The temporomandibular joint (TMJ) is a joint of the jaw. A person has two such joints, they connect the lower jaw with the temporal bones of the skull on both sides of the head. The joints are located directly in front of the ears and thanks to them the lower jaw moves.
Each joint consists of two bones with a cartilage disc between them. Ligaments and muscles surround the joint. The TMJ is one of the most frequently used joints in the body. When these joints work properly, you can talk, chew or yawn without pain, if not – then a person may experience unpleasant symptoms, such as a clicking jaw and painful sensations.
The temporomandibular joint is characterized by its complex character, as it provides synchronous and three-dimensional movements. This feature makes it the most complex joint in the human body. In addition, its biological composition is different from that of other load-bearing joints, such as the hip or knee joints.
What are temporomandibular disorders
Temporomandibular disorders are a complex and understudied group of conditions characterized by pain in the jaw joint and surrounding tissues, as well as limitation of jaw mobility.
Injuries and other conditions that commonly affect other joints in the body, such as arthritis, can also affect the temporomandibular joint. The lesion can affect one or both joints, and depending on the severity, it can affect a person’s ability to speak, chew, swallow, express facial emotions, and even breathe.
What causes temporomandibular joint dysfunction
The complexity of such disorders is due to the fact that there can be several causes of this disorder, and in some cases – no obvious cause.
Known causes include:
- autoimmune diseases (when the body’s immune cells attack healthy tissues);
- infections;
- injuries in the area of the jaw;
- dental procedures (even prolonged opening of the mouth);
- insertion of a breathing tube before surgery;
- various forms of arthritis.
Studies have shown that a certain variant of the gene increases sensitivity to pain, and this variant is more common in patients with TMJ dysfunction than in the general population. The observation that problems with the jaw often occur in women of reproductive age prompted the study of the role of female sex hormones, particularly estrogen, in the development of TMJ dysfunction. Other risk factors include such habits as frequent chewing gum or prolonged jaw tension.
Scientists have found that most patients with TMJ dysfunction also have other medical conditions. Comorbid conditions include chronic fatigue syndrome, chronic headache, endometriosis, fibromyalgia, interstitial cystitis, irritable bowel syndrome, low back pain, sleep disorders, and vulvodynia. They are called comorbid because they occur together more often than can be explained by chance.
These findings stimulate research into the common mechanisms underlying these conditions. TMJ dysfunction is considered a complex disease, similar to hypertension or diabetes, that includes genetic, environmental, behavioral, and gender factors.
Symptoms
TMJ dysfunction pain is often described as dull and aching, which occasionally occurs in the jaw joint and adjacent areas. However, some people may not feel pain and still have problems with jaw mobility.
Symptoms may include:
Painful clicking, crunching or rubbing in the jaw joint when opening or closing the mouth. With TMJ dysfunction, patients often complain of jaw clicking when opening the mouth, chewing or yawning. Usually this sound is not very strong, and it is barely audible only to the patient himself, but sometimes the click can be loud, which can be heard by outsiders. Symptoms that are related to sound effects can also be manifested by crunching, crepitation (noise that occurs as a result of the friction of bones or cartilage surfaces in a joint), fluttering sounds.
Stiffness of the jaw muscles, limited movement or locking of the jaw. When opening the mouth, jaw movements become irregular. In some cases, the patient needs to find a position in which the mouth will open freely. For this, you need to make movements of the jaw up or down, as well as to the sides.
Symptoms of TMJ dysfunction also include the following conditions:
- feeling that the bite is “wrong”;
- dizziness;
- vision problems;
- tinnitus;
- photophobia (photophobia);
- sleep disturbance
When to consult a doctor
It is worth noting that periodic clicking or discomfort in the jaw joint or masticatory muscles is quite common and is not always a cause for concern. Often the problem goes away on its own within a few weeks or months. However, if the pain is severe and lasts more than a few weeks, you should consult a doctor.
Who to contact?
Dysfunctions of the temporomandibular joint (TMJ), masticatory muscles, as well as bite disorders are diagnosed and treated by a gnatologist.
Gnathology is the branch of dentistry that studies the operation of the dento-maxillofacial system, examines how teeth, jaws, muscles and joints work.
It is very important to rule out other conditions that can mimic TMJ dysfunction.
For example, pain in the face can be a symptom of many diseases, such as:
- sinus or ear infections;
- dental caries or abscesses;
- different types of headache;
- facial neuralgia;
- tumors
Diseases such as Ehlers-Danlos syndrome, dystonia, Lyme disease, and scleroderma can also affect temporomandibular joint (TMJ) function.
Therefore, first of all, with the help of additional studies, the doctor must identify the cause that causes the patient’s various symptoms of the disease, and then choose a plan of treatment measures.
During the examination, doctors can determine whether the patient experiences pain when lightly pressing on the joint itself or the masticatory muscles. A patient’s medical history should not be limited to teeth, head or neck. It should include a complete medical record that may reveal the presence of one or more comorbid conditions that are common in patients with TMJ dysfunction.
Blood tests are sometimes recommended to rule out possible medical conditions as the cause of the problem.
Treatment
Most people with TMJ dysfunction have relatively mild or intermittent symptoms that can resolve on their own within weeks or months with simple home therapies. Useful practices are:
- eating soft food;
- application of ice or heat;
- avoiding excessive jaw movements (for example, yawning a lot, singing loudly, chewing gum).
If the pain persists, doctors prescribe therapy aimed at eliminating or reducing the pain syndrome.
Medical treatment:
- non-steroidal anti-inflammatory drugs that reduce pain, swelling and inflammation;
- antidepressants are prescribed to patients with symptoms that affect work capacity or sleep disorders;
- means with a sedative effect also improve the quality of sleep and reduce irritability;
- botulinum therapy (injection of a special preparation of botulinum toxin (botulism toxin) under the skin) – the use of such injections leads to relaxation of facial muscles, reduction of facial expressions and slowing down of the transmission of nerve impulses.
- blockade of the joint with the help of corticosteroids: with long-term TMJ dysfunction, damage to the joint begins, which requires restoration of its surfaces.
Non-drug treatment:
- massage, which helps to reduce the severity of spasm of muscle fibers;
- physiotherapy (laser therapy, magnetotherapy, electrophoresis with drugs).
Dental treatment:
- grinding of teeth and fillings, which can interfere with the closing of the jaws;
- dental prosthetics or replacement of a dental prosthesis, if it was installed incorrectly;
- bite correction using braces, orthopedic splints and caps.
Surgical methods:
- myotomy (incision or surgical division) of muscle fibers;
- condylotomy of the head of the lower jaw;
- arthroplasty with pronounced changes in the joint bag.