The Temporomandibular Joint
The Temporomandibular Joint (TMJ) is the most complex joint in the entire body. It is the only bilateral connected joint (right and left sides) that exist in the human body.
It is a rotational (hinging) and sliding joint that connects the lower jaw (mandible) to the skull’s temporal bone. It is not a typical ball and socket shoulder type joint. The two joints are located in front of each ear.
The TMJs allow rotation, up and down movement, and side to side movement of the lower jaw enabling a person to articulate speech, chew, yawn, and swallow.
It is a load bearing synovial joint that, like other load-bearing joints is subject to breakdown by damaging molecular events triggered by overloading or systemic disease.
TMDs may present in a variety of pathologies. One may see persistent Oral-facial Pain, Muscular Pain and Dysfunction of the head and neck, TMJ Osteoarthritis, TMJ Disc Derangements and a number of problems caused by systemic disorders.
TMJ/TMD disorders are most often thought to occur due to problems with a person’s bite (occlusion), jaw joints (TMJs), and surrounding muscles used for facial expression, chewing, swallowing, and head and neck movement.
The shoulder and upper back muscles are also routinely involved with TMJ/TMD disorders.
TMJ/TMD symptoms may go away without treatment in some cases however, this is rare. It is usually best to avoid overuse of the jaw muscles by eating soft foods, cutting food into small bites, avoiding chewing gum, chewy or sticky food.
Ice and OTC (over the counter) ibuprofen are first line treatments for acute pain in or around the TMJs followed by warm moist heat in some instances.
When symptoms persist, the first step in treatment is to orthopedically re-position the TMJs to relieve head and neck pain, start the healing process and achieve a stable jaw joint position.
It usually takes anywhere from 8-12 weeks of full time positioner wear for women and shorter periods of time for men to achieve healing and orthopedic stability.
Some patients take longer depending on the overall health of the joint when starting stabilization. Corrective dental treatment that improves the bite and its relationship to the TMJs can only be attempted after a correct diagnosis is established and proven as the cause of the symptoms.
This type of treatment is considered non-reversible and may include orthodontic treatment, adjusting of the bite, and replacement of tooth form that has been damaged due the bite discrepancy.
Surgery is usually not necessary in tooth position to jaw joint position discrepancies unless the size of the discrepancy warrants orthognathic (jaw) surgery to align the upper and lower jaw.
Surgery of the joints themselves is usually only warranted in acute injury situations such as whiplash or in instances of bone tumors and complete disc displacement.