The Temporomandibular joint (TMJ)

The temporomandibular joint (TMJ) is the area directly in front of the ear, on both sides of the head; it is where the upper jaw (maxilla) and the lower jaw (mandible) meet. If a clicking sound is heard when opening the mouth, pain is experience in the face area, headaches or chewing problems, a dentist needs to be consulted. If the pain worsens and it becomes difficult to open the mouth wide, the patient may be suffering from TMJ disorder. The disorder can affect people of any age, but it is very common in young women.

Symptoms of TMJ tend to be chronic and many of them don’t appear to be related to TMJ itself. The pain usually occurs because of unbalanced activity, spasm, or overuse of the jaw muscles. Patients complain of headaches (80% suffer from headaches and 40% report facial pains), ear aches (approximately 50% of patients), fullness of the ear (33% report this discomfort), clicking, popping or a grating sound when opening or closing the mouth, patients also report experiencing a ringing in their ear for unknown reasons. Approximately 33% of people with TMJ experience some form of ringing in the ear (tinnitus). Other chronic symptoms associated with TMJ are experiencing a migraine, particularly in the morning, reduced ability to open or close the mouth, loss of hearing, and even neck and shoulder pain.

There are many external factors that could cause TMJ disorder to develop, trauma, bruxism (repetitive unconscious clenching or grinding of the teeth, often at night), jaw thrusting (causing unusual speech or chewing habits), size of food bites taken, degenerative joint disease, such as osteoarthritis or organic degeneration of the articular surfaces.

The most common joint and muscles problems in the jaw are temporary and with simple treatment, often do not become worse. Patients need to eat soft foods, apply ice packs, avoid extreme jaw movements (wide yawning, loud singing and gum chewing), and practice gentle jaw stretching and relaxing exercises that will ease jaw movements. A physical therapist may recommend exercises if appropriate for that particular patients condition.

Though it is rare, sometimes TMJ disorder needs surgery to correct it. Orthodontic and restoration treatments are often all that is needed to correct most bite problems. In some cases the dentist will give the patient the option of correcting the problem using an appliance. The most common is Occlusal equilibration, the dentist will examine the occlusion and the joints before treatment. This method works to remove deflective interferences and enable the jaw to open and close properly. It involves reshaping the tooth surfaces that are involved in biting.

The dentist may provide the patient with a plastic shield that acts like a mouth guard to protect the upper and lower teeth. The guard or splint can protect the teeth from unconscious grinding at night. If the TMJ disorder is not relieved through Occlusal equilibriation or the use of splints, the dentist will recommend an X-Ray if they suspect the disorder is caused by a structural problem. MRI (Magnetic Resonance Imaging) may also be recommended, to give a better look at the soft tissue that surrounds the joint. A CT scan may be ordered in some cases to check the bony parts of the jaw. Failing that and depending on the results of the scans, the dentist may then recommend orthodontia, an intra-oral appliance or maxillofacial surgery. Patients will then be referred to an oral or maxillofacial surgeon.

Any surgery performed for TMJ disorder is performed under general anaesthesia. Two needles are inserted into the temporomandibular joint, one connected to a syringe containing a cleansing solution and the other acting as an exit for the fluid. This procedure is undertaken to rinse out the joint. In some cases, the surgeon may use a scalpel to remove any tissue adhesions in the joint. Orthoscopy is another type is surgery that treats TMJ disorder, in this case, an incision is made at the temple to insert an endoscope into the area. Using images provided by the endoscope, the surgeon removes adhesions, or repositions the disc. Open joint surgery is the only option that allows any access to tumours, scarring or worsening bone structure.