TMJ Disorders

TMJ disorders are a common type of disorder in adults. TMJ disorders can cause facial pain or stridor and may affect one or both sides of the face.

What is the temporomandibular joint?

The temporomandibular joint is one of the most complex joints in the body. It is the joint that connects the jaw to the temporal bones of the skull. It is located in front of each ear. The jaw joint moves the jaw up and down, side to side and back to front, enabling one to talk, chew and yawn.

It can be felt as it moves by pressing the index finger on the cheeks and opening and closing the mouth. The joint has bones and muscles as well as a small piece of cartilage (hard tissue) that acts as a shock absorber and protects the bones from wear and tear.

Problems with the jaw and the muscles that control it are known as temporomandibular disorders (TMD).

Causes of temporomandibular joint disorders

It's not always clear what causes TMJ disorders. The most common cause is a piece of cartilage in the joint slipping out of place. Dentists also believe that symptoms may arise from problems with the jaw muscles or other parts of the joint.

• An injury or dislocation of the jaw, injury to the joint itself, or injury to certain muscles of the face and neck can cause a temporomandibular joint disorder.
  

Symptoms of temporomandibular joint disorders:

Disorders of the TMJ often cause severe pain and discomfort. Symptoms can be temporary or last for many years. They affect men more than women. They are more common in people between the ages of 20 and 40. Common symptoms include:

• Feeling of pain in the face, jaw joint area, and the neck, and may extend to the shoulders and inside or around the ear, when chewing, speaking, or when opening the mouth wide, as is the case when yawning.
• The jaw is attached to the open or closed position of the mouth.
• Popping or squeaking in the TMJ when opening or closing the mouth and when chewing. This may or may not be painful.
• Feeling of tiredness in the face.
• Difficulty chewing or a sudden uncomfortable bite, as if the upper and lower teeth do not fit together properly.
• Swelling on the side of the face.
• Toothache, headache, neck pain, dizziness, earache, hearing problems, upper shoulder pain, ringing in the ears.

How are TMJ disorders diagnosed?

Many other conditions cause symptoms similar to this disorder, such as tooth decay, sinus problems, arthritis, or gum disease. To know the exact condition, the dentist asks several questions related to the condition and performs some physical examinations.

• The doctor carefully examines the temporomandibular joint and looks for the location of the pain, and listens for sounds made by the joint, such as clicking, crackling, or annoying squeaking when moving.
• The doctor will also make sure that the jaw is working as it should and that it is not stuck when the mouth is open or closed, in addition to testing the bite and checking for problems with the facial muscles.
• The dentist may take x-rays of the whole face so that he can see the jaws, jaw joints, and teeth to rule out other problems, and the doctor may do other tests, such as an MRI or computed tomography (CT), where an MRI can show whether The TMJ disc is in the proper position as the jaw moves, while the CT scan shows the full bony detail of the joint.
• The patient may be referred to an oral and maxillofacial surgeon for further care and treatment. This doctor specializes in surgery in and around the entire face, mouth and jaw area. The patient may be referred to an orthodontist to ensure that the teeth are positioned and that there is no excessive pressure from the teeth and muscles on the temporomandibular joint.

Home Remedies for TMJ Disorders

There are several home methods that patients can do on their own to help treat TMJ disorders:

• Take over-the-counter or prescription medications. The patient can take non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to relieve muscle pain and swelling.
• Use cold compresses. Applying ice packs to the TMJ helps reduce swelling.
• Do some stretches for the jaw, and when you are done it is recommended to put a warm towel on the same area for 5 minutes, this routine must be repeated several times a day
• Eat soft, easy-to-chew foods such as yogurt, mashed potatoes, cheese, soup, cooked fruits and vegetables, beans and grains, cut foods into even small pieces to avoid excessive chewing motions, and avoid hard and crunchy foods (such as pretzels, raw carrots) and thick or large meals that require the mouth to open wide .
• Avoid vigorous jaw movements, such as trying to minimize yawning and chewing (especially chewing gum). Avoid yelling, singing, or anything that forces the mouth to open wide.
• Avoid some harmful positions such as resting the chin on the hand or placing the phone between the ear and the shoulder.
• Keeping the upper and lower teeth as far apart as possible, this will relieve pressure on the joint, and the tongue can be placed between the teeth to reduce bruxism during the day.
• Perform some relaxation techniques to help relax the jaw. Your dentist may recommend physical therapy or massage, as well as biofeedback.

Conventional treatments for TMJ disorders:

There are some proven treatments that your dentist may prescribe to treat jaw joint disorders.

• Drugs: Your doctor may prescribe higher doses of NSAIDs to relieve joint pain and swelling, your doctor may recommend muscle relaxants to relax the jaw, especially in patients with stridor, or an antidepressant medication to relieve tension that may worsen TMJ disorders.
• orthosis night squeak guard: These oral pieces are suitable for the teeth as they are placed on the upper and lower teeth to prevent their contact, thus reducing the effects of grinding or pressure on the teeth and correcting the bite by placing the teeth in a more comfortable position.

