TMJ

TEMPOROMANDIBULAR JOINT SYNDROME

 

Does it hurts or do you hear noise when chewing? You may suffer from Temporomandibular Joint Syndrome (TMJ).

The Temporomandibular Joint Syndrome (TMJ) is characterized from a group of problems attributed to the dysfunction of temporomandibular joint. It may adversely affect the patient’s quality of life since it hampers everyday functions like chewing, swallowing and speaking.

The main symptom of the disease is:

– The chronic craniofacial pain and jaw movement problems.

The disease affects the mandible (jaw), the temporomandibular joints and masticatory muscles. Previously this disease was known as Costen syndrome, by James Costen that was the first who recorded characteristics of temporomandibular dysfunction but also connected with occlusal problems. It occurs more often in women than men at a ratio of 2: 1.

What is TMJ?

The temporomandibular joint is a movable joint that connects the lower jaw to the remainder of the skull in the region of the temporal bone. It is located just in front of each ear on each side of the face to the point of closure with the upper mandible.

This is one of the most complex structures of the human body. It consists of the temporal bone, the mandible, the unilateral disc and masticatory muscles that ensure the smooth movement of the jaw and in three dimensions (up-down, front-back, left-right) necessary for the functions of mastication and speech.

The lower jaw terminates in a rounded end (condyle) which fits into a recess of the temporal bone (temporal facet) on each side of the skull. Between them lies the unilateral disk which can move freely within the joint between the two parts. The purpose of structured disk is the damping of vibration and to facilitate the smooth movement of the jaw when we open and shut our mouth.

 

Causes of TMJ Dysfunction

Most of temporomandibular joint disorders are associated with shift or structural damage to the unilateral disk, damage or fracture of the condyle of the jaw with degenerative joint such as osteoarthritis or rheumatoid arthritis, whereas in relatively fewer cases the problem is the facial muscles controlling movement of the jaw. In several cases, however, there is more than one of these problems.

 

The main causes of the Temporomandibular Joint Syndrome are:

Poor dental occlusion. When the teeth of the two jaws have occlusal problems so are misaligned to uniformly click when biting, the pressure of the chewing is distributed unevenly in the two sides of the jaw exerting excessive pressure on the joint and the muscles of one side of the face. A similar problem can occur even when there is no problem of occlusal teeth, but we are often forced to chew only from one side (eg. Because some teeth are missing on because we have a thrush one side of the mouth). The prosthetic restorations (crowns, bridges) may also cause a similar problem if made higher than the natural tooth.

  • Bruxism (clenching and teeth grinding). The bruxism, ie the habit to tighten or grind our teeth are among the most common causes of malfunctions of the temporomandibular joint. The pressures on the teeth, the jaw and the joints and muscles of the face are very strong and prolonged, and are therefore causing problems.
  • Stress and psychological pressure. Psychological factors such as chronic stress are often the root causes of temporomandibular syndrome either through continuous contraction of facial muscles or through bruxism challenge.
  • Injuries of the jaw joint or the muscles may progress to dysfunction of TMJ. A blow to the jaw can cause movement or damage to the disk or condyle of the jaw, thus changing the position of the jaw, the way that teeth come in contact is altered and this can result to poor occlusion and further burden the temporo mandibular structure.
  • Business practices such as eg. Someone talking too long on the phone supporting it between the head and shoulder
  • Poor posture and head tilted forward during a prolonged period on a computer
  • Excessive movements such as excessive mouth opening beyond the normal range eg. A yawn
  • Bad habits, such as constantly biting our nails, a pencil or other objects
  • Chewing gum for many hours a day stresses the joint and can cause problems
  • Osteoarthritis or rheumatoid arthritis.

 

Symptoms of temporomandibular joint syndrome        

The most common symptoms in cases of TMJ dysfunction are:

  • Pain in the joint region or the person usually manifests itself during chewing, speaking, and generally at the opening of the mouth. At the same time the intensity of the pain is not indicative of the magnitude of the problem, a joint incipient damage may hurt more than when the joint is nearly destroyed.
  • Sounds in the joint (clicking) when opening and closing the mouth (sometimes accompanied by pain but not always). These sounds are caused by the change of position of the disc, or due to the direct friction between the two bone when the disc is damaged or completely moved.
  • Inability to open the mouth sufficiently. What frequently happens to patients with TMJ Disorder, is inability to open or close the mouth properly forcing them to move the jaw sideways, forward or backward in order to open or completely close.
  • ‘Lock’ mouth, open or closed position. In extreme cases the mouth can be locked completely.
  • Difficulty in movement of the jaw control.
  • Difficulty in chewing. Teeth give the impression that they are not in the correct position and not clicked ‘right together.
  • Pain in the jaw or teeth after sleeping.
  • Headaches, becoming more intense with the twinkling of the mouth are also common symptoms in patients with temporomandibular syndrome.
  • Pain or ringing in the ear.

