What is TMJ?

“TMJ” is an abbreviation for the temporomandibular joint. The TMJ is not a disorder/disease. It is a part of the body. A joint is a connection between two bones that allows for movement between those bones. Healthy joints allow for smooth, pain-free movement through a wide range of movement or motion. There are two temporomandibular joints, one on each side of the face, located directly in front of the ears. The TMJs differ from other joints in our body in several ways. The first is that it is the only joint that rotates, slides or translates, and pivots. If a finger is placed on the TMJ directly in front of the ear and the jaw is opened slightly and closed, one can feel the rotation. If the teeth are closed together and the jaw is protruded straight out or when the jaw is opened wide the sliding motion, or translation, is felt. If the jaw is moved to the left, for example, the left joint pivots while the right joint slides. The second way the TMJs differ from other joints in our body is that the right side is connected to the left side. The right and left TMJs are in essence opposite ends of the same bone which is the jaw or mandible.

It is a common misconception that people call a wide collection of chewing system disorders, “TMJ”. More appropriate terminology for this large category of joint and muscle symptoms is temporomandibular disease/disorder (TMD) or craniomandibular disorders (CMD) (cranial meaning head and mandible meaning the lower jaw). Each problem or group of symptoms stems from a specific system dysfunction that can be measured.

The TMJs must withstand tremendous force from the jaw muscles as we chew. Because it is such a complex joint and must withstand such great stress, it can be affected by a variety of disorders/diseases. These can range from mildly uncomfortable to severely painful. Most of these conditions can be treated or managed.

Any noisy joint is a damaged joint. Clicking in the TMJ during movement (opening/closing) indicates that there is damage to the ligaments that secure a cartilage disc to the condyle of the mandible.

Causes of TMJ

TMJ disease or damage is often the result of trauma, either singular or accumulated. Traumas can damage the structures of the TMJ just as any other joint in our body. The structural changes that can result will necessarily cause changes in how the TMJ functions; changes in how the system functions mechanically. The “system” is the Stomatognathic System which is more than the sum of its parts. It is more than just teeth, gums, bones, muscles, cartilage, neural tissue and blood vessels. As a functional system, the only moving areas are the TMJs. When there is structural damage in the joints, usually evident by noise in the TMJs with opening and closing, the bite can change. When the bite changes, the muscles cannot work the way they were designed to and muscle spasms can result. The spasms can then become part of a cycle that results in tissue damage, pain and tenderness of the face or headache. It is possible that malocclusions, when the teeth do not meet together properly, can lead to muscle spasm and then to TMJ damage.

Grinding of the teeth, bruxism, is an oral habit that appears to be a result of the body attempting to adapt to the disharmony between the temporomandibular joints, the bite and the chewing muscles. The body tries to adjust the bite through grinding of the teeth; however this process is very damaging. It is thought that stress causes bruxism but this typically is not true. Stress will make an underlying situation worse but typically is not the underlying cause of bruxism. The oral habit of bruxism, either day time or sleep time, can lead to more TMJ damage and instability.

Signs & Symptoms of TMJ

TMJ disorders have many signs and symptoms. Some of the most common include the following:

Pain in or around the ear. This pain often spreads to the face.
Tenderness of the jaw muscles.
Clicking/popping noises when one opens or closes the mouth.
Difficulty in opening one's mouth.
Jaws that get stuck, lock, or go out.
Pain brought on by yawning, chewing, or opening the mouth widely.
Certain types of headaches or neck aches.

Dr. Grill can determine the cause of your symptoms via a thorough interview/examination process and by conducting a series of diagnostic tests. These tests may include Doppler examination, CT & MRI scans of the TMJs, mounted study models of the teeth, and X-rays. This process may seem time-consuming, but proper diagnosis is essential before the appropriate treatment can be recommended. It can save time, suffering, and money by ensuring that you receive the treatment appropriate to manage your particular problem.

Treatment Options

Since the whole stomatognathic system and related muscles, including various supporting facial, neck and upper back muscles, is involved in Temporomandibular Joint Disease/Disorder patients, treatment can vary greatly. It is essential that an accurate DIAGNOSIS of the damage or pain source be made FIRST. To venture upon a treatment without making an appropriate diagnosis is not acceptable in any facet of health care.

Dr. Grill reviews all of the data recorded during the interview and examination process, along with the information available from TMJ imaging (CT and/or MRI) if necessary and mounted study models in order to generate a lengthy report that outlines the history and findings along with a management plan. Management options are varied and specific but may include orthotic appliance therapy possibly concurrent with specific head and neck physical therapy. Along with a licensed physical therapist, other clinicians that may be requested to aid in a patient’s management could include an oral/maxillofacial surgeon, restorative dentist, physicians of various specialties, chiropractors, and massage therapists. Care for a patient often involves a team approach in order to achieve a stable, more comfortable outcome.

Dr. Grill and other health professionals who provide treatment for TMJ disease/damage care about your health and comfort. Follow the recommendations they give you and discuss with them any concerns you may have. Remember, in many cases the pain, headache, and other symptoms associated with TMJ disease/damage can be successfully managed and treated.