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How Are TMJ Disorders Managed?

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Temporomandibular joint disorders are a group of conditions affecting the joint and masticatory muscles. Read this article to know more.

Medically reviewed by

Dr. P. C. Pavithra Pattu

Published At February 3, 2022
Reviewed AtSeptember 11, 2023

Introduction:

One of the body's complex joints is the temporomandibular joint (TMJ). The mandible may move up and down, side to side, and back and forth attributable to these joints and a number of muscles attached to it. Temporomandibular joint disorders cause pain and discomfort, difficulties in mouth opening, and referred pain to the ear. Studies report that factors related to the neurological system, senses, genetics, and psychology may increase the risk of temporomandibular disorders. The treatment varies from nonsurgical to surgical, depending on the severity of the pain and discomfort.

This article discusses temporomandibular disorder in detail.

What Is Temporomandibular Joint (TMJ)?

The temporomandibular joint, a hinge joint, is located on the lateral side of the skull through the temporal bone to the lower jaw or mandible. It is present on each side of the jaw. It has specific movements like rotation, protrusion, and retraction. It is one of the complex joints in the body that allow the movement of the mandible along with the muscles attached to it. The alignment of the temporal bone and joint, mandibular bone, and ligaments all together help in mandibular movement and function. The functions that it enables include chewing, talking, swallowing, and yawning. The malalignments of the joint or injury to the ligaments, or bones may cause difficulties in performing these functions.

What Are Temporomandibular Disorders (TMD)?

More than 30 conditions collectively known as temporomandibular disorders (TMDs) affect the muscles and joints that regulate the articulation of the jaw and cause pain and dysfunction. The malalignment in the joints, jaw muscles, nerves supplying the temporal bone and the mandible, and ligaments cause some discomfort or pain in the joints causing difficulty chewing, talking, and swallowing. Mostly, the pain is reported to be chronic.

The primary classification of temporomandibular disorders is

1. Joint Disorders- Joint disorders such as internal derangement (a condition in which the joint is dislocated or cartilage is dislocated, which usually occurs when the mandibular condyle is injured during trauma) and degenerative joint disorders such as osteoarthritis and rheumatoid arthritis.

2. Muscle Disorders- Muscle disorders such as myofascial pain is a common temporomandibular disorders, causing pain in the fascia which is the connective tissue of the muscles and joints.

3. Headache associated with TMD.

What Are the Causes of TMD?

The primary and definite cause of the temporomandibular joint disorder is not known. There are possible ways to identify and conclude the reasons. Bruxism, stress, muscle strain, malalignments in jaw muscles, and disorders of the disk can cause TMJ disorder.

Bruxism is clenching of the teeth, either by habitual or involuntary clenching or grinding of the teeth. The muscles strained by bruxism may cause difficulty in swallowing, chewing, and talking. Moreover, the trauma to the head may cause joint dislocation and injury to the temporomandibular joint resulting in temporomandibular joint disorders. Furthermore, medical conditions such as irritable bowel syndrome also increase temporomandibular joint pain.

What Are the Signs and Symptoms of Temporomandibular Disorders?

The signs and symptoms of temporomandibular joint disorders are as follows:

  • Jaw discomfort.

  • Jaw pain on one or both sides.

  • Limited mouth opening called trismus.

  • Clicking sound.

  • Lockjaw.

  • Soreness in joints.

  • Occlusion of upper and lower teeth gets affected.

  • Sensitivity in the teeth.

  • Referred pain to face, ears, head, and eyes.

  • Clenching of teeth.

  • Grinding teeth.

  • Pain while chewing.

  • Difficulties in opening and closing the mouth.

When to See a Doctor for Temporomandibular Joint Disorder?

The temporomandibular joint disorder needs to be consulted with the doctor if

  • The person has severe and continuous pain and discomfort.

  • The person cannot open their mouth widely.

  • The person has lockjaw symptoms such as the inability to close the mouth.

  • The person experiences referred pain in the ears, eyes, face, and head.

How Is a Temporomandibular Joint Disorder Diagnosed?

The doctor or dentist will observe or notice the following conditions:

  • The extension of the opening of the mouth.

  • The restrictions of the movements while opening the mouth.

  • Palpate the jaws and surrounding areas to locate the pain and discomfort site.

  • Dental x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) are done to confirm the diagnosis. Dental x-rays reveal the condition of teeth and bones. CT scan shows a detailed image of the bone. MRI scan reveals the connective tissue between the joint, inter radicular disk, and soft tissue surrounding the joint.

  • Temporomandibular joint arthroscopy may also be done for confirming the diagnosis of temporomandibular joint disorder. In this procedure, a cannula or a thin tube is inserted into the joint area connected to the camera. This reveals the condition of the joint through the image generated from the cannula.

How Can Temporomandibular Disorder Be Managed?

The management of temporomandibular joint disorder depends upon the conditions below:

  • The severity of pain.

  • The duration or span of pain.

  • The medical history of the patient.

  • The age of the patient.

