The term TMJ is an abbreviation for Temporo-Mandibular Joint, or the jaw joint. In fact, there are really two TMJs, one in front of each ear. The TMJ is the joint formed by the temporal bone of the skull (Temporo) with the lower jaw or mandible (hence, mandibular). These joints move each time we chew, talk or even swallow. The TMJ is actually a sliding joint and not a ball-and-socket like the shoulder. This sliding allows for pressures placed on the joint to be distributed throughout the joint and not just in one area. The TMJ is the most complex joint in the human body. Placed between these two bones is a disc, just like the one between your back bones. This disc is primarily made of cartilage and in the disc functions like a third bone. The disc, being attached to a muscle, actually moves with certain movements of the TMJ.

The nerve to the TMJ is a branch of the trigeminal nerve and therefore, an injury to the TMJ may be confused with neuralgia of the trigeminal nerve. The two bones of the TMJ are held together by a series of ligaments, any of which can be damaged, just like any other joint. A damaged TMJ ligament usually results in a change in the position of the disc, the lower jaw, or both. Also, the bones are connected by two main muscles: the temporalis, the masseter. Any or all of these muscles may be painful and produce pain in the TMJ or at the very least, abnormal movement of the lower jaw.

Causes of TMJ

***There are several contributing factors and several ways you can get TMJ disorder. The jaw joint is the most used joint in your entire body, and one of the most delicate. From a simple bump to a severe car accident, you can be the next victim of TMD.***

Trauma:

According to statistics published in the Journal of the American Dental Association in 1990,* 44% to 99% of TMJ problems are caused by trauma. By trauma, we mean an injury as obvious as a blow to the jaw with a fist or something as subtle as a whiplash injury with direct trauma to the head or jaw. (*JADA 1990;120:267) Thing that are considered trauma are NOT just car accidents or major injuries. Several things we classify as trauma include; your child head butting you in the chin, sports injuries, recreational vehicle accidents, skiing, weight lifting, running, a fall of any degree, and the list continues but as you can see there are countless ways this type of injury can occur.

Cervical Acceleration/Deceleration (Whiplash):

Whiplash is one common cause of TMD and can be caused from a motor vehicle accident or other such trauma.

Common complaints following a CAD or Whiplash injury may include:

1. Neck pain
2. Neck stiffness (difficulty in turning the head)
3. Headaches (especially, temporal and occipital --where neck attaches to head)
4. Back pain
5. TMJ symptoms (joint pain, limited opening of the mouth, change in bite, TMJ noises, pain in face and TMJs with mouth opening, ear pain)
6. Dizziness
7. Visual changes (light sensitivity, blurred vision, pain behind the eyes, etc.)
8. Swallowing difficulties and even hoarseness

Air Bag Deployment

Direct trauma to the mandible in auto accidents, like indirect trauma in whiplash injuries, are both known to produce TMJ injuries. Recently, however, the advent of air bags, which no doubt have saved numerous lives, has been implicated in causing TMJ problems.

Patients who have been injured with air bags often have the following symptoms:

1. Burned or abraded skin on the chin, face and even the nose
2. Almost immediate TMJ pain
3. Swelling of the TMJs
4. Limited mouth opening
5. Lateral and cervical neck pain
6. Change in the fit of the teeth coming together

Opening Too Wide:

All joints have limitations to movement and the TMJ is no exception. If you open wide for a long time, or if your mouth is forced wide open, ligaments again may be stretched or torn. Swelling and bruising develop and disc dislocation may occur. For example, if your mouth is open for a long time at the dental office while having a root canal, an extraction or a tooth prepared for a crown, the joint can dislocate. This rarely happens without a prior history of trauma; however, it does happen. Also, this type of injury may occur if someone's mouth is opened too wide when they are being put to sleep for surgery. Again, both of these examples are accidental and consequences of the given procedures.

Contributing Factors-

Bruxism:

Bruxism is the abnormal grinding of the teeth. If grinding continues the TMJ condition will get worse. Bruxism usually occurs during sleep. That is why so many people do not realize that they are bruxers. One indication that a person is a bruxer is sore jaw muscles or headache when waking in the morning. Some researchers feel that the constant grinding of the teeth causing pressure on the TMJs may injure the ligaments, thus allowing for the disc to dislocate. At the very least, bruxism produces muscle pain, sensitive and worn teeth.

Malocclusion:

Malocclusion is simply a bad bite. Malocclusion may be produced by poor development of the jaws or removal of teeth without replacement, a high dental filling, a poor fitting denture or partial denture, or a displaced TMJ disc.