Less often TMJ symptoms are also:
• Sensitivity to light, dizziness
• Swelling of the face on the side
• Pain in the neck or shoulders

 

Diagnosis

Many of the symptoms caused by temporomandibular syndrome, are common to those of other diseases making it  difficult to diagnose it. Diseases that can cause symptoms and accordingly should be considered in the differential diagnosis are trigeminal neuralgia, diseases of salivary glands, migraines, otitis, fibromyalgia etc.
The dentist, the OMFS or the ENT must obtain a full medical and dental history and clinical examination of the temporomandibular joints and the movements of the jaw. Panoramic radiography, 3D Cone Beam or MRI might be taken for the patient. Depending on the diagnostic findings the most appropriate treatment of temporomandibular syndrome will be decided.

Treatment

Because most problems of TMJ disorders are temporary and do not get worse, simple treatment is usually desired to relieve the discomfort. Practices of self-care, for example, eating soft foods, applying hot or cold patches and avoiding sharp movements of the jaw (pronounced yawn, loud singing, chewing gum) are helpful for reducing symptoms. Learning special relaxation techniques and dimming can also help patients to handle the pain often occurring with the disorders of the temporomandibular joint.
Other conservative, reversible treatments include physical therapy that can be done at home and focusing on muscle relaxation exercises and short-term use of muscle relaxants and anti-inflammatory drugs.
The Oral and Maxillo Facial surgeon may recommend using a plastic splint applied to the upper or lower teeth. The splint can help reduce the tightening and creaking of the teeth and in relaxing muscle tension. The intraoral splint can be used only for a short time and should not cause permanent changes in occlusion. If the splint causes or increases the pain, stop using it and visit your dentist.
There are other therapies for TMJ disorders, such as surgery (special endoscope) or injectable drug infusions intervening tissues. Some treatments involve injection of analgesic drugs to painful points of the muscles, which are usually and the pain initiation points. Researchers are studying this kind of treatment to see whether these injections are effective over time.

 

ARTHROSCOPY

Temporomandibular joint (TMJ) arthroscopy is a procedure that uses a device called arthroscope to look inside your joint to see what is causing your problems. An arthroscope is a bendable tube with a small camera attached to it that captures images to enable the surgeon to repair your TMJ. In some situations, not only the surgeon will look inside and wash out the joint, but also perform surgical procedures like removing scar tissue that cause pain and inflammation, smoothing the bone and even attempt repositioning the disc. With the arthroscopy, jaw pain can be reduced and jaw movement can improve.This surgery requires general anesthesia and it is performed in an outpatient facility in a hospital. The recovery period is shorter and easier than with an open joint procedure and the scar is smaller and mostly visually undetectable.

 

Prevention

Many of the steps you can take at home to deal with TMJ problems can help prevent these problems:

  • Avoid eating hard foods and chew gum.
  • Learn relaxation techniques to reduce overall stress and muscle tension.
  • Maintain good posture, especially if you work all day at a computer. Pausing frequently to change position, Rest hands and relieve tired muscles.
  • Use safety measures to reduce the risk of fractures and dislocations

 

 

EXERCISES FOR THE TMJ AND MASSETER MUSCLES

1. Let yourself free (relaxed) and lower your shoulders.
2. Leave your chin free and uttered the sound Em making sure to avoid touching the teeth.
3. Begin to demotivate your chin up – down with slight movements and the same left – right notion, without touching the teeth.
4. Open and close your mouth. Bring your jaw forward as much as you and then backwards. Repeat the same moves left – right.
5. Repeat the same movements of number 4, but by resistance with your hand, ie with closed fist applied to the base of the jaw opened your mouth with the thumb applied in front of the jaw during movement of the jaw forward, with your palm to the side of the jaw during movement of the mandible left – right. At the end point of each exercise keep your jaw in this position for a few seconds.
6. Open your mouth and put the tips of your fingers on the cutting surface of the front lower teeth. Press your fingers down while trying to close your mouth holding resistance you’re your fingers. Continue the effort for a few seconds.
Check in the mirror if the mandible when opening your mouth, moves vertically, without departing from side to side. Do the same when demotivating the mandible forward. Try to avoid movements that cause the sound of the temporomandibular joint (cliking).
8. Finishing the exercises, take some rest for about 5 ’15’. Relax and let your jaw free stressing the sound EM! Your teeth will not normally come into contact with each other, other than mealtimes.

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