The temporomandibular joint (TMJ) is the small joint that is located in front of the ear.  This joint, which is the most constantly used joint in the body, allows the lower jaw to move and function.  The TMJ has been called a ball and socket joint.  The condyle is the ball portion of the joint; the fossa is the socket portion.  A soft tissue disk is located between these two structures.  This disk, which is shaped much like a contact lens and is sandwiched between the condyle and fossa, is composed of dense, fibrous tissue.  This disk has no blood vessels or nerve endings; it is meant to act as a shock absorber.  Muscles and ligaments are also attached to this disk, which will normally glide quietly back and forth between the two bones and allow the jaw to open smoothly.

 

The TMJ is more than just a joint and is probably best regarded as a complex joint with many structures.  There are ligaments and muscles that attach to the bones within the joint as well as ligaments and muscles that attach to the upper and lower jaws.  The teeth are also an important component of the TMJ complex.  If they don't fit together properly, stresses can be generated that can displace the condyles and consequently result in the dislocation of the disk.  This in turn causes the ligaments to stretch and the muscles to become sore.  When all of the components of the TMJ are working properly, this joint operates very smoothly and effectively.  However, TMJ disorders can develop if these elements are not functioning as they should.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TMJ disorders can be relatively minor, or they can be extremely painful and potentially debilitating.  Emotional stress may result in habits such as grinding or clenching the teeth.  These habits may cause TMJ symptoms, which may be isolated either inside or outside the joint and result in spasms or cramping of the muscles that attach to the jaws.  It is often difficult to determine where the pain is originating.  Jaw deformities also may produce TMJ problems.  In some cases arthritis may result.  Injury like a blow to the chin or jaw can displace the condyle or disk and cause problems.  In some instances of TMJ disorders, the disk is displaced.  This interferes with its ability to properly interface between the condyle (ball) and fossa (socket).  The condyle then applies pressure against the ligament, which attaches to the back end of the disk.  The result is tenderness and pain in the joint.  In some cases the disk becomes stuck, the mouth cannot open the normal amount, and the patient may experience discomfort when opening the mouth.  This condition can lead to degenerative joint disease or arthritis and may result in deterioration of the bones in the joint.

 

The signs and symptoms of TMJ disorders are:

 

    * painful clicking in the joint when opening or closing the mouth,

    * tooth grinding or clenching,

    * sore jaw muscles,

    * stiffness when opening the mouth,

    * headaches,

    * pain in the jaw joint area,

    * locking of the jaw.

 

 

 

 

 

 

 

 

 

 

 

 

 

If you feel you are experiencing any of these symptoms, we suggest you discuss this with your dentist or your oral and maxillofacial surgeon.  Once an evaluation has been completed and the appropriate diagnosis established, a proper treatment plan can be recommended.

 

Our philosophy of treating TMJ disorders is a conservative one.  We believe that the most reversible and least invasive procedure is the wisest and easiest treatment plan to implement.  The body and the jaw joint are very adaptable, and in most cases these disorders can be successfully treated.  Contributing habits are also identified and corrected.  Conservative treatment recommendations usually include a soft, non-chewable diet for a week or two, a limit to the amount of mouth movement and jaw function, anti-inflammatory medications, and occasionally a TMJ splint appliance.  This splint is also known as a muscle-relaxing appliance.  Its main function is to help distribute the forces generated by the jaw and thus to help relax the muscles that are attached to the jaw.  The muscles begin working more harmoniously, and the jaw feels more comfortable.  Even though splints are generally temporary appliances, occasionally they indicate that the bite may require further adjusting.

 

 

 

 

 

 

 

Sometimes a condition may not respond to conservative therapy, and some patients require a more thorough workup.  There's a possibility that surgery is necessary.  Fortunately, this is the exception, and only a few of the patients with TMJ disorders require surgery.