TMJ (temporomandibular joint) disorders are a family of problems related to your complex jaw 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. TMJ stands for temporomandibular joint, which is the name for each joint (right and left) that connects your jaw to your skull. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.
No one treatment can resolve TMJ disorders completely and treatment takes time to become effective. Dr. Levine can help you have a healthier and more comfortable 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.
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.
There are various treatment options that Dr. Levine can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, Dr. Levine 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:
Stress management techniques such as biofeedback or physical therapy may also be recommended, as well as a temporary, clear plastic appliance known as a splint. A splint (or nightguard) fits over your top or bottom teeth and 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.
What About Bite Correction Or Surgery?
If your TMJ disorder has caused problems with how your teeth fit together, you may need treatment such as bite adjustment (equilibration), orthodontics with or without jaw reconstruction, or restorative dental work. Surgical options such as arthroscopy and open joint repair restructuring are sometimes needed, but are reserved for severe cases. Dr. Levine does not consider TMJ surgery unless the jaw cannot open, is dislocated and non-reducible, has severe degeneration, or the patient has undergone appliance treatment unsuccessfully.
Where direct involvement of the joint has been determined, there may be a number of treatment options. One of these is arthroscopic surgery, which is an important diagnostic and therapeutic procedure in the treatment of temporomandibular joint dysfunction. For instance, a dislocation of the cartilage (meniscus) within the joint may cause persistent pain and difficulty in opening. This is a condition where arthroscopy has proven quite useful. Surgical arthroscopy is considered an alternative to open joint surgery (arthroplasty) as it can be successful in reduction or elimination of symptoms of reduced and painful jaw function. Unlike open joint surgery, arthroscopy can usually be performed on an outpatient basis at a surgicenter, rather than as an inpatient at a hospital. The procedure is done under general anesthesia and usually takes about 30 minutes. After a recovery period, the patient is discharged from the outpatient facility. There is usually only minimal to moderate swelling and pain postoperatively so analgesics and anti-inflammatory medications are prescribed. There is no need for the jaws to be wired together and jaw exercises can be started immediately. Patients are encouraged to begin a regular diet as soon as possible.