Temporo Mandibular Joints


doctor pair

The jaw joints or TMJ are positioned just in front of both ears and their function is to allow the lower jaw to move and have a wide range of safe movements. This allows the mouth to open for chewing, speaking, yawning etc. These basic life functions use a number of structures inside and outside the joint to allow smooth and normal functioning. Inside the jaw joint there is a cartilage (similar to the knee) and a lubricating fluid to act as shock absorber and enable smooth movement. The ligaments around the joint provide strength and control the range of movement, stopping it from popping out of alignment. The muscles close to the joint and the neck muscles power the jaw movement, and their nerves control and regulate them. Joint movements are controlled by the brain’s activity; they also send sensory messages to the brain. Teeth position and bite must be in harmony with every aspect of the jaw joints as to successfully cut and crush food, as well as providing support to the facial height.

It is absolutely essential to have all these structures acting synchronously with each other and to have both jaw joints to work harmoniously with each other.

Unfortunately problems can arise when there is lack of co-ordination, TMD (Temporomandibular dysfunction) or there are abnormal (pathological) conditions that destroy some of these structures or prevent their harmonious functioning. The first is the most common and is caused by a group of conditions. It is self-limiting with or without treatment and for a small number of people can recur over a prolonged period of time.

Causes of TMD

It is not always possible to determine the cause of TMD, however the most common symptoms include injuries to the facial region especially the jaws at some stage in your life, unusual habits and over stressing the joint with excessive chewing of gum, nails or unknown sources of chewing/stresses.

Symptoms of TMD

Symptoms can vary in duration and intensity ranging from mild to severe and they are:

  1. Pain
  2. Clicking
  3. Inability to open the mouth wide
  4. Locking

Accompanying symptoms may include:

  • i) Pain in and around the ears, checks, face, neck, back and shoulders
  • ii) Headaches and migraines
  • iii) Altered sensation
  • (1) blurred vision
  • (2) Loss of hearing, ringing in the ears, dizziness and nausea
  • (3) Uncomfortable bite, sensitive teeth clenching or grinding of the teeth
  • iv)Facial swelling

Diagnosis of TMD

The diagnosis of TMD is primarily based upon your symptoms, physical and x-ray assessment. The aim is to eliminate the possibility of conditions that are unrelated to the jaw joint and rare pathology of the joint.

Management of TMD

Once TMD is diagnosed with its underlying causes treatment can commence and can range from:

No treatment

  1. a) It is a benign condition which should resolves by itself at some stage;

Conservative treatment (most common)

  1. a) Behaviour modification therapy, (avoid overusing the jaws or stressing them too much);
  2. i) Avoiding habits of jaws nails, excessive chewing gum;
  3. ii) Soft diet,
  4. iii) Avoiding extreme jaw movements i.e. opening the mouth widely;

iv) Relaxation and stress management in general and even directly associated with the jaw;

b) Thermal therapy using heat packs;

c) Physiotherapy by exercises done yourself or assisted by a physiotherapist, acupuncturist chiropractor;

d) Medication be it be topical (Voltaren gel) and/or systemic (minor/major analgesics, Valium etc);

e) Reversible management by way of splints, night guards or minor adjustment to fillings, bite adjustments etc.

Invasive treatment (rarely done)

a) Extensive dental treatment, (building up some of the teeth to total mouth rehabilitation);

b) Surgery of the jaw joint by arthroscopy, formal opening up of the jaw joint or even repositioning the jaws.

The treatment selected will depend upon the underlying cause and will be dealt with first in a reversible conservative manner.