Temporomandibular Joint Disorder

Temporomandibular Joint Disorder (TMJD) is a group of conditions that cause pain and loss of normal function to the temporomandibular joint (TMJ) or jaw joint. The temporomandibular joint is located in front of the ear, on both sides of the head.

The joint is made up of the lower jawbone and the skull. A cartilage disk, which functions as a shock absorber and joint lubricant, separates these two bones. The TMJ and the muscles of chewing enable you to open your mouth, talk and chew.

TMJD can originate from the chewing muscles, cartilage disk or the joint bone.

Temporomandibular Joint Positions

Normal Closed Position

The lower jawbone is separated from the skull by a cartilage disk that acts as a cushion when the joint is in function i.e. chewing, speaking and yawning.

Normal Open Position

On the opening of the mouth, the disk will follow the lower jaw bone and they will move together when you move your jaw up and down or side to side.

Abnormal

In an abnormal joint, the disk can be displaced or torn. This displaced or torn disk can cause obstruction in joint movement. A torn disk can result in excessive wear of the bone of the joint, causing inflammation and pain.

Our Oral surgeons perform TMJ (temporomandibular joint) surgery of varying complexity. These include:

• simple washing of the joint (arthrocentesis)
• inserting a scope (arthroscopy) through an incision to examine and treat the joint
• open joint surgery

You may be a candidate for joint surgery if:

• there is disease in your joint
• there are degenerative changes in your joint
• you do not respond to non-surgical management

Signs and symptoms of Temporomandibular Joint Disorder (TMJD) may include the following:

You may experience difficulty in eating and a sudden inability to close your mouth, which may or may not be spontaneously resolved.

• Noises - You may hear clicking or grating noises on opening or closing your mouth. If this is not accompanied by pain and limitation in mouth opening, no treatment is required.
  
• Pain - Dull pain on the opening and closing of your mouth can be experienced over the area at jaw joint area (just in front of the ear), cheek or temple region. A clicking or grating sound may accompany the pain. The pain you experience is usually due to the inflammation of the joint and/or the muscles and may cause difficulty in chewing and biting food. Sometimes you may experience headaches.
  
• Restriction in the opening and closing of your mouth - Trauma, excessive pressure or degenerative changes to the joint can displace the cartilage disk in the joint. This causes obstruction to its normal movement, leading to difficulties in opening and closing your mouth.
  
• Worn-down, cracked and fractured teeth - Teeth may be worn down as a result of nocturnal grinding and you may experience teeth sensitivity, Teeth may also be cracked and fractured as a result of nocturnal grinding and clenching, which leads to pain and difficulties in chewing.
  

• ​Strive for a balanced lifestyle. Stressful episodes predispose one to more grinding and clenching of the teeth.
• Avoid excessive chewing on hard foods.
• Seek help when you encounter the signs and symptoms of TMJD.

​Temporormandibular joint disorder can be caused by:

• Prolonged stress to the jaw joint - Habitual clenching or grinding of your teeth overloads the joint causing pain in the joint and muscles. You may not be aware of these habits if they occur during sleep.
  
• Trauma - A recent trauma or a history of trauma, such as a blow to the lower jaw or face, directly or indirectly, can injure the TMJ.
  
• Arthritis - The jaw joint may be damaged by arthritis (inflammation of the joint). Arthritis may be a degenerative process due to aging or it may be associated with medical conditions such as Rheumatoid Arthritis, Psoriatic Arthritis.
  

Seek consultation with your dentist. Most common issues are related to the masticatory muscles. Jaw disk displacements are also commonly encountered. Arthritis changes jaw joints which can also cause jaw discomfort.

A routine X-ray scan of the upper and lower jaw helps to rule out obvious bony lesions. Sometimes, more complicated imaging may be necessary.

​Temporomandibular joint disorder may be treated surgically or non-surgically, depending on the diagnosis and the cause.

1. Medications - Some anti-inflammation drugs can be helpful in reducing the pain associated with TMJD
   
2. Therapies - Some TMJD symptoms can be relieved with the use of a bite guard. A bite guard is especially useful for patients who grind their teeth during sleep.
   
   
3. Surgery - Surgery may be the best option for patients who do not respond well to non-surgical treatment.  Surgery may range from simple washing of the joint with fluids, (arthrocentesis) to inserting a small scope into the joint to examine and treat the joint (arthroscopy). Click here for more information on the various types of joint surgery.
   
   
4. Restoring natural teeth - Worn down teeth may need to be crowned.
5. Counselling and stress management