  • The patient is under any other treatment, like radiotherapy and other procedures.

Non-surgical Treatment: Basic mouth opening and closing exercises, muscle relaxants, and painkillers can be helpful in the treatment of temporomandibular joint disorders. Night mouth guards are provided for bruxism. The orthopedic appliance is also provided for temporomandibular joint disorders due to bruxism. Painkillers and anti-inflammatory drugs are prescribed. The position and rest position for the temporomandibular joint is corrected by manual guiding. Cold pack applications and hot pack applications can be given for ten minutes, three to five times a day for two weeks, which will also aid in muscle relaxation. Moreover, it is advised to eat soft foods.

Surgical Treatment:

The surgical procedures are done if all other non-surgical procedures do not give the desired result.

The surgical procedures include the following:

  1. Arthrocentesis.

  2. Open joint surgery.

  3. Corticosteroid injections.

1. Arthrocentesis:Tiny needles are inserted into the temporomandibular joint in arthrocentesis. The irrigation is done into the joint with the saline and fluids through these little needles. This irrigation helps in the removal of debris and other inflammatory products.

2. Injections: Corticosteroid injections are also given into the joint. Mostly botulinum toxins are injections given into the jaw muscles. It relieves the pain related to chewing and swallowing.

3. Open Joint Surgery: The open joint surgery, the arthrotomy, is done if all the conservative procedures are unsuccessful. It involves the repair and replacement of joints. Artificial devices known as implants are also utilized to replace all or a portion of the jaw joint.

Conclusion:

The temporomandibular joint disorder is caused by several conditions such as bruxism and disk and cartilage damage. Fortunately, it can all be managed better through non-surgical and surgical therapies. The surgery is done only if the nonsurgical methods are not successful. Therefore, it is advised that if anyone has symptoms, consult a dental health professional and get treated.

Frequently Asked Questions

1.

Can TMJ Disorders Be Cured Without Surgery?

Some TMJ (temporomandibular joint) disorders can be cured without treatment or surgery. However, some cases of TMJ require extensive treatment and even surgery. The extent of the disorder determines the treatment plan. 

2.

What Causes TMJ Disorders?

The following reasons can cause TMJ disorders: 
- Trauma.
- Improper bite. 
- Wear and tear of the joint. 
- Arthritis of the jaw. 

3.

Is TMJ Disorders Classified as a Medical or Dental Problem?

A TMJ disorder can be both a medical and a dental problem. Conditions such as arthritis of the joint are medical problems. Most of the conditions of TMJ come under dental problems and are treated by a dentist. Disorders such as TMJ dislocation and TMJ ankylosis require long-term treatment by a dentist. 

4.

What Can Be Considered a Severe Case of a TMJ Disorder?

A severe case of TMJ disorders may have the following symptoms: 
- Nagging pain in the joint that is persistent.
- Tenderness or pain on touching. 
- Inability to open the jaw completely. 
- Dislocation of the joint. 

5.

Can a Chiropractor Help With TMJ Disorders?

A chiropractor can help relieve trigger points and minor adjustments of the jaw. They can help relieve the tension accumulated in the joints by manipulating the trigger points. This can be helpful for patients with severe TMJ pain. However, in the case of malaligned jaws, it is advisable to consult a dentist before taking up other procedures. 

6.

What Practices Can Help in Curing TMJ Disorders Permanently?

The following practices can help with TMJ pain: 
- Avoiding adverse habits such as tooth grinding with the help of dental appliances. 
- Posture correction. 
- Following a healthy lifestyle. 
- Reducing stress. 
- Using warm compress. 
- Avoiding hard food items until complete recovery. 
- Getting good sleep. 

7.

What Are the Various Treatment Modalities Used by Dentists for TMJ Disorders?

The various treatment modalities used by a dentist include:
- Medications such as pain relievers and steroids. 
- Various dental appliances to break habits such as teeth grinding (bruxism). 
- Orthodontic appliances to correct TMJ disorders due to malaligned teeth. 
- Surgical approach for conditions like TMJ ankylosis.

8.

Can TMJ Disorders Be Caused by Malaligned Teeth?

Malaligned teeth can cause TMJ disorders. Malaligned teeth can cause abnormal distribution of biting force. This can cause strain on the muscles of the jaw. Such imbalances caused due to malaligned teeth can cause TMJ disorders.

9.

What Is the Treatment for TMJ Malalignment?

The treatment for TMJ malaligned teeth includes: 
- Orthodontic treatment involving braces. 
- Dental appliances such as headgear, and jaw expanders. 
- Habit-breaking appliances for teeth grinding and clenching. 

10.

How Does a Dentist Treat TMJ Malignment?

A dentist can treat dental malalignment with the help of orthodontic appliances. An appliance is a metal bracket fixed to the tooth using gum/ resin. The alignment of the teeth happens with the help of wires and bands. The treatment may require surgery if the malignment is not due to the teeth. 
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Dr. Rakshana Devi M
Dr. Rakshana Devi M

Dentistry

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