TEMPOROMANDIBULAR JOINT (TMJ)

DISORDERS & THERAPY

The Temporomandibular Joint (TMJ) is one of the most amazing and complicated joints in the entire body. While many joints fit together tightly like the ball-and-socket of the shoulder, others have limited movements like the elbow to hold them in place. Unlike the others, the TMJ has no socket but merely a depression in the base of the skull in which the condyle of your mandible (lower jawbone) rests. Muscles and ligaments are all that hold it in place. The condyle also uses contours of the skull to slide in all directions. There is an Articular Disc between the bones to facilitate this sliding and rotating motion in all directions. The entire joint is encapsulated and under certain conditions, may be susceptible to problems. Because of this amazing joint's multiple moving parts and its dependency upon muscles and ligaments for stability, diagnosing and treating TMD symptoms can be challenging.

DIAGNOSIS:

First we must decide if it is a muscle or joint problem. Sometimes it is a muscle problem causing joint pain, and vice versa, joint problems causing muscle pain. The most common cause of problems is stress, which most people know through personal experience, is not easy to reduce. After a patient thoroughly fills out my TMJ exam questionnaire, has x-rays taken (when indicated), has a comprehensive TMJ exam performed, we can diagnose the most likely causes of the problem and treat accordingly.

TREATMENT OPTIONS:

Non-Invasive: This is a good early treatment for most muscle disorders.

• Stress Reduction/Relaxation therapy
• Restrictive movements – avoid biting large objects like apples and po-boys
• Warm, moist heat with wet towel applied for 20 minutes to affected areas
• Passive stretching exercises following heat
• Analgesics, Anti-inflammatory (Ibuprofen 600mg every 6 hours for 3 weeks), and muscle-relaxing medications (Flexaril 10 mg before bed for 2 weeks).
• possible PHYSICAL THERAPY

Occlusal Appliance Therapy: This is a good treatment for many joint and muscle disorders

• Centric-Relation (CR) Splint – this gives you a stable bite to reduce grinding and improve stability of the joint. This can be worn every night and during the day if it helps reduce symptoms
• Anterior-Positioning (AP) Splint – this repositions your jaw to allow healing of the joint and reduce painful symptoms. This is only to be worn at night and not long-term.
• Nociceptive Trigeminal Inhibitor (NTI) Splint – this reduces muscle activity by preventing the contact of the posterior teeth, which reduces grinding/clenching. This is helpful for some muscle problems, migraines, and clenching.

Invasive: TM Joint Surgery – this has become a last resort option when pain and symptoms have become unbearable and non-invasive and appliance therapies have been unsuccessful.