TMJ Disorders

What is the temporomandibular joint and what is TMJ syndrome?

The temporomandibular joint is a small joint that connects the lower jawbone or “mandible” to the bone of the skull in front of the ear or “temporal bone”. A small disc made of cartilage is enclosed in the joint formed by these bones. Powered by the muscles used in chewing, this joint is required in chewing, swallowing, speaking, yawning and breathing, and is thus one of the most frequently used joints in the body.

Patients experiencing abnormal symptoms in the TMJ can report pain involving the joint itself or the surrounding muscles and ligaments. Please call us if you think you may need treatement for TMJ in Montreal, Quebec.

Other symptoms patients may experience include:
• clicking
• popping or grinding sounds in the jaw
• pain in the TMJ joint or the ear that may worsen when chewing, yawning or opening the mouth.

Some patients may experience:
• difficulty opening the jaw widely
• a sensation that their jaw is locking when opening or closing the mouth
• headaches, neck, back or shoulder pain
• swelling on the affected side of the face.

 

What causes TMJ disorders?

It is sometimes very difficult to establish the exact cause of a person's TMJ problems.

TMJ disorders may be the result of a number of factors which include too much tension in the jaw muscles, clenching or grinding of the teeth, poor alignment of the upper and lower teeth and jaw, abnormal movement of the jaw joint, displacement of the cartilage within it to an abnormal position, inflammation of the joint or injury to the face. Patients who suffer from fibromylagia or arthritis and those who have poorly fitting dentures or are exposed to increased stress have a greater chance of developing disorders of the TMJ. Some patients are thought to have a predisposition to the development of joint problems based on factors as simple as the anatomic features of their TMJ.

 

How do I know if I have a disorder of the TMJ and who will be involved in evaluation and treatment?

A multidisciplinary team of health professionals may be involved in your evaluation and treatment for a disorder of the TMJ joint. You will receive a detailed evaluation and analysis of your condition. You will be asked you to describe your symptoms and medical conditions you have had in the past and will examine your teeth, jaw joint and facial muscles and evaluate your bite. He or she may test the range of motion of your jaw and listen for sounds in the joint. You may need to have X-rays or panoramic dental X-rays of the joint that make the bony structures visible. In some cases a CT scan is requested to create a computerized image of the bony structures of the joint and an MRI may be requested to provide detailed views of the soft tissues of the joint.

 
   
 

What treatment options exist for TMJ disorders?

Disorders of the TMJ joint are treated by a team of health professionals which can include your dentist, orthodontist, oral surgeon and physiotherapist and at times facial pain specialists.

Non-surgical options:

  • If you have pain on chewing, a soft diet may be suggested.
  • You may also apply cold or hot packs to the joint area.
  • You should avoid opening your mouth very widely and chewing gum.
  • You may be prescribed medications such as nonsteroidal anti-inflammatory drugs (ibuprofen), muscle relaxants or antidepressants. In some cases you may receive an injection or a pain reliever such as cortisone or lidocaine directly into the jaw joint.
  • You may be referred to a physiotherapist who will teach you techniques to relax the involved muscles such as gentle massage or stretching exercises and transcutaneous stimulation (TENS). He or she will work with you to increase the range of motion of your jaw and correct bad postural habits.
  • You may be referred to an orthodontist who may recommend braces to correct the problem by correcting the alignment of your teeth.
  • You may be asked to wear a custom-made splint or nightguard in your mouth to help relax your muscles and reduce clenching or grinding of your teeth.
  • You may be offered counseling to learn stress management and relaxation techniques and better coping strategies for stress.

Surgical options:

If all other treatments have not been successful and the patient is in great discomfort, surgery may be a last option. Surgery of the TMJ to relieve pain is a very controversial area. Surgery is sometimes recommended when patients have a significant structural or anatomic abnormality in their TMJ joint. However, results of research to date have shown that while these surgical procedures may somewhat improve the movement of the joint they have not been very successful at relieving pain in a consistent manner. The question of surgery of the TMJ joint must be approached very carefully and tailored to each patient on a case-by-case basis, usually after a lengthy period of systematic patient evaluation and discussion.