Temporomandibular Joint (TMJ) Disorders
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The temporomandibular joint (TMJ), functioning as a sliding hinge, connects the jawbone to the skull, with one joint located on each side of the jaw. TMJ disorders, falling under the broader category of temporomandibular disorders or TMD, can lead to discomfort in the jaw joint and the muscles responsible for jaw movement.
Identifying the precise cause of an individual’s TMJ disorder can be challenging. The discomfort may stem from various factors, including genetics, arthritis, or injuries to the jaw. Although clenching or grinding of the teeth (bruxism) is common among individuals experiencing jaw pain, not everyone who clenches or grinds their teeth will develop TMJ disorders.
Generally, the symptoms associated with TMJ disorders are temporary and can be alleviated through self-care or non-invasive treatments. While surgery is considered a last resort, only pursued after other treatments have failed, it may be beneficial for certain individuals with TMJ disorders.
TMJ disorders are categorized into three main types by healthcare professionals:
- Disorders affecting the jaw joints.
- Disorders involving the muscles used for chewing.
- Headaches stemming from TMD.
Symptoms
The following signs and symptoms of TMJ disorders includes:
- Jaw pain or tenderness.
- TMJ pain.
- Pain around your ear.
- Difficulty chewing or pain while chewing
- Lock jaw, difficult to open or close the mouth.
- Popping or clicking sound of jaw.
- Headache or migraine.
- Tinnitus or ringing in the ears.
- Changes in the teeth formation, or malocclusion.
The patient may generally don’t require treatment for a TMJ disorder if your jaw clicking isn’t accompanied by any pain or movement restriction.
If you can’t fully open or close your jaw or if you have ongoing jaw pain or tenderness, seek medical attention. Possible causes and treatments for the problem might be discussed with your healthcare provider, dentist, or TMJ specialist.
Causes
Temporomandibular joint (TMJ) disorder arises from a multitude of factors or their interplay rather than stemming from a singular cause. This condition involves the intricate joint, which facilitates both sliding and hinge-like movements, with its interacting bone sections covered by cartilage and separated by a thin, shock-absorbing disk to ensure smooth operation.
The following cause may include:
- Injury to the jaw that cause fracture, dislocation, or moves out of its proper alignment.
- Joint arthritis that damage the cartilage.
- Malocclusion is the term used to describe when teeth don’t fit together perfectly.
- Teeth grinding or clenching (bruxism).
Risk factors
The following factors may increase the likelihood of having TMJ disorders:
- Different kinds of arthritis, including osteoarthritis and rheumatoid arthritis.
- Jaw injury.
- Particular conditions of connective tissue that might lead to issues affecting the temporomandibular joint.
- Prolonged teeth clenching or grinding.
Diagnosis
The following procedure may assist in properly diagnosing TMJ disorder:
- Physical examination: Your healthcare provider or dentist will examine your jaw and talk with you about your symptoms. They will most likely feel and hear your jaw move as you open and close it. Examine your jaw’s range of motion and apply pressure to the surrounding areas to pinpoint any sore or uncomfortable spots.
- Imaging test: If the healthcare provider or the dentist suspect any problem with your jaw, they may recommend imaging test to properly assess the jaw joints and the structures around it.
- Dental X-rays to assess your jaw and teeth.
- Computed tomography (CT) scan to get detailed pictures of the joint’s corresponding bones.
- MRI to identify issues with the soft tissue or disk in the joint.
- Arthroscopy: When diagnosing a TMJ disorder, a TMJ arthroscopy may be performed. A tiny camera, called an arthroscope, is introduced to see the area and assist in the diagnosis after the healthcare provider inserts a thin tube, called a cannula, into the joint space during a TMJ arthroscopy.
Treatment
In some cases, TMJ disorders may resolve spontaneously without medical intervention. The persistence and severity of symptoms, as well as the underlying cause of pain, dictate the most appropriate treatment approach. If symptoms persist, healthcare providers may recommend a combination of treatments tailored to the individual’s needs, addressing the issue comprehensively.
- Medications: These medication choices, when combined with other nonsurgical treatments, may help reduce the pain and discomfort caused on by TMJ disorders:
- Pain relievers and anti-inflammatories: When over-the-counter painkillers failed to treat TMJ pain, your dentist or healthcare provider may recommend stronger painkillers, such prescription-strength ibuprofen, for a brief period of time.
- Antidepressants: Medication for depression is the main use for medications such amitriptyline, however they can also be used, in small dosages, to treat pain, regulate bruxism, and insomnia.
- Muscle relaxants: These medications are occasionally used for a few days or weeks to assist treat TMJ disorders that result from spasms in the muscles.
- Nonsurgical TMJ treatments: Treatments without medications for TMJ disorders include:
- Dental appliances: People who experience jaw pain can often find relief by placing a hard or soft appliance over their teeth. Mouth guards and oral splints are examples of dental appliance that can assist reposition your jaw or lessen the effects of clenching and grinding.
- Physical therapy: Treatment options may include ice, moist heat, and ultrasound in addition to jaw muscle strengthening and stretching exercises.
- Counseling: You can prevent certain behaviors and activities that can exacerbate your pain by being educated and getting therapy. Examples include chewing your fingernails, leaning on your chin, and clenching or grinding your teeth.
- Trigger point injections: Dry needling or injecting medications (such as botulinum toxin or corticosteroids) into excruciating jaw muscle knots are the methods used for this.
- Ultrasound therapy: Heat is injected deep into your tissues during the procedure using sound waves. In addition to promoting muscular relaxation, it enhances blood flow.
- Transcutaneous electrical nerve stimulation (TENS): Your jaw muscles can be relaxed with this technique by using low-level electrical currents.
- Behavioral changes: This includes avoiding chewing on ice and working on your posture.
- Surgical procedures: If medication and nonsurgical treatments are ineffective, your healthcare provider may recommend the following procedures:
- Arthrocentesis: In order to remove debris and inflammatory byproducts out of the joint, a minimally invasive surgery called arthrocentesis involves inserting tiny needles into the joint.
- TMJ arthroscopy: When treating different kinds of TMJ disorders, arthroscopic surgery may occasionally be just as successful as open joint surgery. An arthroscope is introduced into the joint area, a small, thin tube known as a cannula is inserted, and tiny surgical instruments are utilized to perform the procedure. The procedure will help realign the disk in your joint, remove scar tissue, or sculpt bone.
Compared to open-joint surgery, TMJ arthroscopy carries less risks and side effect, but it is not without restrictions. - Open-joint surgery: Your healthcare provider or dentist may recommend open-joint surgery (arthrotomy) to replace or repair the joint if more conservative treatments fail to relieve your jaw pain and it seems to be the result of a structural issue with the joint. In order for the surgeon to immediately reach your jaw joint, a lengthy incision is necessary. After weighing both advantages and disadvantages, open-joint surgery should be carefully examined as it has greater risks than other operations.
- Modified condylotomy: A modified condylotomy involves surgery on the mandible rather than the joint itself, so indirectly addressing the TMJ. When pain is being treated and locking is occurring, it could be beneficial.
When considering treatment options for TMJ disorders, it’s crucial to discuss with your healthcare provider the potential advantages and disadvantages of any suggested surgeries or procedures. Additionally, it’s important to explore all available alternatives. Your healthcare provider will guide you through a comprehensive discussion, weighing the benefits and drawbacks of each option to help you make an informed decision about the most suitable course of action for your condition.
