TMJ Disorder Management and Surgery
What Causes TMJ Disorders?Determining the cause of a TMJ problem is important, since the cause will guide your treatment. Arthritis is one cause of TMJ symptoms. It can result from an injury, autoimmune disease, age-related wear and tear, or, from excessive forces such as clenching during the day or grinding your teeth at night. Another common cause involves displacement or dislocation of the disk that is located between the jawbone and the socket. A displaced disk in the TMJ may produce clicking or popping sounds, cause pain when opening and closing the mouth and result in possible “locking” of the jaw, which can all result in loss of normal joint anatomy and function. The disk can also develop a hole or perforation, which can produce a grating sound with joint movement. Conditions such as joint trauma or severe arthritis that can also cause the bony parts of the TMJ to fuse (ankylosis), preventing jaw movement altogether.
Anatomy of the TMJ
The Joint, the Muscles or Both are the Problem
The TMJ is a hinge and gliding joint and is the most constantly used joint in the body. The round upper end of the lower jaw, or the movable portion of the joint, is called the condyle; the socket is called the articular fossa. Between the condyle and the fossa is a disk made of cartilage that acts as a cushion to absorb stress and allows the condyle to move easily when the mouth opens and closes.
Stress may trigger pain in the jaw muscles that is very similar to the pain caused by TMJ problems. Affected patients frequently clench or grind their teeth at night causing painful spasms in the muscles and difficulty in moving the jaw. Patients may also experience a combination of muscle and joint problems (joint clicking or arthritis) That is why diagnosing TMJ disorders can be complex and may require various diagnostic procedures.
Do You Have a TMJ Disorder?
- Are you aware of grinding or clenching your teeth?
- Do you wake up with sore, stiff muscles around your jaws?
- Do you have frequent headaches or neck aches?
- Does the pain get worse when you clench your teeth?
- Does stress make your clenching and pain worse?
- Does your jaw click, pop, grate, catch, or lock when you open your mouth?
- Is it difficult or painful to open your mouth, eat, or yawn?
- Have you ever injured your neck, head, or jaws?
- Have you had problems (such as arthritis) with other joints?
- Do you have teeth that no longer touch when you bite?
- Do your teeth meet differently from time to time?
- Is it hard to use your front teeth to bite or tear food?
- Are your teeth sensitive, loose, broken or worn?
The more times you answered “yes”, the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they are treated.
There are various treatment options that can be utilized to improve the harmony and function of your jaw.Once an evaluation confirms a diagnosis of TMJ disorder, Dr. Moy or Dr. Kahenasa will determine the proper course of treatment. It is important to note that treatment always works best with a team approach which will include your own self-care, in addition to professional care which will include Dr. Moy or Dr. Kahenasa, your dentist and possibly various other specialists (physical therapist, pain management specialist, orofacial pain specialist, behavioral therapist and/or neurologist). The initial goals are to use conservative (non-surgical)measures to relieve the muscle spasm and joint pain. This is usually accomplished with a pain reliever, anti-inflammatory medicine or muscle relaxants. Steroids or hyaluronic acid can be injected directly into the joints to reduce pain and inflammation. Self-care treatments will also be effective and include:
- Resting your jaw
- Keeping your teeth apart when you are not swallowing or eating
- Eating soft foods
- Applying ice and heat
- Exercising your jaw (depending on the cause of your TMJ disorder)
- Practicing good posture
Stress management techniques such as biofeedback or behavioral therapy and physical therapy may also be recommended. A clear plastic appliance, known as a splint, should be worn. A splint or nightguard fits over your top or bottom teeth and helps keep your teeth apart, thereby relaxing the muscles and reducing pain. There are different types of nightguards used for different purposes and your dentist will help you to determine the correct one for your situation. Your dentist will then custom mold the nightguard to your teeth. When worn nightly, the night guard helps to reduce muscle tension during night time clenching or grinding, which will in turn help protect the cartilage and joint surfaces within your TMJ. Dr. Moy or Dr. Kahenasa are happy to see you for your TMJ disorder management and surgery, however, we will refer you to your dentist or an orofacial pain specialist for a custom made nightguard.
What about bite correction or surgery?
If your TMJ disorder (TMD) has progressed despite all the measures stated above, additional procedures may be considered. There are various safe and minimally invasive treatments, including arthrocentesis or arthroscopy, that we can discuss as the next step in your TMD treatment. Most of the time, TMJ surgery is reserved for those patients who feel their jaw can’t open, can’t close or is locked, dislocated, or has severe degeneration (arthritis). For most patients, conservative therapy along with a night guard will successfully manage their TMJ Disorder. However, if surgery is needed, Dr. Moy or Dr. Kahenasa will assure your thorough understanding of the problem and treatment options along with expectations for recovery and success.