Temporomandibular joint disorders

Temporomandibular joint disorders cause pain and affect mouth movements. Find out why they happen and how they are treated.

Last update: September 07, 2021

Temporomandibular joint (TMJ) disorders affect the anatomical and muscular structures responsible for chewing. In this way, the normal functions of the oral cavity may be disturbed.

The specific origin of these conditions is often uncertain or arises from the combination of several factors. Pain is usually the most common symptom, although it can also manifest itself with other discomforts.

In most cases, the discomfort is temporary and is resolved with simple practices. Still, there are surgical techniques to treat this disorder, but they are used only when conservative therapies have failed.

In this article we detail everything you need to know about temporomandibular joint disorders. Read on to learn about its causes, symptoms, and how it's diagnosed. In addition, we tell you about the available treatments and what measures to take.

What is the temporomandibular joint?

The temporomandibular joint (TMJ) It is the system that connects the lower jaw with the skull. It acts as a hinge that allows the mouth to open and close, facilitating functions such as speech and chewing.

They are found on both sides of the head, in front of the ears. Its movement can be felt by placing the fingers just before the ears and opening and closing the mouth.

The TMJ connects the jaw with the temporal bone; hence its name. The rounded ends of each side of the lower jaw, called condyles, slide through the articular cavity of the skull.

Between both bone surfaces is a soft disc It absorbs chewing forces and allows smooth movements. The muscles and ligaments attached to this joint system control its position and movements.

Due to the flexibility of the joint, it is possible to move the maxilla up, down and from side to side. These actions they are those that allow the patient to chew, speak, laugh and yawn.

Blood vessels, nearby nerves, and teeth present in the maxilla complete the structures that make up the articular system.

What are temporomandibular joint disorders?

Temporomandibular joint disorders are a group of disorders that affect the structures that make up the system. They cause pain, discomfort and dysfunctions in the elements responsible for mandibular mobility.

These ailments are more frequent in women and in an age range that goes from 20 to 50 years. In general, they are classified into three large groups:

  • Myofascial pain: it is the most common form of temporomandibular joint disorders and can occur in patients with normal TMJ. These are discomfort or pain in the muscles involved in chewing, as well as in the fascicles of the neck and shoulders. They often affect the mobility of the mouth.
  • Internal disorders of the temporomandibular joint: in this case there is an alteration in the articular structures; disc displacement, condyle injuries, jaw misalignment or dislocation. The characteristic symptomatology is localized pain and the presence of clicks and noises when moving the mouth.
  • Degenerative and inflammatory disorders: these are joint diseases, such as rheumatoid arthritis or osteoarthritis, that affect the TMJ.
The various structures of this complex joint can cause discomfort and pain.

A person can have several of these TMJ disorders at the same time.

Causes of Temporomandibular Joint Disorders

Temporomandibular joint disorders can appear for a variety of reasons. In some cases, it is difficult to determine the cause of the problem. In general, it is the coexistence of several factors.

Here are some of the most common causes that can cause the appearance of temporomandibular joint disorders:

  • Blows and trauma: receiving a direct impact on the joint or another area of ​​the jaw bone can cause damage to the TMJ structures.
  • Arthritis: This degenerative disease damages the structures of the joint.
  • Malocclusions: compensatory movements by patients to avoid bite problems can overload the joint.
  • Stress: Physical and mental stress can cause or aggravate TMJ disorders. It is common for stressed people to clench or grind their teeth, overloading the TMJ, straining the muscles and causing pain.
  • Bruxism: As we already mentioned, grinding or clenching the teeth in a habitual way damages the structures of the TMJ.
  • Tooth losses: due to the lack of dental elements, the maxilla loses height and bone structure. These changes can cause TMJ problems.
  • Congenital and developmental disorders that cause structural problems and malformations of the jaw.
  • Condylar subluxation: the weakness and laxity of the ligaments lead to a dislocation of the joint, with or without displacement of the disc. It can be caused by an exaggerated and sustained mouth opening over time, causing pain and difficulty in closing the mouth again.
  • Ankylosis: It is the fusion of the bones of the joint due to a process of calcification of the joint structures. This problem prevents the ATM from being able to move.
  • Other pathologies: neurological and muscular problems, inflammations, infections and neoplasms.


Symptoms of Temporomandibular Joint Disorders

The most common manifestation of TMJ disorders is pain. Symptoms can appear on one side or both.

The discomfort usually occurs over the joint area, near the ear, in or around the ear. The painful sensation can also spread to the cheek muscles and other regions of the face, neck, head, and shoulders. The muscles may also feel stiff, contracted, or spasm.

Pain or tenderness appears when touching the jaw or spontaneously. The intensity is also variable and it depends on each case.

Other problems associated with TMJ disorders include limited movement and difficulty chewing, speaking, or yawning. Blockage of the TMJ that prevents opening or closing the mouth can occur.

