What are TMJ Disorders?
Proper diagnosis is paramount for correct treatment of TMJ disorders. Most patients who have discomfort in or around the jaw joints with or without limitation of jaw opening have either muscle problems or problems with the meniscus (disc inside the joint).
If you have had symptoms like pain or a “clicking” sound, you’ll be glad to know that these problems are more easily diagnosed and treated than they were in the past. These symptoms occur when the joints of the jaw and the chewing muscles (muscles of mastication) do not work together correctly.
No one treatment can resolve TMJ disorders completely and treatment takes time to become effective. Dr. Burger can help you have a healthier and more comfortable jaw.
Trouble With Your Jaw?
TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. You may have a damaged jaw joint due to injury or disease. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. As a result, the disk, which is made of cartilage and functions as the “cushion” of the jaw joint, can slip out of position. Whatever the cause, the results may include a misaligned bite, pain, clicking, or grating noise when you open your mouth or trouble opening your mouth wide.
Do You Have A TMJ Disorder?
- Are you aware of grinding or clenching your teeth?
- Do you wake up with sore, stiff muscles around your jaws?
- Do you have frequent headaches or neck aches?
- Does the pain get worse when you clench your teeth?
- Does stress make your clenching and pain worse?
- Does your jaw click, pop, grate, catch, or lock when you open your mouth?
- Is it difficult or painful to open your mouth, eat, or yawn?
- Have you ever injured your neck, head, or jaws?
- Have you had problems (such as arthritis) with other joints?
- Do you have teeth that no longer touch when you bite?
- Do your teeth meet differently from time to time?
- Is it hard to use your front teeth to bite or tear food?
- Are your teeth sensitive, loose, broken or worn?
The more times you answered “yes”, the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they are treated.
Patients who have been diagnosed with muscle spasm or hyperactivity that is causing the problem with the jaw are given a splint. We have found that splint therapy relieves the discomfort and the patient is able to open their jaw better. The splint is usually worn for about three to six months and as needed thereafter.
Patients with problems that have developed inside the joint are diagnosed as meniscus displacement. The disc is found to be displaced out of its normal position. If the disc is displaced but goes back to its normal position during jaw motion, it is referred to as meniscus displacement with reduction. If the disc does not go back to its normal position, it is referred to as meniscus displacement without reduction. Many times we will have the patient have a magnetic resonance imaging study in the open and closed mouth position to determine the degree of meniscus displacement.
There are various treatment options that Dr. Burger can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, Dr. Burger will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care joined with professional care.
The initial goals are to relieve the muscle spasm and joint pain. This is usually accomplished with a pain reliever, anti-inflammatory, or muscle relaxant. Steroids can be injected directly into the joints to reduce pain and inflammation. Self-care treatments can often be effective as well and include:
- Resting your jaw
- Keeping your teeth apart when you are not swallowing or eating
- Eating soft foods
- Applying ice and heat
- Exercising your jaw
- Practicing good posture
We have found that splint therapy works well with patients with muscle spams or soreness. The splint is a semi-hard acrylic that is worn over the lower teeth. The splint helps keep your teeth apart, thereby relaxing the muscles and reducing pain. There are different types of appliances used for different purposes. A nightguard helps you stop clenching or grinding your teeth and reduces muscle tension at night and helps to protect the cartilage and joint surfaces. An anterior positioning appliance moves your jaw forward, relives pressure on parts of your jaw and aids in disk repositioning. It may be worn 24 hours/day to help your jaw heal. An orthotic stabilization appliance is worn 24 hours/day or just at night to move your jaw into proper position. Appliances also help to protect from tooth wear. We recommend that the splint be worn for three to six months. Initially, the splint is worn at all times, but not during eating. We have found that after the initial period of therapy, patients will wear the splint only as needed. Dr. Burger may recommend physical therapy to relax and stretch the deep muscles that control jaw function in order to further aid in the treatment of the TMJ disorder.
The temporomandibular joint has synovial fluid which allows the disc to move freely as the jaw moves. If the disc is displaced or is not moving correctly, the synovial fluid within the joint becomes more viscous. Over time, this causes the disc to be stuck causing the jaw to lock.
Arthrocentesis is a technique that washes out the affected synovial fluid and is replaced with sterile saline. Within a very short period of time, the joint space is replaced by new synovial fluid which allows the disc to have greater mobility. A steroid is also injected into the joint space to decrease any inflammation that usually occurs when the disc is displaced.
The procedure is usually performed in the office either under local anesthesia or light IV sedation. The patient is instructed to wear their bite guard immediately after the procedure and to eat soft food for a few days. There is usually minimal if any postoperative discomfort.
Patients who have disc displacement will benefit tremendously from arthroscopy. Arthroscopy is performed in the surgery center and only takes one hour per joint. An arthroscope is placed in the joint in front of the ear. By arthroscopy, we are able to visualize the entire joint space and remove any pathology. This will allow the meniscus to move more freely and function better. The patient will be able to move their jaw better and without any discomfort or pain immediately after surgery. There is very little postoperative discomfort and the patient is able to eat and drink immediately after the procedure.
Very rarely, we have to open the joint space to remove pathology that cannot be corrected with an arthroscope. The surgery takes about two hours and is done as an outpatient in the surgery center. The incisions are cosmetic and cannot be seen after the wound is healed.