Facts About The Temporomandibular Joint
The Temporomandibular joint or TMJ is the most discussed joint in dentistry. It is constantly in motion as we chew, swallow, speak, and grind our teeth. Often it is the source of chronic pain for many patients. These individuals seek treatment from their local family dentist since dentistry has the best understanding of this unique joint.
TMJ Anatomy
In order to understand problems with the TMJ, it is necessary to have a general understanding of the functional anatomy of this region of the head and neck. The condyle is the part of the lower jaw that makes up the TMJ. The condyle articulates or is in close association with the fossa of the skull. These two bony areas are separated by the disc of the TMJ. This entire unit is encapsulated. This zone has muscle attachments to the lower jaw. The temporomandibular joint is unique in the fact that it has both rotational and translational movement . We are familiar with the other joints of the human body. The knee for example rotates around one point when the lower leg is extended. The temporomandibular joint however rotates initially upon opening the mouth followed by translation as we fully open our mouth. This translation is accomplished by the condyle disarticulating or moving forward along the fossa. In order to prevent bone on bone erosion, the disc follows suit with the translation. As the mouth is closed, the TMJ is re articulated in it's original position and the disc follows.
TMJ Dislocation Clicking and Popping
The above description of the normal movement of the TMJ is very complex. The unique function of the TMJ leads to many forms of disease. Many people suffer from chronic pain of the temporomandibular joint as one of the many components become injured or inflamed. Some chief complaints include abnormal sounds such as clicking and popping. These noises often are early signs of TMJ disease. If left untreated, the clicking and popping can lead to pain and restricted opening of the mouth.
Dental Evaluation of Clicking and Popping of the TMJ
The unattractive noises of clicking and popping emanating from the TMJ will bring patients to their local family dentist for answers. Evaluation always starts with a good medical history. The TMJ is a joint and like other joints are susceptible to arthritis. A family history of rheumatoid arthritis must be documented on your medical history forms at your dental visit. Do not hesitate to discuss a history of psoriasis as well with your dentist since this skin disease has at certain stages joint involvement and the TMJ is no exception. Dental trauma can also precipitate TMJ disease. A fall from a bike as a child landing on the chin can directly injure the TMJ progressing to chronic problems as an adult. During the examination the dentist has the patient move the jaw in different ways, protrusive or forward, lateral or side to side. Depending when the pop occurs is an indication just how severe the pathology is. When you open and close the clicking and popping is the sound of the disc snapping back Into position. If the click is almost immediate, the disc is lagging slightly behind. This is called an early click. The early click has a better prognosis than a late click. The late click indicates the disc is severely displaced. The disc must move back and forth to protect the condyle from rubbing on the fossa. Other parts of the TMJ examination by the dentist include simply palpating the muscles that are attached to the TMJ. Pain with palpation can at sometimes be severe. This indicates that there are extracapsular factors attributing to the patient's symptoms. Your dentist may send you for an MRI or magnetic resonance imaging of your TMJ to fully evaluate the disc location. Certain techniques obtaining the MRI produce diagnostic images with great accuracy. Treatment depends on reviewing all the clinical and imaging results.
Treatment of TMJ
Treatment of temporomandibular joint disorders may start out with conservative modalities. Patients with muscle inflammation may be treated with anti inflammatory medication, soft diet, and splint therapy. The splint or night guard is specially made by the general dentist to prevent clenching of the teeth at night which places a unnecessary strain on the TMJ. After reevaluation, the dentist may make some adjustments in the treatment. Patients with severe internal derangement of the disc may require surgery to reposition the disc or repair it. In certain severe cases of deforming arthritic disease such as rheumatoid arthritis with TMJ involvement, the patient may require joint replacement.
Discuss your concerns with your family dentist. Understanding the problem of TMJ will help you minimize your discomfort. Compliance with whatever treatment modality is determined to meet your needs is paramount.