What is TMJ?
What is TMJ and how does one get it?
TMJ is the name of the joint that’s on either side of the jaw which you can feel in front of the ears as you open and close your mouth. The proper term for a problem with the Temporomandibular joint (TMJ) is Temporomandubular dysfunction (TMD). TMD is a disharmony between the way the jaw and the joint works in its most unstrained position; it has to do with the way the teeth come together during those movements.
Because the lower jaw (the mandible) has many jobs, including opening and closing the mouth, it helps us position where the joint needs to be in order for the teeth to interdigitate properly for function. But if the top jaw, or maxilla, is canted/tilted/sloped it may be too far forward, or back, it will cause the lower jaw to be strained to come together.
What are some of the symptoms of TMD?
Some of the symptoms that, as a doctor, I can see clinically are odd wear patterns on the teeth. You can have loosening of teeth as well as some bone loss around the teeth on X-ray. Another thing that is commonly seen is the fracturing of certain teeth.
A symptom that a patient might complain of is head pain; it could be muscular head pain anywhere around the head, neck, upper back and shoulders. Some of the more obvious indications of TMD that patients will complain of are clicking, or popping, of their jaw when they open and close their mouth. Patients will have sore or painful muscles, difficulty chewing, jaw deviating to one side or the other and clinching or grinding their teeth.
Other symptoms a patient may encounter are vertigo, or dizziness, and a ringing in the ears. Low back pain, poor posture and stuffiness in the ears are other examples of symptoms. In some cases, depending on the severity of the condition, some patients may sense tingling or numbness in the fingers or hands.
What causes TMD?
There are numerous variables that can cause TMD as it is improper interdigitation of the teeth and could be related to a number of structural problems such as a deviating jaw. Another possible cause could be that one side of the mandible is shorter than the other or that a patient’s lower jaw has grown further forward than the upper jaw allows for or vice-versa.
The lower jaw can also be what we call retrognathic, or small, and positioned backward in relation to the upper jaw. When those things occur the teeth do not interdigitate properly which may subconsciously cause a patient to grind their teeth because of the human body’s natural tendency to try and correct itself. Unfortunately, because the human body cannot self-correct a bite a person will grind their teeth down. Anytime there is a loss of tooth structure that can cause a compression in the joint, either unilaterally or bilaterally, that compression will tend to throw the condove into an awkward position in the joint. When that occurs, the disk that separates the two bones (the bone of the skull and the bone of the mandible) will move out of proper positioning. This is typically when clicking or popping occurs when the mouth is opened or closed.
How is TMD treated?
There are many different ways to treat TMD depending on what is presented to us by the patient. If it is a minor situation where a patient needs proper interdigitation of the teeth, we will orthodontically make those corrections. In the most severe cases it could require some type of Orthognathic surgery (jaw surgery) or possibly surgery of the joint oftentimes in conjunction with a periodontist, an oral surgeon and a cosmetic dentist where we’ll rebuild the teeth structure that has been lost due to grinding of the teeth, etc.
If a person is missing teeth, the teeth around the space where the tooth is missing will tend to collapse. When that collapse occurs there is a change in the way the top and bottom teeth meet. So oftentimes we’ll have to regain the space, separate the teeth to increase the vertical dimension that we’ve lost then have an implant placed for a missing tooth with a crown. This is when we need to involve other doctors to help us with the cases. But, typically, the most important person to visit is an orthodontist because we’re actually the professionals that are most aware of occlusion and how the teeth fit together as well as jaw positioning. So it really should start in the office of an orthodontist who will then refer the patient if they need to be referred out of the office.