Orthodontics:

Some feel that orthodontic treatment, or braces, might be a cause of TMJ. By moving teeth with orthodontic appliances, malocclusion is produced during treatment. Also, people undergoing orthodontics do report sensitive teeth, pain in the jaw muscles and even bruxism. However, as with malocclusion and bruxism, there has been no scientific controlled study to prove that orthodontic treatment produces a TMJ problem.

Ligament Laxity:

People who appear to be double-jointed actually suffer from a problem termed Aligament laxity. If this occurs, then the joint appears to be double or, loose. This definitely can happen to the TMJ's. Ligament laxity is a fairly common problem in active young women who suffer with TMJ (and injuries to other joints). Laxity of ligaments can be the result of trauma or over stretching the join.

Stress:

Stress has many effects on our bodies: some good and some bad. Stress, being both physical and psychological. Physiological changes can produce muscle tightness and pain and if you are subjected to chronic stress, these physical changes may produce harmful effects. For example, people subjected to chronic stress develop ulcers, diarrhea, tension headaches, muscle tightness and other physical symptoms. Stress is just like throwing gasoline on an existing fire: the fire is a TMJ problem and the gasoline is stress. The gasoline causes the fire to flair up and burn widely for a time, but the gas did not produce the fire (or, TMJ), it just made it worse. This is how it appears that stress acts in conjunction with a TMJ problem. Muscles tighten, teeth clench, abnormal pressure is forced against the TMJ disc, and if the ligaments are weak or if the patient is one that has ligament laxity, then the disc may dislocate.

Systemic Diseases:

Various diseases can cause or aggravate TMJ problems. Immune disorders such as rheumatoid arthritis, psoriatic arthritis, and systemic lupus erythematosus can produce inflammation in the TMJ. In addition, viral infections such as mononucleosis, mumps and measles can cause damage to the surfaces of the TMJ, which ultimately can lead to an internal derangement.

General TMJ (disorder) Treatment

Dentists use a variety of treatment modalities which may be divided into Phase I, Phase II and Phase III Therapy. The purpose of Phase I Therapy is to eliminate muscle spasms, TMJ swelling and dislocation (if possible), and generally reduce any type of pain. This treatment usually includes the use of splints, exercises, medication, local anesthetic injections, injections of other medications, physical therapy and chiropractic treatment. The purpose of Phase II Therapy is to definitively correct any discrepancies, if necessary, between the upper and lower jaws. This means to get the bite right. Phase II Therapy may include adjustment of the dental occlusion, orthodontics, reconstruction of the teeth, surgery, or a combination of some of the above treatments. It is important to note that Phase II Therapy should not be attempted without successful Phase I Therapy modalities.

Phase I Treatment. Phase I treatment for TMJ is conservative treatment, producing no irreversible changes. Generally, the use of an intra oral splint, sometimes medication is required, the combination of chiropractic treatment or physical therapy are recommended in some cases depending on the extent of the injury, and life-style changes are all very effective in treating most truly TMJ problems. Other disorders which mimic TMJ (for example, temporal tendinitis, Ernest syndrome) are often treated with Phase I therapy with medications, injections of local anesthetic and other medications, and soft tissue treatment.

Phase II Treatment. Phase II treatment is, by definition of the American Dental Association, non-reversible, invasive therapy. This is done when you have been evaluated and released of Phase I treatment. Doing so by having satisfied your treatment expectations and have a stable jaw joint. Each individual is different unlike phase I not everyone will be prescribed the same phase II. Some of the recommendations are; adjustment of the occlusion (adjusting the "bite") which is done in our office by painlessly filing each tooth until there is a precisely even and comfortable fit. Some of you my need orthodontic treatment which of course will be done by an orthodontist and not in our office. The placement of crowns and bridges and for some replacing missing teeth is necessary. It is rare but surgery of all types may be necessary and most certainly produce changes which can't be reversed. Therefore, it is most important that no one undergoes Phase II Treatment until a correct diagnosis is established and proven as the cause of the symptoms.

Last of all, if a TMJ sufferer is experiencing severe emotional and/or psychological problems (which if often the case for many reasons), failure to address these most important issues will virtually guarantee a surgical failure. Psychological (as well as physical) problems must be considered as sources of unresolved pain complaints involving the TMJ or associated structures.

If you or a family member or friend who suffers with a TMJ problem has doubt or unresolved pain, get a second or even third opinion before any Phase II Treatment is initiated.

Phase III Treatment. Phase III treatment is the long term management of a patient following successfully completing Phase I and Phase II treatment. Phase III (the maintenance phase) involves the use of a night time/stress splint. Regular personal TMJ therapy and cautious use of the jaw to avoid new and additional injury to the jaw joints and muscles.

Procedures