Advanced Dental Care Centre Chandigarh India

Temporomandibular joint (TMJ) as the jaw joint is known in medical language, exists one on each side of the face in front of the ear. This joint comes into function each time the jaw moves ie. During speech, swallowing, yawning, eating etc. Considering the fact that an individual swallows some 600 times while awake you can imagine the amount of wear & tear this joint goes through.

The TMJ comprises a fibrous disc in between two bony surfaces moving against each other. The disc protects the bony parts from wear & tear, & thus often takes the brunt of it all.

These problems can be broadly divided into two categories :
1. Localized conditions involving the Disc, Ligament or Bony parts
2. Underlying systemic causes reflecting in TMJ malfunction

The former make up the majority of cases seen by an Oral Surgeon.

The most common complaints experienced by a patient of Temporomandibular Dysfunction (TMD) would be :

Pain on mouth opening

Clicking sounds on opening the mouth / on chewing

Pain in / around the ears

Pain along the side of neck

Pain in the upper jaw radiating to the forehead and eyebrows

Inability to open the mouth or a transient lock-jaw after wide opening

MYOFASCIAL PAIN

What exactly does this term mean?
It is a kind of myogenous pain characterized by local areas of hypersensitive bands of muscle tissue known as Trigger Points.

These Trigger Points cause central excitatory effects manifested as referred pain. For the treatment to be effective it should be directed towards the source of pain not the site.

Central excitation may also produce autonomous effects such as drying or tearing of the eye and nasal discharge .Treatment is aimed at eliminating the cause of local muscle soreness and also reducing the local and systemic factors.
Eliminating the Trigger Ponts may be done by painless stretching of the muscle.
For treatment to be effective and long lasting there has to be full cooperation from the patient's side.

ROLE OF SPLINTS IN TMD
There are splints and then there are more splints, but the goal which a practitioner has to achieve is to provide a patient with a splint that alleviates his symptoms.

Splints are helpful in ruling out certain causative factors. When malocclusion is considered to be a contributing factor to TMD, splint therapy may quickly introduce a more desirable relationship. If it does not affect the symptoms then malocclusion is probably not the cause and the need for irreversible occlusal therapy should be considered.

Many appliances have been suggested for treating TMD but the two most commonly used are the :

Muscle Relaxation Appliance

Anterior Repositioning Appliance

The muscle relaxation appliance is used to reduce muscle activity while the anterior repositioning appliance is used to change the position of the mandible.

Initially an increase in salivation may occur which should resolve in a few hours. If wearing the appliance causes an increase in pain the patient must discontinue wearing it and report to the therapist for further evaluation.

1. What are the most important symptoms I should be concerned about?
Pain, and or Jaw "locking" episodes.

2. What is a "locking" episode?
A "locking" episode can occur during opening or closing movement. What happens is that the patient experiences an interruption of jaw movement - a "catch" or a "stop", and in order to complete the movement must jiggle, or somehow, self manipulate the jaw.

3. Why does "locking" episode happen?
Referring back to my anatomy lesson, and in the simplest of terms, what is happening within the Joint is that the Articular Disk which rides on top of the Condyle Head is getting stuck in the wrong place and is preventing the Condyle Head from moving.

4. If I can jiggle my jaw and reduce the dislocation, why should I be concerned?
Because each time it happens more damage is occuring to the tissues in the Joint, and the tissues controlling the Articular Disk. As a consequence there is the risk that if the problem is not addressed by appropriate treatment, one day you will be unable to reduce the dislocation yourself, and you will require an emergency visit to a TMJ practitioner, if one is available in your community, or an oral surgeon. In severe cases, reduction can only be accomplished under general anesthesia.

5. What is a limited range of opening?
If you open your mouth as wide as you can, and then place the last three fingers of your hand (middle, ring, and pinky) perpendicularly (with your thumb pointing to the ceiling) between your upper and lower teeth, you have a normal range of opening, provided that you can do that without pain and strain. In general, two fingers, or less, is a limited range of opening.

6. I can get four fingers in. What does that mean?
Not much. You may either have thin fingers, or you have slight hyper-extension. In the absence of pain, and other symptoms, not to worry.

7. I can only get two finger in. Does that mean I need treatment?
Here comes a typical doctor's answer - "that depends". It depends on several factors. The most important being, to what degree is this restricted jaw function affecting your quality of life. If you have no pain, and it is the ONLY symptom you have, and you never think about it, and you can eat anything you want without pain and strain. The answer is no. Otherwise the answer is yes.

8. I hear a lot of noises in my TM Joints when I move my jaws. Sometimes there is a kind of click, and sometimes there is a crunching or grinding sound. What's happening?
Probably lots of things. Joint noises during jaw movements are a sign that the functional elements are not working smoothly. Crunching grinding noises are called Crepitus, and it is associated with hard tissue contact during movement. In order to explain Clicking, you have to first know that the Articular Disk has, what is most simply described as, a depression, in the middle of it. That depression, and the Condyle Head are supposed to move together in sync. When they don't, and the Condyle Head passes over the outside ridge of the depression, you get a Click.

9. Is the presence of these Joint sounds serious?
Again, in the absence of other symptoms, no. BUT these Joint sounds are a sign that the Joint is not functioning smoothly, and each sound's occurrence is a micro trauma to the Joint tissues. This means that as time goes on, a full blown TM Joint disorder may develop. The correct approach, if you have TM Joint sounds during jaw movements in the absence of all other symptoms, is to tell your regular family Dentist about them, and he will keep your condition under observation.