[{"@context":"https:\/\/schema.org\/","@type":"BlogPosting","@id":"https:\/\/nqsurgicaldentistry.com.au\/temporo-mandibular-joint-problems\/#BlogPosting","mainEntityOfPage":"https:\/\/nqsurgicaldentistry.com.au\/temporo-mandibular-joint-problems\/","headline":"Temporo-mandibular (TM) Joint Problems and Therapy","name":"Temporo-mandibular (TM) Joint Problems and Therapy","description":"[et_pb_section fb_built=”1″ fullwidth=”on” custom_padding_last_edited=”on|desktop” _builder_version=”3.22.3″ background_color=”#ffffff” custom_padding_tablet=”0px|0|0px|0||” custom_padding_phone=”” custom_css_main_element=”z-index: 0;” transparent_background=”off” padding_mobile=”off”][et_pb_fullwidth_header background_overlay_color=”rgba(255,255,255,0)” module_id=”top-header” _builder_version=”3.16.1″ title_font_size=”25px” background_color=”rgba(255,255,255,0)” background_image=”https:\/\/nqsurgicaldentistry.com.au\/wp-content\/uploads\/2016\/06\/tmj-symptoms-problems-and-treatment.png” hover_enabled=”0″ custom_css_main_element=”height: 350px; 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[…]","datePublished":"2016-06-19","dateModified":"2021-04-19","author":{"@type":"Person","@id":"https:\/\/nqsurgicaldentistry.com.au\/author\/admin\/#Person","name":"admin","url":"https:\/\/nqsurgicaldentistry.com.au\/author\/admin\/","image":{"@type":"ImageObject","@id":"https:\/\/secure.gravatar.com\/avatar\/7e8332d597554647ad1a751e441d0749?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/7e8332d597554647ad1a751e441d0749?s=96&d=mm&r=g","height":96,"width":96}},"publisher":{"@type":"Organization","name":"Dr Colin Priestland","logo":{"@type":"ImageObject","@id":"https:\/\/nqsurgicaldentistry.com.au\/wp-content\/uploads\/2016\/06\/index.png","url":"https:\/\/nqsurgicaldentistry.com.au\/wp-content\/uploads\/2016\/06\/index.png","width":577,"height":143}},"image":{"@type":"ImageObject","@id":"https:\/\/nqsurgicaldentistry.com.au\/wp-content\/uploads\/2016\/06\/tmj-symptoms-problems-and-treatment.png","url":"https:\/\/nqsurgicaldentistry.com.au\/wp-content\/uploads\/2016\/06\/tmj-symptoms-problems-and-treatment.png","height":290,"width":619},"url":"https:\/\/nqsurgicaldentistry.com.au\/temporo-mandibular-joint-problems\/","about":["TMJ Dysfunction"],"wordCount":3766,"keywords":["clicking jaw","jaw issues","oral surgery","popping jaw","Temporo-mandibular","TMJ","Treatments"],"articleBody":"\t\t\t\t\t[et_pb_section fb_built=”1″ fullwidth=”on” custom_padding_last_edited=”on|desktop” _builder_version=”3.22.3″ background_color=”#ffffff” custom_padding_tablet=”0px|0|0px|0||” custom_padding_phone=”” custom_css_main_element=”z-index: 0;” transparent_background=”off” padding_mobile=”off”][et_pb_fullwidth_header background_overlay_color=”rgba(255,255,255,0)” module_id=”top-header” _builder_version=”3.16.1″ title_font_size=”25px” background_color=”rgba(255,255,255,0)” background_image=”https:\/\/nqsurgicaldentistry.com.au\/wp-content\/uploads\/2016\/06\/tmj-symptoms-problems-and-treatment.png” hover_enabled=”0″ custom_css_main_element=”height: 350px; padding: 1px;” background_url=”https:\/\/nqsurgicaldentistry.com.au\/wp-content\/uploads\/2016\/06\/tmj-symptoms-problems-and-treatment.png” button_one_letter_spacing_hover=”0″ button_two_letter_spacing_hover=”0″ button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”on” button_one_letter_spacing__hover=”0″ button_two_letter_spacing__hover_enabled=”on” button_two_letter_spacing__hover=”0″ button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off” sticky_enabled=”0″][\/et_pb_fullwidth_header][et_pb_fullwidth_header title=”Temporo-mandibular (TM) Joint Problems and Therapy” _builder_version=”4.9.4″ title_font=”||||||||” background_color=”#0aaaaf” hover_enabled=”0″ custom_css_main_element=”height: 80px; padding: 1px;” button_one_letter_spacing_hover=”0″ button_two_letter_spacing_hover=”0″ button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”on” button_one_letter_spacing__hover=”0″ button_two_letter_spacing__hover_enabled=”on” button_two_letter_spacing__hover=”0″ button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off” min_height_last_edited=”on|phone” min_height_phone=”150px” sticky_enabled=”0″][\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=”1″ custom_padding_last_edited=”on|desktop” _builder_version=”4.0.3″ background_color=”#ffffff” custom_padding_tablet=”50px|0|50px|0″ custom_padding_phone=”” top_divider_style=”wave2″ top_divider_color=”#0aaaaf” top_divider_height=”32px” transparent_background=”off” padding_mobile=”off”][et_pb_row _builder_version=”3.25″ background_size=”initial” background_position=”top_left” background_repeat=”repeat”][et_pb_column type=”4_4″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”3.27.4″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” use_border_color=”off”]This article aims to give a slightly simplified but clear explanation of the various problems that may arise in the temporo-mandibular joint or jaw joint.\u00a0 To do so obviously requires some understanding of the anatomy of the jaws and joints and some explanation of the physiology of how the muscles work.\u00a0 I have tried to write the article in everyday language to try to make this complex subject understandable to a non-medical or dental audience.\u00a0 I hope I have succeeded! First my definition of Temporo-mandibular DysfunctionTemporo-mandibular dysfunction is the name given to a range of problems that affect the jaw joint and the many muscles that cause the jaw to open and close.\u00a0 The majority of those muscles are collectively referred to as the muscles of mastication (the chewing muscles).\u00a0 These muscles must work in harmony with the joint structures and the joint must have a healthy and undamaged disc located correctly above the condyle head of the mandible (lower jaw) within the joint to allow normal smooth free movement to take place. Symptoms of\u00a0Temporo-mandibular\u00a0Dysfunction (TM Joint)The symptoms of temporo-mandibular (TM joint) dysfunction are extremely variable, making a diagnosis of the problems difficult. Diagnosis requires a careful examination in most patients, although sometimes a detailed history will clearly identify the problem.Symptoms may include facial pain, earache, headache, migraine, a feeling of a blocked ear, ringing in the ear (tinnitus), limited mouth opening, a changed jaw position when the teeth are together, shoulder aching, neck pain, difficulty swallowing, joint noises including popping, clicking or a grinding (crepitus), or jaw locking. The Temporo-mandibular (TM) joint anatomyThe jaw joint, also known as the temporo-mandibular joint (TM joint), like any joint consists of bones, cartilage, a disc, joint fluid, nerves and blood vessels.\u00a0 Figure 1 below shows a diagrammatic representation of this joint. The two temporo-mandibular (TM) joints (left and right) are unique in that they are joined by the lower jaw (mandible) and each, therefore, influences the position of the other.\u00a0 During function, up to 16 pairs of teeth contact each other and therefore the manner in which the teeth meet further influences the position of the joints.\u00a0 Finally, there are numerous muscles attached to the lower jaw and these all have an influence on the position of the lower jaw with respect to the skull.\u00a0 With so many outside influences, there are many factors that can lead to destabilisation of the joint and incorrect position or function.The intra-articular discThis disc is designed like a saddle that sits within the joint cavity on the joint surface of the condyle head of the mandible (lower jaw).\u00a0\u00a0 As the jaw opens so the disc moves forward with the condyle but is held in place by ligaments and tissue bands within the joint. The joint actionThe first 2mm of mouth opening is the result of a pure hinge movement of the jaw joints.\u00a0\u00a0 Thereafter the opening is due to a sliding action of the condyle head down the bone slope in front of the joint.The movement of the temporo-mandibular (TM) joint is the most complex throughout all the joints in the body.\u00a0 We describe this movement of the TM joint as a \u201chinge and slide\u201d movement.Causes of TM joint painThere are many reasons why the temporo-mandibular (TM) joint or the associated muscles can become painful.\u00a0 Trauma may damage the joint, the ligaments of the joint or the disc within the joint.\u00a0 Muscular injuries can be caused by trauma and can also result from disharmony between the joints, the disc and the way in which the teeth meet.