TMJ

TMJ is a term used to refer to temporomandibular joint disorder. It is also called TMD, TMJ dysfunction, or TMJ syndrome.

The temporomandibular joint is very complex. It has a hinge motion but also has sliding motions. The term TMJ disorder can refer to problems with the joint itself, such as arthritis or inflammation, but often actually refers to disorders of the muscles: spasms, tenderness, etc. The disorder and resultant dysfunction can cause significant pain that can be confined to the jaw area or can radiate into headaches of varying degrees of severity.

There are various treatment philosophies. They are based on ideas about how the jaw ought to function, and usually the treatment is centered around restoring jaw function to that ideal, which relieves the pain and discomfort.

Successful TMJ treatment requires advanced training in occlusion beyond what most dental schools offer, and I recommend that, if you have this disorder, you seek the services of a dentist with this advanced training. Two respected institutes that offer advanced training in occlusion are: The L.D. Pankey Institute and The Las Vegas Institute for Advanced Dental Studies. The treatment philosophies of these two institutes are very different, but dentists trained at either one have success in the treatments they offer.

Expert cosmetic dentists tend to understand this area of dentistry very well, and many of the dentists we recommend, in addition to their cosmetic dental training, have training at either the Las Vegas Institute or the L.D. Pankey Institute. This training is mentioned in their listings. See our cosmetic dentist referral pages for these listings.

Signs and symptoms
Signs and symptoms of temporomandibular joint disorder can be very complex. They may involve the associated muscles, nerves, tendons, ligaments, bones, or the teeth, or combinations of these.

Muscles
Any dysfunction of the muscles may cause the teeth to occlude with each other incorrectly. Teeth can be traumatized by abnormal occlusion, and this may cause them to become sensitive. This illustrates the complex interplays between muscle, joint and teeth.

Temporomandibular joints
This is the most complex set of joints in the human body. Unlike other joints, each temporo-mandibular joint actually has two types of movement which allow it to both rotate and to translate (slide). There is a disc in the joint that slides with the bone, and it is common to see wear of both the bone and the disc. The disc can also become displaced, causing abnormal movements and noises. Clicking is common as are popping motions and deviations in the movements of the joint. When there are multiple, rough sounds, it is described as "crepitus." Noises aren't necessarily a concern, unless there is pain associated with the joint.

Ear pain
Due to close proximity of the ear to the temporomandibular joint, TMJ pain can often be confused with ear pain. Tinnitus (ringing in the ears) may be present.

Teeth
Disorders of the teeth can also be present in TMD patients. This can include tooth mobility, tooth wear, and tooth sensitivity.

Treatment

Restoration of the occlusal surfaces of the teeth
If the occlusal surfaces of the teeth have been damaged through dentistry or trauma, the proper occlusion must be restored through modification of the occlusal surfaces of the teeth. This can include a range of treatments from occlusal adjustment (selective grinding of the teeth to restore normal shapes to the teeth) to full-mouth reconstruction, involving the crowning of all the teeth.

Comprehensive approach
Thorough diagnosis of TMJ disorder involves the taking of a detailed history and careful physical examination. The medical history should be explored to reveal duration of illness and symptoms, previous treatment and effects, contributing medical findings, history of facial trauma and a search for habits that may have produced or enhanced symptoms. Particular attention should be directed in identifying damaging jaw habits such as clenching or teeth grinding, lip or cheek biting, or positioning of the lower jaw in an edge to edge bite. All of the above puts strain on the chewing muscles and the TMJ. If palpation of these muscles causes pain, that indicates abnormal muscle function.

Treatment is oriented to eliminating oral habits, physical therapy to the chewing muscles and alleviating bad posture of the head and neck. A bite splint is often is helpful to control bruxism and take stress off the TMJ.
 

Read Dr. Hall's blog posts about TMJ.