Understanding TMJ Disorders
Dysfunction of the temporomandibular joint (TMJ) is probably the most undiagnosed cause of chronic pain in this country. It is estimated that there are 52-80% of people who are affected with this condition.
The Temporomandibular Joint, TMJ, is a synovial Hinge and Planar joint. This is a joint that is surrounded by a capsule of muscle which is lined with a fluid producing membrane called the synovium. This synovium fluid feeds the internal structures which include cartilage, ligaments, and connective tissues. The internal structure does not have blood vessels or nerves. This joint is located just in front of your ear hole.
When you first begin to open, the "ball-like" part of the lower jaw rotates inside its own cartilage. This represents the first 19-23 millimeters of mouth opening. As the jaw opening continues, the ball and cartilage together slide down and forward, riding on a part of the skull called the eminence until the jaw is fully open. This opening, or joint flexion, is limited by a ligament connected to the ball similar to any other joint in the body. The major difference between this joint and all the others occurs when we close our mouth, extending the joint back. The TMJ does not have a ligament to limit this movement as do all the other joints. Instead, the only limit to this closing movement occurs when the teeth come together. This, we believe to be the pivotal point in understanding the TMJ. For the health of this joint the teeth function as a ligament functions in other joints. If some teeth stop the closing movement, limiting the joint movement to a normal range of motion, this joint works well. However if nothing comes together soon enough, the joint movement will continue beyond its intended range of motion (hyperextend) and will incur joint dysfunction and damage of some kind. As with any joint, the amount of joint damage is dependent upon the forced movement of the joint beyond its intended range of motion. If it is slight, we call that a sprain and that is possible in the TMJ. More damage however occurs when a joint is forced more severely past that normal range. As the ball continues into the back of the joint, it places pressure on the tissue in that area that contains blood vessels and nerves. These tissues produce both the joint pain and inflammation of the TMJ.
As with any joint, including TMJ, damage may occur and the damaged joint may continue to function for a given period of time without incident. If a MRI was performed on everyone in the USA, most would probably have some TMJ damage. Fortunately, most of those joints are functional and may remain that way indefinitely. Therefore, the vast majority of injured TMJ's should not be treated nor do they require such treatment. The need for treatment is based upon the pain and dysfunction the TMJ injury is causing the individual. This would not include and acute lock which requires treatment with or without the presence of pain. TMJ disorders MUST be treated by a dentist because the teeth are involved, however the dentist needs to treat a ligament problem in the joint.
Situations that may cause TMJ Disorders:
- Untreated or incorrectly treated "bite" problems
- Traumatic injuries to the lower face
- Whiplash injuries
- Airbag injuries
These terms are commonly used to describe the global dysfunctions involving the jaw joints. TMJ, however, is simply the correct name of the joints of the jaw.
- TMJ- Temporomandibular Joint
- TMD- Temporomandibular Disorder
- CMD- Craniomandibular Disorder
- TMJ Emergencies
Common Symptoms of TMJ Disorders:
- Chronic recurring headaches
- Facial pain
- TMJ pain
- Ear pain
- Tinnitus (Ringing in the ears)
- Other noises or earaches
- Fullness or stuffiness of the ears
- Clicking noises in the jaw joint
- Sore throat
- Pain behind the eye or even visual disturbances
- Neck pain
- Shoulder pain
- Back pain (upper and lower)
- Chronic fatigue ad digestive distress
- Vertigo (Dizziness)
Chronically occurring head pain which can range from constant daily head pain to severe head pain is classically diagnosed as a migraine. As objective studies suggest that as many as 70% of all TMJ's have injuries to some extent. Any individual with chronic headaches should have their TMJ's evaluated and diagnosed.
Face pain, joint pain, ear pain and tinnitus all are usually related to injuries of the TMJ. They arise from joint inflammation which results from the vascular and innervated tissues found in the back of the joint. This tissue is physically connected to the middle ear by a two headed ligaments that allows the inflammation and fluid to produce auditory disturbances ranging from pain to a sense of fluid in the ears. Again, a good diagnosis is required.
Neck pain, shoulder pain, head pain and vertigo are related through the bio-mechanical implications of TMJ injuries. Alteration in the range of motion within the TMJ and specifically the position of load directly affect the function of the cervical spine, especially at the base of the skull. This usually produces compensatory compromise into the shoulders and even thoracic and lumbar function. All of the above respond well to a combination of TMJ orthotic use and certain forms of muscular skeletal intervention.
Please schedule an appointment with Dr. DiStefano to discuss your concerns and care plan. As one of the premiere TMJ dentists in Howell, Michigan, Dr. DiStefano has over 30 years experience caring for his patients’ health. He strives to educate his patients and improve their lives through dental care and disease prevention.