TMJ

Common Signs/Symptoms Of TMJ Or Temporomandibular Joint Related Problems


Pain in front of the ear.
  1. Is your pain located in front of the ear canal?
  2. And does this pain gets worse on jaw movements (opening, closing side to side)?
  3. If this is true, then the source of pain could be TMJ related.

Clicking, popping, Joint locking and Joint Dislocation.
  1. Although, clicking of the TMJ is fairly common, if there is Pain associated with clicking, then it needs to evaluated further.
  2. Sometimes the Jaw can get locked in an "Open" or "Closed" position or can get Dislocated due to TMJ disc related problems.

Difficulty opening the jaw.
  1. TMJ health is important to perform our lower jaw movements.
  2. Changes within the joint space, joint surface, disc destruction, joint adhesions, arthritic changes etc can lead to jaw movement limitations. These problems worsen with time, if left unattended.
  3. Traumatic injuries can also cause such restrictions.

Change in the bite and chin position.
  1. Progressive destruction of the TMJ can cause an open bite in between the upper and lower front teeth.
  2. In worse cases, seen in aggressive arthritic destruction of the joint, patients notice progressive backward shift in chin position.

Head and Neck pain.
  1. Myofascial Pain Dysfunction Syndrome, is the leading cause of pain in head and neck muscles.
  2. This is primarily related to the TMJ and bite related problems.

Causes Of TMJ Problems


Direct Trauma to the Face/Joint.
  1. Traumatic injuries can result in bruising/effusions in the joint space, fractures of the joint, injuries to the joint disc or ligaments.
  2. These injuries can cause joint problems, immediately or later in life.

Dental crowding, Jaw mis alignment.
  1. Severe dental crowding, can lead to excessive forces on the TMJ, can lead to progressive changes in the joint.
  2. Sometimes, the upper and lower jaw fail to grow in sync, and bony malposition can lead to progressive joint problems.
    • Such patients usually have dental crowding, and should be treated with Orthognathic/Jaw surgery along with Orthodontic/braces to treat the problem.

Premature loss of teeth
  1. Loss of teeth, especially complete loss, can lead to over closure of the lower jaw.
    • This can lead to excessive strain on the joint tissues.
    • Such patients need replacement of teeth and also correction of over closure.

Arthritis of the TMJ
  • TMJ can also suffer from Rheumatic Arthritis and Osteoarthritis.
  • Rare form of Juvenile Arthritis is seen in children.

    • Special Studies For TMJ Evalution


    Good Clinical Examination.
    1. Evaluation of any problem, begins with a good clinical examination.
    2. Dr Mogre will evaluate your TMJ for its range of function, identify presence of abnormal clicks, check for Myofascial Pain Dysfunction syndrome.
    3. A detailed clinical examination is then supported with radiographic studies.

    Supporting Radiographic Studies.
    1. Panoramic X-ray, can show a quick picture of the joint anatomy (shape of the condyle, joint space, presence of fractures)
    2. CT scan of the TMJ may be necessary if there is a suspicion for bony destruction of the joint.
    3. MRI is a good study to evaluate the health of soft tissues within the joint and its surroundings.
      • MRI can show the position of the joint disc, and can identify any disc perforation/destruction.

    Treatment Options For TMJ Related Problems


    Conservative therapy.
    1. Most of the times, acute pain in the joint, can be self limiting, and can be treated with very conservative approach.
      • Lifestyle changes to support the health of joint include:
        • not chewing gum
        • applying warm compress over the affected joint
        • supporting chin during yawning with palm or fist to prevent excessive stretching during painful symptoms.
        • Eating soft diet during acute painful symptoms.
    2. An custom fitted occlusal splint works well in reducing over 80% of TMJ related pain.
      • The results are better with a hard acrylic splint.
      • Avoid a store bought soft moldable bite splint, this may make your TMJ condition worse.
    3. A detailed clinical examination is then supported with radiographic studies.

    Medications.
    1. Sometimes the above mentioned conservative approach may need to be supplemented with medications.
      • NSAIDS like Ibuprofen, are the best class of analgesics to control inflammation and pain from the TMJ.
      • These medications are sometimes advised to be taken for few weeks, on a continuous basis, even if there is no joint symptom.
      • Joint repair/recovery phase also needs to be Inflammation free.
    2. Narcotic Pain medications, are not helpful for reducing inflammation, which is the source of TMJ related pain, and are therefore not prescribed.

    Minimally Invasive Surgery
    1. Most of the TMJ related problem which are resistant to the above therapies may benefit from minimally invasive surgery such as
      • TMJ arthrocentesis, which is flushing the joint space to get rid of toxins within the joint space.
      • TMJ arthroscopy

    Open Joint Surgery
    • If the above therapies do not help or in cases where there is evidence of aggressive joint destruction at the time of examination, it is recommended that patient undergo Open joint surgeries which can involve the following options:
      • Discectomy: removal of the TMJ disc,
      • Arthroplasty: reshaping the bony contours of the joint
      • Joint replacement

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