The temporomandibular joint, or TMJ, is a small joint located in front of the ear where the skull and lower jaw meet. This joint allows the lower jaw (mandible) to move and function, and is the most used joint in the body. Between the jaw and the joint is a disc made of cartilage that acts as a cushion to absorb stress and allows the lower jaw to easily move when the mouth opens and closes. The teeth themselves are also important for proper TMJ function, because if they don’t fit together properly, stress can be generated injuring the joint.
WHAT ARE TMJ DISORDERS?
TMJ disorders can be relatively minor, or they can be extremely painful and potentially debilitating. Emotional stress, with attendant habits such as grinding or clenching the teeth, can trigger TMJ symptoms of headaches, clicking, stiffness, locking and pain around the joint and jaws. Malpositioned jaws also may produce TMJ problems and, in some cases, arthritis may be the cause of TMJ disorders. Injury, such as a blow to the chin or jaw, can displace the lower jaw or disc, thus causing problems. These conditions and situations can cause pain and discomfort.
EVALUATING YOUR NEED FOR TMJ TREATMENT
When symptoms of TMJ trouble appear, our office specializes in the areas of the mouth, teeth and jaws and can diagnose TMJ problems using a variety of tools and techniques.
You should be prepared to complete a thorough medical history, including information about your lifestyle and the level of stress you experience on a daily basis. Our office will physically examine your head and neck area, including the TMJ and a variety of tests may be used to confirm or eliminate a diagnosis of a TMJ disorder. Your teeth will also be examined, and models or molds may be made of your teeth so the surgeon can determine if your bite is contributing to your TMJ problem. If necessary, referrals to other dental or medical specialists such as an orthodontist, restorative dentist, psychologist, neurologist, or physical therapist, may be suggested.
TREATMENT OPTIONS FOR TMJ DISORDERS
In the treatment of TMJ disorders you will be working in partnership with our office and in some cases your orthodontist and restorative dentist. It is important to know that most types of TMJ disorders can be treated, in whole or at least in part, by “self-care” and specific changes in lifestyle on your part. Other problems, in addition to self-care techniques, require more extensive therapy, sometimes including surgery. The following are treatment options that will be reviewed by you and your surgeon to determine the specific treatment needed in your case.
Self-Care
In almost all cases it is important to rest the jaw by keeping the teeth apart for periods of time and to practice good posture. It may be necessary to avoid hard foods that strain the jaw when chewing. Just as resting the jaw can be beneficial, proper exercise of the jaw may also be helpful at appropriate times. Flexing exercises can help restore normal range of jaw motion in cases where jaw movement is restricted by TMJ disorder. These exercises should consist of gentle opening/closing movements to avoid stressing the joint. Moist heat can be used to help relax muscles, and in cases of joint injury ice packs applied soon after the injury can help reduce swelling. Counseling on relaxation techniques may also be part of your self-care program, and our office may prescribe medications such as muscle relaxants and/or anti-inflammatory drugs that can help relieve discomfort and reduce inflammation.
Physical Therapy
There are a variety of physical therapy techniques that can be used to treat certain types of TMJ disorders, and these may require referral to the appropriate specialist. These techniques include jaw exercises, posture training, electrical stimulation, ultrasound, biofeedback, and others.
Splint Therapy and Dental Treatment
We may recommend the construction of a night guard device, or occlusal splint to be worn for varying amounts of time, depending on the nature of your TMJ problem. There are many types of splints to help reposition the jaw, prevent clenching and grinding of the teeth, rest the jaws, and help relax jaw muscles. Orthodontic treatment or dental treatment such as restorations to correct a defective bite may be necessary and potentially therapeutic as they restore proper harmony between the teeth, muscles and joint.
TMJ Surgical Options
It is important to understand that even if non-invasive procedures are ineffective in certain cases, surgery may not be the next step if the diagnosis indicates that surgical procedures will not help. TMJ surgery is performed under general anesthesia in a hospital or ambulatory surgical center. The following are surgical options you and your doctor may consider:
Arthroscopy
we can visualize the joint with a small camera and can perform minor surgical procedures such as treating cartilage damage. Arthroscopic surgery is performed in a hospital or ambulatory surgical center under general anesthesia, using the same sterile and surgical conditions as for other types of joint surgery. We can then perform needed treatment, such as removing scar tissue that is interfering with joint function.
Arthroplasty
involves making an incision in front of the ear to expose the joint and allow more complex treatment and procedures to be performed.
Following Surgery
Depending on the complexity of the surgical procedures, the amount of swelling following surgery will vary. For arthroscopic procedures, there is little swelling, but even minimal swelling may cause the ears to ring and the joint and ear to ache. Also, the bite may be temporarily out of alignment. You may be required to wear an occlusal splint, and a soft diet must be adhered to for several weeks. As a rule, the more complex the surgical procedure is the longer the recovery time will be.
Follow-up Care
After TMJ surgery it is important that you avoid as many factors as possible that could contribute to a return of your TMJ disorder. Control of stress, avoidance of hard foods, protecting the jaw joints from injury, and adherence to the self-care regimen described earlier can help reduce the chances of a return of TMJ problems. We will discuss ongoing treatment options such as occlusal splints, physical therapy and other techniques applicable to your individual case.