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TMJ and TMD Evaluations at Ryedale Dental Practice in Pickering

What are TMJs?

Temporomandibular joints - TMJs - are located on both sides of the face in front of the ears, connecting the jawbone (mandible) to the skull (temporal bone). They are the most complicated joints in the human body, providing rotation (pivoting) movement like all joints, as well as sliding movement, called translation. That's what allows us to open our mouths wide and move our jaws from left to right. Between the top end of the jaw (condyle) and the socket in the skull is a disc of cartilage, which - like the discs in the neck and back - serve as shock absorbers, protecting the bones from hitting eachother.

The joints work with the neuromuscular system
The movement of the jaw is orchestrated by a complex set of muscles, which are, in turn, controlled by the body's local and central nervous system. Together they are called the neuromuscular system. The whole jaw-joint system is held together by ligaments, which limit the range of motion in all directions - as they do in all the joints of the body.

A unique system of many parts
The TMJ joint system is unique in many ways. The left and right joints must coordinate, working at the same time for the jaw to move. While the opening, lateral and forward movements of the jaw are controlled by the shape of the bones and are a function of muscles and ligaments, the closing end-point of the jaw movement is controlled by the coming together of the teeth - the bite or occlusion. No other joint in the body has such a rigid end-point limit.

The proper healthy function of the TMJ system requires normal structure and function of all the common parts, including muscles, nervous system, ligaments, joints (bones, discs and connecting tissues) and the dental occlusion.

illustration of facial muscles

What are TMJ / TMDs?

Temporomandibular Disorders (TMJ / TMD) are often called "TMJ" by doctors, patients and even insurance companies, although the term TMJ actually refers only to the jaw joints.

TMD/TMJ describes a group of diseases that can involve the jaw joints, the muscles that control jaw movement and the dental occlusion. TMJ/TMDs are physical disorders arising from an imbalance in the delicate working relationship of the jaw and skull with the muscles that move the jaw, as well as the nervous system associated with these systems. This imbalance results in muscle fatigue, spasm and/or joint dysfunction, and even changes in the teeth, which in turn cause a variety of symptoms, unique for each person.

The Causes of TMJ / TMDs

The symptoms of TMJ / TMD, which affect millions of adults and children, can gradually appear with no apparent, specific cause. They can also occur after a trauma, such as a traffic accident or a blow to the face. Even subtle repeated traumas, like clenching the teeth or excessive gum chewing, nail biting or cradling a phone between your shoulder and the side of your head can cause TMJ / TMD. These conditions can also be caused by a bad bite (dental malocclusion), which is not synchronised with healthy muscle and joint function. Systemic diseases and developmental abnormalities can also cause TMJ / TMD.

Stress may play a part
Stress and tension may awaken a quiet, asymptomatic TMJ / TMD or aggravate an existing temporomandibular condition. However, stress alone does not cause TMJ / TMD, if a patient has healthy dental occlusion and muscle and jaw function.

A thorough exam is critical
All too often patients are classified as "chronic pain patients" and their complaints pigeon-holed as stress or psychological disorders. These patients may be relegated to treatment focusing only on medication and counseling, with no treatment of the physical cause of their illness. A thorough analysis of each patient is essential to determine the cause of the pain. Early and appropriate treatment of a TMJ / TMD may avoid the progression to a chronic pain state.

Do you have TMJ / TMD?

If you think you may have temporomandibular disorder, ask yourself these questions:

  • Do you experience pain in your face, ears, below or in front of your ears or headaches for which your medical doctor has not found a cause?
  • Do your ears muffle or feel clogged?
  • Do your jaw joints (TMJ), located in front of your ears, hurt when you chew and do they make clicking or crackling noises?
  • Do your facial muscles feel tired or stiff when you awaken, during the day, after a lot of speaking or when yawning?
  • Do you clench your teeth together while sleeping or awake? A spouse can often tell you about your jaw muscle activity during sleep?
  • Do you have headaches in the sides of your temples?
  • Are you not able to open your mouth freely, smoothly and as wide as you are accustomed to doing?
  • Can you not move your jaw from side to side with your mouth open?
  • Do you experience episodes when your jaw feels that it locks open or shut?
  • Do you feel that your upper and lower teeth don't fit together as they usually do?
  • Is your bite uncomfortable? Is chewing tough foods uncomfortable or painful?
  • Do you experience dental pain in lots of teeth for which your dentist has found no cause?
  • Are your teeth chipping and are the front teeth worn flat on their edges?
  • Do your upper front teeth completely cover the lower teeth when you bite together?
  • Have your teeth been shifting, creating spaces or crowding for no apparent dental reason?

