joint from chewing and other movements.
 
The temporomandibular joint is different from the body’s other joints.  This is due to the joint being covered by a special cartilage (fibrocartilage).  Fibrocartilage is unique as it can change over time as it responds to forces applied to the cartilage covering the ball and socket and the cartilage that comprises the central region of the disc.  The disc is attached to a muscle on the front and has an elastic type of ligament in the back along with fat cells, arteries, veins and nerves  
 
 The tissues of the joint are highly innervated and have a rich supply of blood, except the central region of the disc.  This central region is designed to withstand pressure as the synovial fluid moves into and out of this central region when compressed or when pressure is released.  The combination of motions and structures makes this joint one of the most complicated joints in the body.  Also the tissues that make up the joints differ from other load-bearing joints as the functioning surfaces are covered by fibrocartilage, which can adapt if not over-stimulated.  The position of the ball of the joint against the central region of the disc against the front surface of the joint is what helps maintain the joint integrity and function.  Problems arise when this relationship is lost or compromised during treatment.

  

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What are TMJ disorders?

TMJ disorders are a breakdown in form or function when the relationships of the structures of the joints, teeth, muscles and related structures are compromised.  These general involve:

People who have a rheumatic disease, such as rheumatoid arthritis, may find their TMJ involved. Rheumatic diseases refer to a large group of disorders that cause pain, inflammation, and stiffness in the joints, muscles, and bone. Both rheumatoid arthritis and some TMJ disorders involve inflammation of the tissues that line the joints. The exact relationship between these conditions is not known, but new research has demonstrated that the bacteria associated with periodontal disease can be one source of the chemicals that cause inflammation, swelling and pain.
 
Because TMJ problems do not self-correct, signs and symptoms may worsen  over time. Most people have relatively mild forms of the disorder in the beginning, but without proper intervention this condition may worsen and become chronic, causing long-term persistent and debilitating pain.

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What causes TMJ disorders?

Trauma to the jaw or temporomandibular joints, muscles, ligaments and associated structures play an important  role in TMJ disorders. Trauma can be microtrauma or macrotrauma.  Microtrauma can be an injury that is so slight that it goes unnoticed, but if allowed to be repeated time and time it causes tissue damage, inflammation and pain.  Macrotrauma is an even of such magnitude that it causes tissue injury, inflammation and pain.  Because the condition is more common in women than in men, scientists are exploring a possible link between female hormones, repair tissue types and TMJ disorders.

A healthy jaw joint is painless, noiseless and has a full range of motion that is straight without deviation or deflection.  There is much scientific evidence that clicking sounds in the jaw joint is abnormal and indicates changes that can lead to serious problems.   In fact, jaw clicking with or without pain or limited jaw movement, can indicate a TMJ disorder and warrants an examination, diagnosis and/or possible treatment.

The most common cause of a TMJ disorder is when the forces within the joint are no longer applied in an upward and forward manner (below left), but instead become displaced upward and/or backward (below right).  This upward and backward force would cause the ball (condyle) to compress the enlarged back of the disc that serves to help hold the disc in the proper place.  If this enlarged area is lost further compression can cause the disc to become displaced or dislocated. 
 
Any joint that becomes displaced or dislocated causes the muscle that moves or support the movement of the joint to be compromised.  This can cause knots (trigger points)  that can be painful to the touch, can cause continued muscle pain or can refer pain to other structures (ear, temple, teeth, etc.)  Left unchecked, these problems can become worse.

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What are the signs and symptoms?

A variety of symptoms may indicate a TMJ disorders. Pain, particularly in the chewing muscles and/or jaw joint noise are the most common.  Other likely signs and symptoms include:

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How are TMJ disorders diagnosed ?

Patient and doctor awareness of the signs and symptoms of dysfunction are usually the first indicators that something is wrong and an evaluation is needed.  The simplest diagnostic procedure is a range of motion and pathway of movement analysis.  The patient should be able to open at least three  fingers wide and there should be no noise during this straight movement. 
 
Positive findings in these simple tests warrant a more thorough examination of the jaw, head, neck and upper quadrant region.  This may involve special radiographs to evaluate these structures, possible MRI evaluations and other diagnostic procedures. 
 
A reversible diagnostic phase using an orthotic and physical medicine is one common method to evaluate the extent of the tissue damage.  These techniques modify the pressures applied within the joint and work to decrease the muscle pain.  The degree of success also helps determine what type of finalization treatment might be needed.

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How are TMJ disorders treated?

The patient response to the diagnostic phase will be one important step in determining what form of treatment may be needed.  Patients able to recover normal function without problems in the diagnostic phase may require minimal options, whereas patients with more severe injuries may require more comprehensive therapy.  The treatment options will vary according to the individual patient’s conditions, tissue recovery and responses to the diagnostic orthotic and physical medicine phase.

Conservative Treatments

Conservative treatments help  correct the causes that initiated the tissue injury.    Some patients may require using an appliance part-time, at night or as needed.  Other conditions may warrant a more comprehensive correction, such as TMJ-Orthodontics to maintain a stable functional jaw position.

      

In other cases patients bite, jaw, muscle, head, neck and upper quadrant relationships may require other conservative treatments to maintain the diagnostic phase relationships.  These restoration procedures would be customized to meet the individual patient’s needs.   These may involve:

Some patients will require more extensive treatments due to their more involved cause and effect conditions.  In some instances the jaw joint structures do not respond adequately to the conservative diagnostic phase and dislocated discs may need to be surgically repositioned and maintained.  In other instances the joint structures are beyond repair and must be replaced.  This usually requires a much more comprehensive form of therapy to ensure the jaw, head, neck and upper quadrant relationships are able to function in the best means possible.  These conditions may involve:

     

The patients with more severe damage and injury will not be “cured”, but their more involved circumstances must be managed long-term.  Patients with related medical problems may need appropriate therapies as directed by their physician.    This can involve prescription medications or other medical treatments.  Patients may also require the usage of night-time appliances, physical therapy, upper quadrant therapies, and/or other medical or dental procedures.  The Perio Protect Method is required for most patients to maintain their dental conditions in optimal health.

  

Since most TMJ problems are managed it is possible that some problems may reoccur or even worsen over time.  This may involve the need for additional therapies beyond the initial corrections if these circumstances occur.
 
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