TMJ Syndrome also called TemprorMandibular Joint Dysfunction or Temporomandibular Joint Disorder (TMD) is a rather confusing group of conditions that plague many people at various times in their life.
The Temporomandibular Joint is the most complex joint in the body. It is actually a double joint of the Mandible to the Maxilla requiring 2 identical sets of muscles coordinated to perform its function. This joint moves in a rotating and sliding motion, and it has a disc between the bones to facilitate movement.
Joint Injury
The Joint can be injured by trauma, destructive habits, Rheumatoid Arthritis, and Gout. In some individuals poor posture, stress, or unusual growth pattern can lead to TMJ problems.
Joint Sounds
TMJ popping us usually a sign of changes in the disc which can become progressive until the disc is dislocated. Early diagnosis and treatment can reverse this problem. Pain and limited movement may accompany various stages of these joint sounds.
Pain and Limited Movement
More commonly, pain of limited movement is the reason people seek care. there can be several causes other for pain and limited movement.
This joint is in close proximity to several vital structures including the eyes, the nose, the ears and the several sinus cavities. The nerves of the head and neck are highly concentrated and there are quite a few functions going on in this area.
Since head pain is one of the most common disorders of a patient, and there are so many various structures in the head and neck, diagnosis can be rather complicated.
Most patients seeking treatment for true TMJ problems will be experiencing either one or a combination or the following:
- limited motion
- joint pain
- noise on jaw movement
Other symptoms can include:
- Back, Neck, cervical pain
- Postural problems (forward head posture)
- Pain in the face
- Headaches (tension type)
- Pain in the muscles surrounding the temporomandibular joints
- Pain in the occipital (back), temporal (side), frontal (front), or sub-orbital (below the eyes)
- Pain behind the eyes - dagger and ice pick feelings
- Multiple bites that feels uncomfortable or, "off," and continually changing
- Clenching/bruxing
- Tender sensitive teeth to cold
- Deviation of the jaw to one side
- Ringing in the ears, ear pain, and ear congestion feelings
- Sinus like symptoms
- Dizziness or vertigo
- Visual Disturbances
- Tingling in fingers and hands
- Insomnia - difficulty sleeping
There are quite a few "experts" who have a philosophy and methodology for diagnosis and treatment. These "experts" all have about the same success rate no matter what philosophy or treatment modality they utilize for the "Normal TMJ patient".
Treatment can range from biofeedback, trigger point injections, counseling, hypnosis, chiropractic adjustments, massage therapy, bite splints, and full mouth dental reconstructions.
Dental Treatment
Since I am a dentist, I will focus on the dental approach.
In Dentistry, there have been several approaches to TMJ treatment involving changing muscle balance or repositioning the condyle "Ideally" in harmony with the bite and the muscles. Unfortunately, many of these methods recommend a permanent change in the "bite" to a new position "in harmony with the muscles and joint". Any one permanent change does not seem to lead to any higher success rate than any other philosophy according to Dr Charles Greene. The real concern is that the permanent change may not have any better success rate but will be very expensive to perform.
Facts
- There are about 150 classifications of headaches, and they can be easily misdiagnosed.
- there is a lot we do not know about the causes of headaches.
- A true migraine cannot be cured with a bite splint.
- Muscle relaxants and NSAID analgesics can be quite useful.
- Antidepressants and certain other medications can make night bruxism worse when taken at night.
- A muscle spasm in a muscle of mastication is extremely rare, and usually points to a general condition of muscle spasm syndrome throughout the body.
- Fibromyalgia is a poorly understood condition that can involve the muscles of mastication as well.
- Up to 80% of TMJ patients will get better no matter what treatment is performed.
- 30% of adults have or will have a displaced disc in the TMJ.
- Almost all adults will brux (grind their teeth) at night at some time in their lives.
- Internal disc derangements are rarely successfully treated with surgery and should only be undertaken as a last resort.
- Clicking and popping though annoying do not necessarily mean that some exotic "disc recapturing protocol" must be undertaken. (often an oral appliance at night will improve the situation).
- TMJ disorders are not really a dental problem requiring a dental "permanent change in occlusion (bite), however an oral appliance at night is quite successful in treatment.
- Sleep Bruxism must be controlled as it can destroy the teeth and gums.
- If the teeth are being destroyed from sleep bruxism/ and or GERD, then and only then should permanent restorations be placed to rebuild the teeth
- If the periodontal ligaments around teeth are being destroyed by a combination of gum disease, missing teeth, a poor bite and sleep bruxism, intervention is required.
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