What is the difference between them? The nocturnal stridor guard is used while sleeping. While the splint is used all the time, the dentist's job is to tell the patient what kind he needs.

• Dental treatments, the dentist can replace missing teeth and use crowns or bridges or Calendar To balance the biting surfaces of the teeth or to correct a patient's biting problem.
  

Other treatments for TMJ disorders:

If the aforementioned traditional treatments do not work, the dentist may do one or more of the following:

• TENS . transcutaneous electrical nerve stimulation This treatment uses low-intensity electric currents to relieve pain by relaxing the jaw joint and facial muscles. This treatment can be performed in a dentist's office or at home.
  

During the injection, the doctor inserts a small needle into the fascia stimulation point and injects medication into it. People with particularly tense muscles may feel a grinding sensation when the doctor inserts the needle. This feeling usually subsides as the muscles relax.

• Radio wave therapy. Radio waves activate the joint, increasing blood flow and relieving pain.
• Low-level laser therapy: This treatment reduces pain and inflammation and helps the patient move their neck more freely and open their mouth wider.

TMJ Disorder Surgery:

If all previous treatments fail, surgery is a last resort.

The disease must consult two or more dentists before resorting to surgery.

There are three types of surgery for TMJ disorders, the type that a patient needs depends on the type of problem they have.

• TMJ paracentesis and lavage:

Minimally invasive surgical techniques include puncture of the joint (puncture), where fluid is withdrawn from the joint using a special needle, and in the presence of inflammation, inflammatory fluid often collects in the upper fossa of the joint, and this is called a “temporomandibular joint effusion.”

This pool of articular fluid containing many harmful inflammatory protein compounds is drained first, then the joint chamber expands and the articular capsule is released, and the disc can move better directly in the joint, then the joint space is punctured with another needle and washed with approximately 200 ml of sterile saline, The effect of the washing liquid is not only to eliminate harmful inflammatory proteins from the articular space but also into the deeper layers of the joint capsule and fibroarticular cartilage.

The next step is to inject hyaluronic acid or another drug into the joint space, so that the articular disc is finally able to move easily and any defect in the function of the joint subsides.

This technique is performed under general anaesthesia. It is suitable for treating all forms of inflammation in the temporomandibular joint. In cases of non-response displacement of the articular disc, this method can be used to quickly correct the position of the articular disc, and it must always be accompanied by treatment with splints and physical therapy.

• Arthroscopic surgery:

It is done using an arthroscope, which is a special tool with a lens and light. The endoscope enables the doctor to see inside the joint. The patient is placed under general anesthesia, then the doctor makes a small incision in front of the ear and inserts the endoscope previously connected to a display screen, so that he can examine the joint and the surrounding area. With it, it may also remove inflamed tissues in the joint.

This type of surgery is called minimally invasive surgery, and it has a smaller scar, has fewer complications, and requires a shorter recovery time than major surgery.

• Open joint surgery:

Depending on the cause of the TMJ disorders, arthroscopy may not be possible, as a patient would need this type of surgery if:

There was erosion in the bony structures of the joint

There have been tumors in or around the joint.

A crack was found in the joint.

In this surgery, the patient gets general anesthesia, and then the doctor opens the entire area around the joint so that he can get a full view and better access.

The patient needs a longer recovery time after open joint surgery, and there is a greater chance of scarring and injury to the surrounding nerves.

Some useful exercises to treat TMJ disorders:

These exercises aim to gradually restore a wide range of motion of the jaw and reduce any discomfort caused by the TMJ. These exercises primarily target the mandibular bone at the base of the skull, but also target the muscles of the throat and neck more broadly.

• Goldfish Exercise: This exercise helps in correct alignment of the lower jawbone while chewing.

Step 1: Press your tongue against the roof of your mouth.

Step 2: Now place your index finger on the left TMJ and the other index finger on your chin.

Step 3: Drop your chin down, applying gentle pressure with each finger and keeping the tongue at the roof of the mouth. Repeat this exercise for the right temporomandibular joint.

Repeat this exercise six times in each set, doing six sets daily.

• Mandibular stabilization exercise: This exercise similarly helps align the lower jawbone and improve its range of motion over time.

Step 1: Place the jaw in a neutral, comfortable position.

Step 2: Place your thumb at the base of the jaw, just below the chin, and press gently while opening your mouth.

Step 3: Repeat the movement, moving your thumb to the left and right sides of the jaw, respectively.

Repeat this exercise five times in each set, doing five sets daily.

Sources

1. WebMD
2. Mayo Clinic
3. NIH
4. NHS