\u00a0 However, one of the most common causes of TM joint dysfunction is a damaging habit known as clenching.Clenching is not the same a grinding.\u00a0 Indeed, tooth grinding, also known as bruxism, has the effect of damaging the teeth due to severe wear, rather than the joint.\u00a0 Clenching, however, tends to damage the joint but not the teeth.\u00a0 Many people clench their teeth during times of tension or stress.\u00a0 It is one of many stress coping mechanisms that humans use.Clenching the teeth together uses the muscles of mastication (the chewing muscles) and has the effect of causing heavy loading of the joint, squashing the fibro-cellular disc within it.\u00a0 The disc is held in place by ligament tissue and with repeated heavy loads generated by clenching, these ligaments become inflamed and painful as they have an extensive nerve and blood supply. Disc damageThe disc can also become damaged and altered in shape by heavy loading that takes place during clenching or during trauma such as a fall.\u00a0 Such an injury may result in a change in disc shape or damage to those tissues that keep the disc in its correct position, on top of the condyle head.\u00a0 The distorted or mobile disc can then act as a mechanical obstruction to smooth movement of the joint.Movement of the joint over the deformed or displaced disc may then lead to joint noises during movement (opening and closing the mouth and during chewing).\u00a0 Such noises have variously been described as jaw clicks, \u201cclunking\u201d, popping or grinding (also known as crepitus).Joint imperfections can also cause sudden jerking movements of the joint, during what should be a smooth opening movement, as the disc is either trapped or freed from between the glenoid fossa and the condyle head of the mandible.A common disc related problem is disc displacement.\u00a0 It occurs usually due to acute trauma, the disc is then able to move from its correct location due to damage to the soft tissue that holds it on the condyle head.\u00a0 Once this restraining tissue becomes loose, the disc can move independently of the condyle head.Disc displacement most commonly occurs to a position in front of the condyle.\u00a0 It may return to its correct position with a click and then on opening may displace forward again with another click.\u00a0 We refer to this as disc displacement with reduction.Alternatively, the disc may remain displaced in the forward position causing locking of the joint or restricted opening and often severe pain.\u00a0 We refer to this as disc displacement without reduction.\u00a0 The forward entrapment of the disc results in the posterior ligament or band containing nerves and blood vessels becoming placed between the condyle head and the glenoid fossa hence it becomes loaded during closure or clenching.\u00a0 This results in the band becoming inflamed, swollen and painful. The ability of the disc to healAs the disc is made of both fibrous tissue and is also partly cellular in nature, it retains the ability to heal due to cellular activity.\u00a0 Healing takes time and is more effective if the joint is given a rest.\u00a0 Resting the temporo-mandibular (TM) joint is difficult, however, as the joint moves all the time when we speak, when we eat and even when we sleep.\u00a0 This is why a soft diet is important if there is a disc injury and why a mouth splint that allows the jaw to relax is helpful in resolving the disc injury. Muscular damage, spasm,\u00a0and overloadNot all cases of temporo-mandibular (TMJ dysfunction) involve injury to the disc.\u00a0 Sometimes it is the muscles of mastication that can become tired and may be subject to small contractions that may be referred to as a spasm with the effect of the muscle becoming painful.\u00a0 This indicates the need for muscular relaxation to allow repair and resupply of nutrition to the muscle fibres and the removal of chemical waste products produced in the muscle fibres when they contract.\u00a0 This requires rest for natural healing to take place and may be assisted by massage or manipulation of the muscles by a skilled therapist.Muscular healing can be activated by stimulation of muscular trigger points.