Temporomandibular Joint problems (TMJ) are diversely classified as intracapsular and extracapsular conditions. Intracapsular being in the joint structures like the mandibular condyle, the articular disc and the glenoid fossa. Extracapsular being in the muscles, tendons and ligaments surrounding and connecting to the TM joints and mandible itself.

INTRACAPSULAR

These disorders are featured by structural alterations of the temporomandibular joint which interfere with the form and function and frequently produce pain. They are made up of four groups of disorders.

   Developmental Disorders: These problems occur as a result of abnormal development of the joint.
    Diseases: These consist of degenerative arthritis, rheumatoid arthritis and neoplasms.
   Injuries: These occur when trauma is induced to the jaw directly or indirectly like in Whiplash.
   Internal derangements: These occur when the physiologic relationship of the condyle, disc, and fossa have been lost. Internal problems constitute the vast majority of this group.
 

In a typical derangement the disc assumes a position forward of the condyle due to a problem with the discal attachment. When this is present, a click is heard during opening movements and usually a softer click is heard in the closing of the mandible. If this is left untreated, it may result in a closed lock and alterations in form occur and the onset of degenerative osteoarthritis usually occur. With this comes the onset of pain often severe, and the likelihood of surgical intervention becomes more probable.
 

HEADACHE:

Headache is the most common symptom of a TMJ problem. Although any area of the head may be affected, usually the TMJ headache is located in the temples and back of the head. Also, a displaced disc in the TMJ may cause pain in the joint and is referred into the temples, forehead or neck. They can be so severe that they are treated with little relief for migraine headaches.

EAR PAIN:

Due to the close location of the ears and the TMJs, an injury to the TMJ caused ear problems. Symptoms like pain, fullness, stuffiness or even hearing loss can occur even though medical evaluation of the ear is normal.

FACIAL PAIN:

Facial pain can show on our faces even though the TMJ does not hurt. Facial pain may be deep or on the surface in the skin. The skin might even become sensitive to the touch or air blowing acrossed it. Neurologists are usually contacted in these instances.

EYE SYMPTOMS:

There can be pain behind the eyes or pressure build up and no evident eye problem detected from the eye doctor. Also there can be unusual eye deviations to the left, right, up or down that occur.

TEETH:

A damaged TMJ may cause tooth pain due to the change in the bite or fit of the teeth. The teeth may become sensitive to temperature changes especially cold. Patients see the dentist and no cause can be found and frequently unnecessary root canals and extractions are performed to rid a patient in pain. But now the pain is still there and has gotten worse. Now is the time to ask yourself, am I suffering from TMJ? Positive answers to some of the following may urge you to seek advice from a TMJ expert.

Do you have frequent headaches?
Do you have sounds in your joint(s) when you chew?
Do you have stuffiness or pressure in your ears?
Do you have buzzing or ringing in your ears?
Are you dizzy a lot?
Do your jaws lock open or closed?
Is your mouth stiff to open?
Do your teeth ache or sensitive to cold?
Are your facial muscles tight or sore?
Do you grind or clench your teeth at night?
Do your ears hurt?
Does your neck, back of your head, or shoulder hurt?
Have you had a jaw injury?
Have you had a whiplash injury?
Do your jaws tire easily or ache after eating?
Are you under a lot of stress?
Have you been diagnosed with fibromyalgia?
Have you seen a neurologist, psychologist or psychiatrist for unexplained head pain?
        If you have answered yes to one or some of these then you may very well need the expert help of a dentist specifically trained in the treatment of TMJ problems.

TMJ TREATMENT MODALITIES

Early treatment is very important and cannot be overstated. TMJ problems can advance in stages and grow progressively worse. Thus, a minor problem now could become a major source of pain in the future. Additionally, chances of successful therapy increase substantially the earlier treatment is accomplished.

After diagnosing the problem, a variety of treatments may be recommended depending on the extent of correction needed. Initial phases of treatment are aimed to eliminate the TMJ pain resulting from the actual problem. In the second stage, the actual treatment to correct the problem is implemented.

Medicines/Muscle Stimulation/Ultrasound

These may be prescribed to alleviate the pain before and during the actual treatment.

Trigger Point Injections

This is the injection of anesthetic into muscle to eliminate muscle spasm.

Splint/Jaw Repositioner Appliances

This is a mouth appliance that is custom made to fit between the patient's upper and lower teeth. It is not only used in diagnosis, but they are also used as treatment to temporarily eliminate the bite disharmony and resulting pain. Then once we have achieved a state of muscle relaxation and an acceptable level of patient comfort then we can determine which forms of permanent treatment are necessary to maintain long term comfort.

Occlusal Equilibration

The tops of the teeth are reshaped in this procedure. This is done to alleviate pressure on individual teeth. The reshaping procedure has been found to be the solution for many conditions which cause discomfort in the head, neck, and shoulders and the breakdown of dental structures. This can be likened to a pebble in your shoe and your foot adapts to that pebble and you may limp. As with a tooth too high for comfort, the jaw also adapts to the uncomfortable tooth fit but develops muscle pain. During equilibration the high tooth is reshaped for a better fit and resulting muscle relaxation.

Occlusal Restorations

This involves the placement or construction of teeth by means of crowns, bridges, implants, inlays, onlays, partial dentures or just routine restorations to build the bite to a more permanent, healthy, relationship.

Biofeedback

This is the technique of learning to relax the jaw muscles on demand, especially in times of greater stress.