WHAT IS TMJ?
The temporomandibular joint (TMJ) is the most unique joint in the whole body as it is two joints in one. The two joints, one on each side of the head, are connected by the jawbone. One joint may influence the function of the other joint. Because they are fused in the midline, this means that you cannot move one joint without moving the other. The two temporomandibular joints can differ in size, shape, and even in function. It is possible to have a problem in one joint but have the symptoms expressed in the other joint. You could also have pain that starts on one side of the head and migrates to the other side simply because of the relationship of these joints one to the other.
The second factor making this joint unique is that another structure dictates its function. This other structure is the teeth. The teeth are passive members of the upper and lower jaw, but they have a specific way they must fit together and interrelate. As far as the brain is concerned, tooth position has priority over joint position. This means that the TM joint is forced by the muscles to move so that the teeth will fit together properly. This can potentially cause a malalignment within the joint capsule. If this happens, the muscles are put in a compromising situation causing them to spasm and result in pain. Many of the problems you may be experiencing are the result of muscle spasm, but the cause is not a muscle problem. The muscles are simply caught between two positions: the tooth position and the jaw position.
The third factor making this joint unique is that it has an articular disc located between the ball (condyle) and the socket (glenoid fossa). This disc has a muscle attached to the front of it that pulls the disc forward as the condyle moves forward in the glenoid fossa. The disc is also attached in the back by elastic connective tissue that is much like a rubber band and pulls the disc back as the condyle moves backward in the glenoid fossa. In other words, this attachment can stretch and recoil as the jaw opens and closes. Since the disc is a separate structure and may move independently from the condyle, it can be displaced causing many problems. We call this disorder an internal derangement of the TM joint. “Internal derangement of the TM joint can be a distressing syndrome of pain, limited jaw movement, clicking, popping and crepitus (a grating sound similar to the crumpling sound of parchment paper) in the joint.
This derangement may be caused by genetic pathological changes in the joint or acquired pathological changes as the result of trauma. Often, internal derangement of the temporomandibular joint is preceded by myofacial pain dysfunction that can involve moderate to severe spasms of the head, neck, shoulder and/or back muscles. A wide range of symptoms may occur, such as headaches, muscle pain, ear pain, dizziness, stuffiness and ringing in the ears, blurred vision, etc. Treatment of these conditions needs to be individualized and may include a combination of medical and dental therapies. Treatment of your particular problem will be determined by your specific diagnosis.
WHAT IS TMD?
TMD or Temporomandibular Disorders are a group of maladies which can affect the temporomandibular joints (the jaw joints located immediately in front of your ears), as well as the associated muscles of the jaw, face and neck as well as related neurological and vascular structures.
Problems within this complex can produce a myriad of symptoms which, at first glance, might appear to be totally unrelated to the jaw complex. These symptoms can include headaches (over the eye, in the temples, behind the eyes, and at the base of the skull), generalized facial pain as well as more specific pain directly in front of the ears. Ear symptoms including ringing, buzzing, congestion, and pain. Additional symptoms also include neck and shoulder pain as well as clicking or grating noises of the jaw joint with movement, and locking of the jaw or pain in the jaw with function. Sufferers may not possess all of these symptoms however it is most certainly possible that they may.
Some estimates would suggest that as high as 20% of the North American population possesses one or more of the symptoms of a temporomandibular disorder. Although all of these individuals may not have conditions severe enough to warrant treatment, many sufferers have developed such debilitating pain so as to degrade the quality of their life making family, social and business interrelationships difficult if not impossible.
If you are a sufferer or know someone who is, feel free to contact our office for more information. Dr. Lawson and the staff at the TMJ & Dental Sleep Therapy Centre of Winnipeg have the training, experience and commitment to treat your TMD and change your life.
DOES TMD TREATMENT PULL THE JAW OUT OF ITS SOCKET?
