What is the TMJ?

The TMJ temporomandibular joint (TMJ) is the jaw joint. The proper position of it is imperative for good oral health.

The movements of the TMJ are complex and allow for multiple functions:

• Breathing
• Chewing muscles/optimal bite of the upper and lower teeth
• Expressions in facial muscles
• Opening and closing the mouth
• Phonation
• Protrusion, retrusion, lateralization of the jaw
• Maintain the correct pressure of the middle ear
• Oral health
• Sucking
• Swallowing

Anatomy of the Temporomandibular Joint

The temporomandibular joint (TMJ) connects the mandible and the temporal bone of the head just above the neck. The joints of the jaw are found in front of the tragus of the ear, on the side of the head.

Ligaments

To stabilize the TMJ, there are three extrascapular ligaments that connect around it. These ligaments are responsible for maintaining the stability and proper alignment of the TMJ. The lateral ligament, stylomandibular ligament, and sphenomandibular ligament all play a significant role in the stability of the TMJ. The lateral ligament runs from the zygomatic arch to the condyle of the mandible, the stylomandibular ligament runs from the styloid process to the angle of the mandible, and the sphenomandibular ligament runs from the spine of the sphenoid bone to the lingula of the mandible. Together, these three extrascapular ligaments work in harmony to ensure that the TMJ remains stable and functional.

Muscles

TMJ is correlated to different facial muscles that function to both protect and move it. The four that directly affect the TMJ are the masseter, temporal, and two pterygoids.

Masseter:  Elevates the mandible, raising the lower jaw.

Temporal: This is the most powerful muscle of the TMJ. The temporal has two separate parts; anterior and posterior.

Lateral pterygoid: The only muscle of mastication that helps in opening the mandible.

Medial pterygoid: Originating from the medial side of the lateral pterygoid plate, the medial pterygoid’s functions include:

• Closing the jaw
• Minor contribution to protrusion of the mandible

Symptoms of TMJ Disorder:

Temporomandibular joint disorder, or TMD, can cause TMJ symptoms as well as pain. The painful symptoms from TMJ dysfunction may appear in varying degrees in different patients.  

Some common symptoms and signs that you have a TMJ disorder or TMJ dysfunction may include:

• Frequent headaches  
• Pain, discomfort or tenderness of your jaw joint and jaw muscles
• Pain in one or both of the temporomandibular joints
• Aching pain in and around your ear
• Teeth grinding or difficulty with bite
• Clicking sound or grating feeling when opening and closing the jaw or with your bite
• Ringing ears or sound in ears while chewing
• Pain when opening or closing your mouth, chewing, or clenching teeth
• A feeling of tightness or tension at the jaw or temple area
• In severe cases of temporomandibular joint disorder or if left untreated, locking and jaw difficulty opening or closing your mouth are possible painful symptoms in patients.

Causes:

Jaw pain and dysfunction could be caused by a combination of: injury, genetics or arthritis. Common causes that may increase the risk of developing painful TMJ disorders in patients are:

• Trauma or injury where the jaw joint is damaged
• Forcefully closing the jaw in a misaligned position by excessive gum or pencil chewing, or nail biting
• Chronic grinding or jaw clenching of teeth
• The TMJ’s cartilage is damaged by rheumatoid arthritis or osteoarthritis
• Degenerative disease
• The disk erodes or moves out of its proper alignment
• Poor posture of the neck and upper back

What to Expect from TMJ Treatment?

When to Seek Help

If you have persistent pain or tenderness, or if you can’t open or close your jaw completely. Your dentist, dr, or a specialist of temporomandibular disorders may suggest TMJ therapy or TMD treatments to examine possible causes and treatments for your problem.

Preparing For Your Appointment

The first step is to schedule a consultation to discuss your TMJ disorder symptoms with your Ottawa dr or dentist for neuromuscular dentistry or other dental care to discuss neuromuscular treatment options. Many factors will need to be considered in your consulation, including the symptoms and exact cause such as the orientation of your skull, your bite, whether you have optimal occlusion or not and your lower teeth fit.

Your therapist will be asking questions to determine the possible causes of your pain and to gauge the severity. Be ready to answer the following questions:

• When did the TMJ pain or disorder symptoms start?
• Has it been a problem in the past?
• Have your stress levels increased?
• Do you have frequent headaches, or aches in the neck or teeth?  
• What medications and supplements are you currently taking?
• Is the pain constant or sporadic?
• Is there a particular activity that triggers the pain?
• Is there any clicking or popping when you open and close your mouth? Is it painful?
• Do you have any difficulty opening or closing your mouth?
• What are your current oral care habits?

Your doctor or treatment specialist will ask further questions based on your symptoms. Being prepared for these questions will help your therapist diagnose the dysfunction and determine a treatment plan.

After reviewing a new patients history, the TMJ specialist will examine the face, skull and neck , looking at bite position of upper and lower teeth, alignment and movements to see what treatments may be effective for reducing your pain.  

Diagnosis

Your specialist for TMJ Disorders will:

• Observe the range of motion in all directions
• Feel intraorally as well as externally to identify areas of pain or discomfort
• Listen for clicking or popping

Imaging may be ordered to find the exact cause of your discomfort:

• Dentists involved in Neuromuscular dentistry may order Dental X-rays to examine your teeth and jaw
• CT scan or MRI to provide detailed images of the area

How Long Does it Take to Recover from TMJ Disorders?

Luckily, people suffering with TMJ symptoms will typically find relief quickly with the right TMD treatments. However, severe cases of TMJ dysfunction, especially those caused by arthritis or bruxism, can last months to years, depending on how severe the underlying condition is.

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TMJ Treatment Options

Lifestyle Remedies

Becoming more aware of oral health and habits, clenching your jaw or grinding your teeth  will help you reduce frequency. The following TMJ treatment suggestions may help you relieve symptoms of TMJ disorders:

• Avoid overuse: To prevent further damage, eat soft foods. Cut food into small bites. Avoid chewy food and gum.
• Stretching & massage: Follow your dr, dentist or Ottawa Physiotherapist’s instructions on prescribed exercises for TMJ therapy that will stretch and strengthen your jaw muscles and how to do self massage.
• Relaxation: Practice slow, mindful breathing to help relax tension, which may relieve pain.

Non-Medication Treatments

• Oral splints or mouth guards (occlusal appliances)
• Physical treatment: Along with treatment and exercises to stretch and strengthen jaw muscles, education is offered to new patients to help you understand the behaviors that may aggravate your pain. A tens unit could be used for pain relief.
• Neuromuscular dentistry

Medications

Your Ottawa doctor or dentist in neuromuscular dentistry may suggest the following:

• Pain relievers, medications for headaches and anti-inflammatories
• Antidepressants
• Muscle relaxants

Surgical Procedures

As a last resort, your Ottawa dr or dentist in neuromuscular dentistry might suggest:

• Arthrocentesis
• Injections
• TMJ arthroscopy
• Modified condylotomy
• Surgery

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