Saturday, November 01, 2014

Temperomandibular Joint (TMJ) Disorder

Definition

Temperomandibular Joint (TMJ) Disorder occurs when the muscles used in chewing and the joints of the jaw fail to work in combination with each other.

TMJ disorder may have any number of causes, among them such habits as clenching or grinding the teeth (bruxism), malocclusion (poor bite) that puts muscles under stress, accidents that damage the bones of the face or jaw and occasionally, disease such as arthritis.

Description

The dental literature reports that TMJ disorders are frequently undiagnosed by physicians. These disorders are responsible for many signs and symptoms related to pain and discomfort in the head and neck. TMJ is often associated with complaints of chronic muscular headaches or craniofacial pain. Many of these disorders produce symptoms that mimic more serious medical problems such as intracranial aneurysms, migraine or neoplasms of the head and neck. These diagnoses should be considered before beginning treatment for presumed TMJ.

Symptoms

The classic symptoms of TMJ are pain and tenderness of the jaw muscles, clicking and grinding noises during movement of the jaw, and limited or irregular jaw movement.

Other symptoms include: spasm and tenderness of various facial and neck muscles, preauricular (in front of the auricle of the ear) tenderness, facial asymmetry, malocclusion and chronic postural head tilting.

The basic problem, aggravated by oral conditions, is often an emotional one. The development of symptoms seems to be caused by a combination of factors: a physiologic predisposition, psychological and physical stress, and the individual's inability to cope with the stress. Stress management, together with supportive treatment with heat and muscle relaxants, can often have a profound effect. Any treatment involving appliances to improve the bite should be of a reversible nature.

Diagnosis

Diagnosis of TMJ requires recognition of the symptom complex and the findings of impaired mandibular range of motion. Further workup consists of radiographic characterization of the joint. The first-line study is plain tomography of the joint in open and closed positions.

Magnetic resonance imaging (MRI) is a recent development in TMJ imaging. MRI has been found to correlate well with surgical findings in the joint. The gold standard in diagnosis is a combination of linear tomography and MRI.

Treatment

A combination of dental and medical therapy is most effective in the treatment of TMJ. In the acute setting, therapy usually consists of anti-inflammatory medications, a soft diet and hot compresses. Some patients may benefit from the use of muscle relaxants. Patients with symptoms that persist longer than a few weeks may benefit from intra-oral occlusal splints, local or regional anesthesia and various medical modalities.

When symptoms have been relieved and normal occlusal relationships and TMJ function have been established, permanent dental corrections may be helpful in persons with chronic or recurrent symptoms. This treatment may be accomplished by means of orthodontic work, fixed dental reconstruction or removable prosthesis. The goal of this therapy is to restore and maintain the normal relationship between the maxillae and the mandible.

Between five and 10 percent of patients with TMJ have dysfunction that is not relieved by medical therapy. These patients eventually require surgical correction of the joint.

In mild cases, simple remedies include the following:

  • Chew evenly
  • Stop clenching, gritting, or grinding teeth
  • Stop chewing gum
  • Avoid hard chewy foods
  • Exercise jaw, bringing lower teeth out in front of upper teeth. Do this ten times at each meal and at bedtime
  • Apply heating pad for one half hour at least twice daily
  • Take two aspirins, or buffered aspirin, four times daily

Questions

Are there any tests that need to be done to diagnose TMJ?

What is the cause of the problem?

What type of treatment will you be recommending?

Will you be prescribing any medications? What are the side effects?

How long does it usually take for the treatment to start relieving symptoms?

Will surgical correction be required?

How effective is the surgery?