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TMJ (JAW JOINT) DISORDERS
It has been estimated that more than 50 million people in Canada and the U.S. suffer from severe headaches. These headaches can be so debilitating that
they can adversely affect their ability to work and their relationships with family and friends.
Although there can be many reasons for headaches, many headache patients suffer from
temporomandibular joint disorders (TMJ disorders). The most common symptoms include:
Headaches, Dizziness, Stiffness in jaw joint, Ear aches, Ringing in the ears, Teeth do not touch when biting,
Neck pain, Pain behind the eyes, Problem swallowing, Fainting, Shoulder or back pain, Tingling or numbness of fingers, Clicking jaw, Inability to open mouth wide, Clenching/grinding teeth, Worn teeth
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TMJ
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SIGNS AND SYMPTOMS OF TMJ
1. Clenching and grinding of the teeth (bruxism) is a common sign of TMJ disorder. The clenching and grinding of the teeth put additional stress on
already tired, overworked muscles and can result in pain being referred to the head, neck, face, shoulder or back.
2. Headaches are one of the most common complaints of TMJ sufferers and these headaches are frequently so severe they can be confused with migraine
headaches. TMJ headaches are most often felt in the temple area, behind the eyes, and at the back of the head with pain radiating to the neck and shoulders. Migraine headaches are mainly on one side with the patient
suffering from visual disturbances and being extremely sensitive to light. The treatment for migraine headaches is much different from headaches from dislocated joints. If you suspect a migraine headache, then a
referral should be made to a neurologist. If the TMJ (jaw joint) is the problem, a referral should be made to a dentist or dental specialist with training in the diagnosis and treatment of these disorders. An
excellent reference for dentists experienced in the treatment of patients with TM joint disorders would be to consult the web site of the American Academy of Head, Neck and Facial Pain.
3. One of the most common signs of a TMJ problem is a temporomandibular joint which is making noise such as clicking, popping or grating sounds.
This clicking sound occurs when the condyle moves forward when the patient opens the mouth and the condyle slips on and off the dislocated disc. The grating sound, called crepitus, is the sound of bone rubbing on
bone and occurs later on when the dislocated discs become completely deformed. Another sign of TM joint dysfunction occurs when the jaw either locks open or closed. Our objective in the treatment of TMJ disorders is
to try and correct the problem of the dislocated disc early in treatment when the jaw is clicking and not wait until the later stages when the grating sound is louder and the patient may experience an extremely
painful situation if the jaw locks open or closed.
4. If the patient suffers from ear pain, ringing or buzzing in the ears, fullness or a stuffy feeling without any ear infection, then this could be
related to a structural problem within the TM joint. Other symptoms include a loss of hearing, dizziness and loss of balance. If the condyle is too far back and the disc dislocated forward, this can cause some of
the muscles of mastication to go into spasm which can cause any of the symptoms as mentioned above. If your medical doctor or ENT (ear, nose and throat) specialist can find no apparent reason for the ear problems,
these patients should be referred to a dentist or dental specialist with training in the diagnosis and treatment of patients with these problems.
TMJ disorders have been called the "Great Impostors"
due to the fact that many of the symptoms have overlapping symptoms which often mimic other conditions. Because these symptoms masquerade so many other conditions, many people travel from medical doctor to medical
specialist in search of a cure. Most patients never think to contact a dentist since the symptoms are primarily medical in nature.
TMJ Anatomy
The temporomandibular joint (TMJ) is the joint connecting the lower jaw (mandible) to the
(temporal bone). The lower jaw and the skull are connected by a
number of muscles and ligaments which function in harmony with each other if the lower jaw is in the correct position. The head of the jaw bone (lower jaw) is called the condyle and it fits into the concavity of the
temporal bone called the glenoid fossa. The TM joint resembles a ball and socket with the round condyle being the ball and the glenoid fossa of the temporal bone being the socket. For normal joint function to occur,
a piece of cartilage called an articular disc acts as a cushion or shock absorber between the two bones.
When the lower jaw opens and closes, the disc stays between the condyle and the glenoid fossa of the
temporal bone at all times. When this happens, this is a normal healthy TMJ and the patient can open wide without any discomfort and without any noise. With a normal opening, the patient should be able to get three
fingers between the upper and lower front teeth when the mouth is open as wide as possible. In cases where the TM joint is functioning normally with the disc in the proper position, the muscles of the head, neck,
and shoulders function relatively pain-free.
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Jaw Joint Displacement
Jaw Joint Displacement The position of your teeth can also affect the position of your jaw joints. Each jaw joint is a ball and
socket joint. When functioning properly, the ball and socket do not actually touch because a thin disc of cartilage rides
between them. The disc acts as a cushion and allows the joint to move smoothly. Each disc is held in place and guided by
muscle. If your bite is not right, the joint is pulled out of alignment. Typically the disc is pulled forward. Since it no longer
serves as a cushion, the joint itself now rubs against the boney socket and presses on pain fibres. Mild displacements cause
a clicking or popping sound in the jaw joint; more severe displacements can be very painful and eventually can cause
permanent damage to the joint. An unstable bite can cause both jaw joint displacement and muscle strain and pain. Many
seemingly unrelated symptoms result which are collectively known as craniomandiular dysfunction. When this condition is
prolonged, the body begins to compensate and adapt by involving muscles in the neck, back and sometimes those of the arms, fingers, pelvis, legs and feet.
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Results of Displacement (RESULTS OF ANTERIORLY DISPLACED DISC)
When there is a structural problem with the TM joint caused by the condyle of the lower jaw being positioned too far back in
the glenoid fossa, this usually results in an anterior dislocation of the disc. The condyle then compresses the nerves and blood
vessels in the back of the glenoid fossa and the patient experiences pain. When the disc is positioned in front of the condyle,
this frequently limits the ability of the condyle to function normally as it restricts its forward movement. Therefore, the patient
does not have a normal opening of the jaw and frequently can barely get one or two fingers between the upper and lower teeth
when opening wide. Clicking or popping noises frequently occur when the condyle is too far back and the disc too far forward.
TM joint disorder is a progressive condition and should be treated as early as the problem is diagnosed. Clinically, we see
patients clicking slightly which becomes more frequent and this progresses to the jaw locking (inability to open mouth) and
eventually to osteoarthritis or degenerative joint disease. It is important that the discs stay in position between the two bones,
the condyle and glenoid fossa of the temporal bone, and act like a cushion to protect them. With the disc out of position, there
is nothing to protect the two bones which can now rub together, and they will eventually undergo osteoarthritic changes.
Another result of this structural problem is that the muscles and ligaments supporting the TM joint shorten which results in
muscle contractions, muscle spasms and pain. The muscle spasms are what cause the headaches, neck aches, ear aches, shoulder and back pain.
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