\u00a0 This is something that is outside the scope of practice of a dentist and comes into the area of expertise of a physiotherapist, remedial massage therapist or chiropractor.\u00a0 Depending on the nature of a patient\u2019s problem, Dr Priestland may refer a patient to a colleague with these qualifications and a different scope of practice if he feels that a different approach is going to result in a quicker resolution of the injury. The effects of clenchingClenching of the jaws frequently leads to trauma of the ligament attached to the intra-articular disc at the rear of the joint.\u00a0 This area of tissue has a very extensive nerve and blood vessel concentration.\u00a0 This trauma leads to inflammation in the tissue.\u00a0 One of the signs of inflammation is swelling.\u00a0 When swelling occurs in the posterior ligament, the ligament becomes painful and can become shortened due to the swelling.\u00a0 When the jaw opens, and the disc moves forward with the Condyl head, the posterior ligament is no longer able to stretch adequately and it tightens up restricting the disc\u2019s forward movement.\u00a0 This leads to pain.\u00a0 Ways in which to solve this problem include restricting the loading of the joint, reducing joint activity, limiting the range of jaw opening, and prescribing non-steroidal anti-inflammatory medications to resolve the inflammation.\u00a0 Very occasionally muscular relaxant medication may also be required. How to reduce clenchingMost clenching takes place subconsciously and also at night as part of our normal stress management. In order to eliminate or reduce this activity, it is necessary to use the body\u2019s own protection mechanism called a neuro-muscular feedback mechanism.\u00a0 This is best explained by considering someone chewing meat that has a piece of bone in it.When the teeth come together heavily during chewing and they bite onto the bone fragment, immediately a message is sent through the nerve sensors in the periodontal ligament that supports the tooth, to the brain, reporting the sudden overload of the periodontal ligament.\u00a0 In a microsecond, the brain turns off the muscles that are closing the jaw and turns on the muscles that open the jaw, thus parting the teeth.\u00a0 All this happens in such a short time period that we are unaware of the reflex action.\u00a0 It is possible to use this naturally occurring reflex action to prevent clenching. How to harness the protective reflex responseA hard acrylic splint (hard plastic splint) is fitted to the upper teeth.\u00a0 This splint has a flat \u201cbite platform\u201d in the midline that allows the lower small incisor teeth to bite onto the acrylic but this is the only contact that exists between the upper and lower teeth.\u00a0 During the night, the brain initiates a clenching action and this applies all the force of loading to the small lower incisor tooth thereby overloading the nerve sensors in the periodontal ligament that supports the tooth, triggering off the protective reflex action described above.\u00a0 A message is then sent to the brain reporting the overload, and the brain immediately turns off the jaw closing muscles and turns on the jaw opening muscles, and in this way stops the clenching activity taking place. But why muscular achingThese symptoms can be explained.\u00a0 Consider the upper and lower teeth clenched together.\u00a0 The high loading is spread across the biting surface of all the teeth and therefore the load distributed to each tooth may not be sufficient to register as an overload.\u00a0 Therefore the clenching muscles will not be turned off, however, the loads are fairly high and the opening muscles attempt to open the jaw.\u00a0 This is unsuccessful because the opening muscles are very small, while the clenching muscles are large and powerful.\u00a0 Hence the teeth remain tightly closed together while the opening muscles contract.\u00a0 The overall outcome of this is a tipping forward of the head and as a consequence of this movement, the muscle fibres at the back of the neck and shoulders are stretched. Threshold electrical stimulation of musclesMuscle fibres must receive an electrical stimulus of a certain magnitude to contract.