IT IS IMPORTANT TO UNDERSTAND THAT DECOMPRESSION THERAPY, WHEN REQUIRED, IS MOVING MANDIBLES TO A POSITION OF HEALTH … NOT AWAY FROM A HEALTHY POSITION TO A MORE ADVANCED POSITION. There is great confusion about the concept of joint decompression. Some TMD detractors will try to convince you that the jaw is being pulled out of its socket to create a false dental open bite thereby creating the need for unnecessary dental treatment. Nothing could be further from the truth. In fact the majority of patients who require joint decompression can be weaned off the appliance after about 8-12 weeks of therapy.
ISN’T THIS JUST ANTERIOR REPOSITIONING OF THE MANDIBLE?
It is very important to distinguish between the position of the condyle in the healthy patient and unhealthy patient. In a healthy joint complex with asymptomatic patients we usually find the condyle to be sitting in the ideal centered position in the glenoid fossa. There is usually 3mm of space behind and above the head of the condyle. This allows the retrodiscal tissue to nourish the joint complex and room for the articular disc to sit on the head of the condyle and provide the important function of guiding the condyle through its movements. This position is commonly referred to as the “Gelb 4/7″ position as described by Dr. Harold Gelb, New York, widely acclaimed leading authority on TMD. The common finding in symptomatic patients is that the condyle is superiorly and distally retruded, sometimes resting against the back wall of the glenoid fossa. In these situations, the retrodiscal tissues are crushed and the articular disc is pushed forward off the head, which accounts for the clicking and popping during opening. Decompression therapy for retruded condyles does reposition the mandible in a three-dimensional direction towards its normal position of health however it is a position that is determined neurologically by the patient utilizing a sibilant phenome technique. This is not arbitrary anterior repositioning determined by the clinician.
WHY DON’T FLAT PLANE SPLINTS WORK?
Most dentists have only been trained to use Flat Plane splints. Accordingly, this seems to represent the limit of dental treatment usually provided to patients. Analgesics, exercises and referral to physiotherapy etc. make up the balance of the treatment protocols. Unfortunately, Flat Plane splints can only provide a temporary relief by increasing vertical thereby decompressing the joint complex in the habitual bite position. This is very different than decompressing to a neurologically defined position that the patient dictates. A Flat Plane splint does protect the teeth from traumatic forces however it does not eliminate clenching and grinding at night. The muscles continue to work hard and the joints continue to be compressed in an inflamed state with the disc dislocated in an anterior position. Furthermore, research indicates that Flat Plane splints will make the airway 50% worse in 40% of the patients if a sleep disorder is present. The preferred appliance to use at night will be one that reduces inflammation, reduces clenching and grinding, and improves the airway. This is accomplished with a decompression appliance that keeps the jaw forward, but that again is determined neurologically by the patient.
DO PATIENTS EVER NEED JAW SURGERY FOR TMD?
RARELY is it indicated or ever successful. Most chronic TMD patients have soft tissue damage and altered mechanical components of the joint complex. All of these situations respond very well to accurately diagnosed and specifically focused treatment with orthotics and supportive care via chiropractors, massage therapy, physiotherapy, etc. Except for fractures or adhesions, oral surgical approaches are used as a last resort approach.
WHY DO WE NEED OTHER HEALTH CARE PRACTITIONERS?
Dentists cannot do it alone! While it is important for all of us to realize that dentistry plays a vital role in TMD treatment due to our expertise in occlusion, we need to work with our fellow caregivers. Chronic pain wears down the patient’s resistance, builds dependence on medications, limits range of motion, affects self-confidence and eventually leads to chronic depression. Dentists obviously are inadequately trained to treat these special needs. Co-treatment by more than one caregiver provides a synergistic effect as each treatment supports the other and allows the body to focus its healing in a positive manner.
HOW COMMON IS TMD AND TMJ ANYWAY?
Much more common than you think! Most statistics indicate that 30-50% of adults suffer from some degree of TMD. Most dentists do not regularly ask their patients about headaches and patients often do not mention headaches to their dentist. Every busy dental practice has hundreds of “silent sufferers” just waiting to be discovered and helped.