Another fairly common symptom is the presence of clicking sounds during jaw opening or closing. Anyway, TMJ noises are quite common and if they are not associated with pain or movement limitation, they do not require any therapy.

Sudden changes in the relationship of the upper and lower teeth and the way you bite are other possible symptoms of these disorders. In the event of a sporadic episode of severe pain over the jaw, a physician's evaluation should be sought. Then there is a relationship between this symptom in the lower jaw and angina pectoris.



Diagnosis

As many times the causes and manifestations of temporomandibular joint disorders are not entirely clear, diagnosis can be difficult. However, in most cases a discussion of the symptoms with the patient and a physical examination of the face and mouth is sufficient.

The physical examination, in addition to observation of the inside of the mouth and the bite, includes palpation of the jaw and chewing muscles. This makes it possible to assess whether there is pain or tenderness present.

Too the patient is asked to open, close and move the mouth to the sides. This detects the presence of noises, clicks or if movements are limited or altered.

Some particular situations require the use of complementary tests to confirm the diagnosis. Dental and TMJ radiographs, for example, can provide insight into the case.

Arthrograms, tests Doppler TMJs, MRIs, and CT scans may also be necessary for special circumstances. They will be useful when the diagnosis is not clear or the case does not improve after treatment.

Interdisciplinary work is often necessary to arrive at the diagnosis. An evaluation of the doctor, the dentist and the otolaryngologist can finally reach the conclusion of the presence of some disorder of the temporomandibular joint.

Treatment options

Discomfort caused by temporomandibular joint disorders many times they remit spontaneously or after the application of simple practices. The dentist will be the one to evaluate the particular clinical case and, depending on the patient's needs, determine the best therapy for each situation.

The treatments can be divided into two large groups: conservative measures and irreversible treatments. We detail each of these possibilities below.

Conservative treatments

These are simple procedures that they do not invade the tissues of the jaw, joint, or face. They are considered reversible because they do not cause permanent changes in the patient's structures.

Conservative treatments are the first choice in most cases. Well, in general, temporomandibular joint disorders are temporary and with simple practices, changes in habits and personal care it is possible to alleviate the discomfort.

Here are some conservative resources to help manage TMJ discomfort:

  • Bland diet: It is indicated for a time to avoid jaw effort and promote deflating.
  • Apply heat or cold to the area: They will help decontract and reduce inflammation.
  • Avoid extreme movements of the jaw: rest the jaw and avoid yawning wide, singing or chewing gum.
  • Physiotherapy: Gentle massage and stretching exercises help the affected muscles relax.
  • Medication use: Muscle relaxants and anti-inflammatories can be used to relieve acute pain, although it is not a long-term therapy. In some cases, Botox injections can reduce muscle tension in the area.
  • Splints: are oral appliances or bite plates that are placed over the teeth to reduce clenching, grinding, and relieve muscle tension. They are used for a short period of time and should not change the way you bite. If using them worsens the situation, their use should be suspended and consult the dentist.
  • Reduce stress: resorting to relaxation techniques helps to calm down and reduce stress.
Relaxation plates can reduce the effects of bruxism on the TMJ.

Irreversible treatments

When conservative treatments don't work, the dentist may suggest an irreversible technique. In any case, the ideal is to be cautious and evaluate the alternatives. The most aggressive treatments are not always the solution.

Since irreversible treatments modify the patient's own structures, they should only be used when unavoidable. It is important to understand the reason for this practice, its risks, and whether there are other alternatives.

In general, in very specific situations, the following interventions may be necessary to treat temporomandibular joint disorders:

  • Orthodontics: It is used to modify the bite and align the teeth to help reduce TMJ discomfort.
  • Arthrocentesis: with intra-articular needles, the inside of the joint is cleaned and a lubricating or anti-inflammatory solution is injected.
  • Arthroscopy: An intra-articular camera is inserted to examine the joint and remove inflammatory tissue.
  • Joint replacement: It consists of the removal of joint tissue and its replacement with artificial prostheses. It is not a highly recommended therapy because it can cause more pain or worsen the condition.
  • Open surgery: This type of surgery is performed to treat tumors located in the joint, which allows access to the inside of the TMJ and remove all the damaged tissue.

Tips to Prevent Temporomandibular Joint Disorders

Regularly practicing a few simple measures can help protect your TMJ. Avoid eating very hard food and chewing gum frequently, for example, it prevents the development of temporomandibular joint disorders.

Paying attention to chewing on both sides equally is also a healthy practice. Maintaining good posture and making changes in position and breaks during work can relieve tight muscles.

Practicing relaxation techniques helps manage anxiety, reduce stress and with this tightening and muscle tension. The realization of small massages on the face and neck is also favorable to avoid pain in the area.

Avoid opening your mouth in an exaggerated manner. For this it is useful to control yawning, screaming and very loud chants.

With these simple practices, the quality of life is improved and the risk of suffering from temporomandibular joint disorders can also be reduced. And in the event that annoyances appear, these measures are usually sufficient and effective in alleviating symptoms.