The article addresses temporomandibular joint dysfunction (TMJD). It thoroughly describes the symptoms (from early signs such as clicks and pain to late symptoms including joint lock), causes, and diagnostic methods. Both congenital and acquired causes are discussed, as well as treatment approaches: from gnathology to prosthetics. Dental Portal provides a deep understanding of the problem and ways to solve it, emphasizing the importance of timely consultation with a specialist.
What is TMJD Syndrome?
Dysfunction, in Latin, refers to poor or difficult action. It is a joint disorder that causes restrictions or the inability to move the lower jaw down, up, backward, or forward, or to perform circular movements.
This condition complicates chewing, speaking, breathing, and changes the shape of the face.
Symptoms
Early signs of the illness:
- Unintentional teeth grinding at night (bruxism).
- Overexertion of the chewing muscles.
- Rapid fatigue of facial muscles during talking, chewing.
- Pain affecting the chewing muscles, the entire face, head, neck.
- Intense clenching of the jaws due to stress or poorly adapted teeth.
- Jaw clicking, crunching while chewing, opening, and closing the mouth, often without pain.
Late symptoms of dysfunction:
- Pain points in the chewing muscles.
- Inability to fully open or close the mouth.
- Muscular hardening detectable by palpation.
- Noises, ringing in the ears.
- Joint locking.
- Muscular fatigue, severe pains that make chewing hard food impossible.
- Shifting of the lower jaw to the side or in a zigzag pattern when opening the mouth, often with jerky movements.
Causes of TMJD
Congenital pathologies:
- Defects in the alveolar ridge.
- Anomalies in the positioning of the joint disc.
- Deviations in the anatomy, size of the jaw.
- Mismatch between the joint head and the cavity of the temporal bone.
Problems with the dental apparatus:
- Incorrect bite.
- Loss of some or all teeth.
- Injuries in the maxillofacial area.
- Atrophy of the alveolar ridge.
- Improperly conducted teeth fitting.
- Decreased crown height due to pathological wear of the teeth.
Muscle disorders:
- Muscle hypertonia in bruxism.
- Damage to muscle fibers.
- Muscle strain due to compression of the facial nerve.
Joint diseases:
- Osteoarthritis with destruction of the joint structures.
- Inflammation of the joint surface in infectious arthritis.
- Rheumatoid arthritis with erosive damage to the cartilage tissue.
Diagnosing TMJD
A gnathologist interviews the patient to identify complaints and collect a history: They gather information about chronic stress, neurological, dental diseases, and injuries in the maxillofacial area. They examine the face, oral cavity, palpate soft tissues, listen to sounds during lower jaw movement, and measure the range of motion. The doctor takes photographs, makes impressions for models to evaluate occlusion, and prescribes diagnostics: CBCT, MRI, myography, condylography, or axiography.
Stages of TMJD Treatment
To heal TMJD, it's necessary to restore the correct relationship between its components, disrupted due to hypertonia of the chewing muscles. Gnathological methods can improve the neuromuscular connection, normalize the position and length of muscles. The muscles relax – the joint returns to its place. To secure the result and prevent recurrence, the bite and teeth are restored.
1. Gnathological treatment:
To alleviate muscle spasm and restore the anatomically correct position of the lower jaw and joint, splint therapy, TENS therapy, botulinum toxin therapy are applied individually or in combination.
Duration: determined by the doctor depending on the pathology's complexity.
2. Orthodontic treatment:
Teeth are moved into the correct position using braces or aligners, positively affecting the anatomy and function of the temporomandibular joint and jaw.
Duration: from six months to 3 years.
3. Prosthodontics:
Large fillings are replaced with inlays, destroyed teeth are extracted, prostheses are placed on implants, and teeth are treated if issues arose from setting crowns too high.
Duration: up to 6 months.
Possible Complications
The TMJD syndrome progresses if left untreated. The joint surfaces begin to deform and wear out, the ligament apparatus gets stretched. This can lead to severe functional limitations, chronic pain syndrome, subluxations, dislocations, arthritis, and osteoarthritis.
If TMJD remains in the wrong position for a long time, other joints adapt to it, leading to spinal curvature. Circulation, lymph flow, and nervous system function worsen. People quickly become fatigued, suffer from headaches, migraines, and notice a deterioration in vision and hearing. The face becomes asymmetrical, increasing the load on the dental apparatus, leading to the wear and destruction of teeth and prostheses.
Prognosis and Prevention
The earlier a patient begins treatment, the greater the chance of fully restoring the functionality of the joint and avoiding degenerative changes. It's crucial to seek a gnathologist's advice even with slight discomfort in the chewing muscles. Preventing complications while undergoing treatment enhances the prognosis: engaging in myogymnastics, adhering to a mechanically soft diet, and restricting the lower jaw's mobility.
How to preserve the functionality of the temporomandibular joint:
- Adjust the bite;
- Address bruxism;
- Visit the dentist yearly;
- Limit stress and learn to manage it;
- Avoid chewing on one side;
- Minimize speaking efforts;
- Ensure timely and high-quality prosthetic and implant procedures;
- Perform exercises to relax the facial muscles.
Frequently Asked Questions
Is surgery necessary to treat TMJ dysfunction?
Surgical intervention is considered only after non-invasive treatment methods have failed. Types of surgeries include arthrocentesis, arthroscopy, and open joint surgery. Each of these has its benefits and risks, which should be thoroughly discussed with a healthcare professional.
What non-medication treatment options are available?
Treatment options include jaw rest, a soft diet, warm compresses, stretching exercises, physical therapy, acupuncture, and biofeedback. These methods aim to alleviate pain and improve function without the use of medication.
When should you see a doctor for TMJ symptoms?
If you are experiencing persistent jaw pain, difficulty moving the jaw, or other related symptoms, it is necessary to consult a healthcare professional. They can help diagnose the issue and recommend appropriate treatment options.
Can TMJ dysfunction be prevented?
While not all causes of TMJD can be prevented, reducing risk factors such as teeth grinding, maintaining proper posture, and using mouthguards during sports can help. Stress reduction techniques, like meditation, can also be beneficial.
How is TMJ dysfunction diagnosed?
Diagnosis involves a physical examination during which healthcare providers observe jaw movement, palpate it, and press on areas to identify discomfort. Imaging tests such as dental X-rays, CT scans, and MRIs provide a detailed view of the jaw's condition.