\u00a0 This electric stimulus is called the threshold stimulus.\u00a0 Any less, and there is no resulting muscle contraction.\u00a0 Any more and the contraction remains the same and does not contract to any greater degree. A reduced threshold of electrical stimulationWhen the muscle fibres are stretched, the threshold stimulus is reduced.\u00a0 This means that the muscle fibres will contract when provided with a lesser electrical stimulus. Background electrical activity of nervesThe nerve system is rather like a telephone exchange.\u00a0 Even at rest, there is a background low level of electrical activity but this level is greatly increased when the muscle is required to contract. Muscular spasms can be explainedAt night while resting, the background level of electrical activity continues to be present, and the clenching causes the forward head tilt therefore stretching the muscles at the back of the neck and at the top of the shoulders.\u00a0 This stretching reduces the threshold level of electrical stimulation required to result in muscular contraction.Now, overnight, due to the clenching action, the posterior muscles start firing off and muscle contractions begin to take place.\u00a0 This is often referred to as spasms.\u00a0 With the continued muscular activity, the muscles tire and there is a build up in the level of waste chemicals due to the muscular activity.\u00a0 In particular Lactic acid concentration rises and the muscles tire and become sore. Treatment for this muscular painThe treatment for the soreness in the neck and shoulder muscles is thereforeto eliminate the clenching habit andrelax the muscles and ensure the muscles are repositioned into their normal positions.The elimination of the clenching is the responsibility of the dentist using an appropriate splint while the correction of the muscular activity and spasms is best treated by a remedial massage therapist with a detailed knowledge of the muscular anatomy and the ability to realign the muscles and encourage their relaxation. ArthritisLike any joint, the TM joint can suffer from wear of the surfaces of the Temporal bone and the condyle head of the mandible.\u00a0 These surfaces can become pitted, abraded or smoothed so that the movement of the joint is no longer smooth and the damaged surface grinding on the opposing bone can cause pain.In severe cases, a surgical procedure may be indicated that may range from an exploratory procedure with irrigation of the joint space and then injection of steroid, to a complete replacement of the condyle head of the mandible.This more advanced surgery is only performed by more highly specialised oral and maxillo-facial surgeons and if such severe joint disease is suspected, Dr Priestland would arrange a referral for assessment with a local oral and maxillo-facial surgeon. Abnormalities of growthCareful assessment of the TM joint using 3-dimensional cone beam volumetric tomography allows visualisation of the joint to check for any unusual shape to the joint surfaces.\u00a0 Rarely, overgrowths of tissues found in the joint can occur that interfere with normal joint movement and function.\u00a0 Once again the removal of such unusual abnormal tissue would be arranged through the oral and maxillo-facial surgeon.contact the friendly team at NQ Surgical Dentistry today on\u00a0(07) 4725 1656 or call in to see us at\u00a0183 Kings Rd, Pimlico QLD 4812[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ custom_padding_last_edited=”on|tablet” admin_label=”Services” _builder_version=”3.22″ custom_margin=”|||” custom_padding=”0|0px|0|220px|false|false” custom_padding_tablet=”|0%|40px|0%|false|true” custom_padding_phone=”” border_radii=”||||20vw” box_shadow_style=”preset1″ box_shadow_vertical=”40px” box_shadow_blur=”60px” box_shadow_color=”rgba(0,64,135,0.06)”][et_pb_row use_custom_gutter=”on” _builder_version=”4.0.3″ background_color=”#0aaaaf” background_enable_color=”off” width=”100%” max_width=”100%” module_alignment=”right” custom_margin=”|||” custom_padding=”0|0px|0|0px|false|false” use_custom_width=”on” width_unit=”off” custom_width_percent=”100%”][et_pb_column type=”4_4″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_blurb title=”BOOK AN APPOINTMENT ” 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