If you have answered "YES" to any of these questions, you may have temporomandibular disorder and should seek care from a dental TMJ expert, who has experience and training in this field.

The symptoms of TMD / TMJ

An initial visit with a TMJ / TMD expert should begin with a careful and comprehensive review. This includes the history of the onset of the problem, how it has progressed, what medical evaluations and treatments have already been performed and their results. It is very important to discuss your TMJ / TMD symptoms, as they provide invaluable clues to the nature of your problem.

TMJ / TMDs manifest as a variety of symptoms, including headaches, ear pain, pain in the temporomandibular joints (TMJ) and disruption of normal mandibular function. Symptoms commonly associated with TMJ / TMD relate to the dental and oral structures, the jaw, TMJ and masticatory (chewing) muscles, or may appear to relate to nearby head and shoulder structures.

Because of the complex anatomic, physiological and neurological interrelationships in the head and neck, symptoms of TMJ / TMD can coexist or mimic symptoms of other diseases. It is important for patients to be avaluated by the appropriate doctor(s) to rule out the presence of other primary diseases.

TMJ / TMD patients frequently experience a combination of symptoms, some which are listed below.

Painful Symptoms
  • Headaches, facial, dental pain
  • pain in the jaw joints or on jaw movement
  • ear pain, tinnitus, ear pressure
  • neck, back, shoulder and chest pain

Dysfunctional symptoms

  • Jaw movement: limited, deviated, slow or irregular
  • Head movement: limited range of motion
  • Ears: muffling, dizziness, clicking
  • Throat: difficulty swallowing, prolonged speech
  • Jaw joint: locked or dislocated jaw, facial asymetry

Dental distruction

  • Traumatic occlusion, clenching, grinding (bruxism)
  • Wear (abrasion), chipping on natural, restored or denture teeth
  • Looseness of teeth: bone loss without gum inflammation
  • Movement of teeth: spreading, crowding, loss of teeth and bite changes

Patients with TMJ / TMD frequently describe the symptoms listed above even though the TMJ / TMD may not be the actual cause of the symptoms. Each person suffering from TMJ / TMD may experience a different constellation of symptoms, which can change over time.

Medical Treatment

Most cases of TMJ syndrome are temporary; thus, treatment is usually conservative.

  • Early therapy starts simply with resting the jaw, using warm compresses (ice packs at first if an injury is present), and pain medication. Jaw rest can help heal temporomandibular joints. Eat soft foods. Avoid chewing gum and eating hard candy or chewy foods. Do not open your mouth wide. Your doctor may show you how to perform gentle muscle stretching and relaxation exercises. Stress-reduction techniques may help you manage stress and relax your jaw along with the rest of your body.
  • The doctor may fit you with a splint or bite plate. This is a plastic guard that fits over your upper and lower teeth, much like a mouth guard in sports. The splint can help reduce clenching and teeth grinding, especially if worn at night. This will ease muscle tension. The splint should not cause or increase pain. If it does, do not use it.
  • If conservative or noninvasive techniques do not work, you may consider more invasive techniques.
  • A more invasive procedure can be performed in the doctor's office or clinic under local anaesthesia. This is carried out by inserting two needles in the temporomandibular joint to wash it out. One needle is connected to a syringe filled with a cleansing solution, and the fluid exits via the other needle. Most people find relief from the pain and return to almost normal. Sometimes, pain medication can be injected into the joint in a similar procedure.
  • Alternatively, a simple injection of cortisone medication can be very helpful in relieving inflammation and pain.
  • A last option, surgery, is often irreversible and should be avoided when possible. If necessary, surgery can be used to replace the jaw joints with artificial implants.

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