What is temporomandibular dysfunction?

Also known as TMJ dysfunction.

What is temporomandibular joint or TMJ?

TMJ is the joint that allows jaw mobility.

These movements are necessary in the making of specific activities such as chewing, talking, swallowing, etc.

Which structures are involved in the temporomandibular joint?

The TMJ is composed of bone, muscle and joint structures.

The bone structures that compose TMJ are the jaw and the skull bone called temporal (therefore the name temporomandibular).

The muscular structures are all the muscles that are involved in the jaw's movements.

The joint structures are the ones that make up this particular joint and they are: the disc joint, the synovials, the joint's ligaments, and the capsule joint.

The TMJ is a complex joint.

There are two TMJ's: right and left, having the specific quality of working both simultaneously in each jaw movement.

What causes TMD?

There is not a specific cause for temporomandibular dysfunction.

It is a multifactor syndrome, meaning there are multiple factors, called contributing factors, which are involved in TMD's genesis.

These factors are:

• Genetic predisposition

• Dental Malocclusion

• Wisdom teeth included

• Bruxism (habit of grinding or tightening the teeth)

• Anxiety, stress, depression

• Postural habits

• Sleep disorders

Which are the symptoms present in TMD?

The symptoms are multiple and are in direct relation to the joint structures altered.

TEETH AND MOUNTH

• Tightening or grinding the teeth (Bruxism)

• Loose or fragile teeth perception

• Uncomfortable Chewing

• Dry mouth

• Hot or scalded mouth

MANDIBULAR PROBLEMS

• Joint noises or snaps

• Jaw muscle pain

• Limitation in the mouth's openness

• Jaw displacement while opening mouth

• Dislocations or blocks while opening or closing mouth

• Impossibility to open mouth without forcing it

• Painful sensibility or swollen muscles

FACIAL PAIN OR HEADACHE

• Frontal area headaches

• False migraine

• Nasal obstruction or sinus pain

• Pain in the back or top area of the head

• Very sensible scalp

• Tingling or pressure sensation in the face

EYES

• Ocular pain or behind the eyes

• Light sensibility (photophobia)

• Alter vision

EAR

• Noises

• Loss of hearing

• Earache (no infection)

• Itching

• Vertigo

THROAT

• Burning, inflammation, congestion

• Constant felling of swelling

• Difficulty swallowing

NECK AND BACK

• Pain, rigidity, muscular inflammation

• Reduced mobility

OTHER SYMPTOMS

• Tingling sensation in arms and hands

• Fatigue

• Depression

How is TMD diagnosed?

TMD's diagnose is based on the presence of different symptoms, such as the ones described before, and other complementary tests. The most frequent complementary test are X-rays and magnetic resonance (MRI).

How is TMD treated?

Firstly and most important, is to find the contributing factors present that influence TMD to eliminate them, if possible.

Basically, there are four types of treatment that, based on the diagnosis, can be applied.

• Physical treatment

• Drug treatment

• Psychological treatment

• Interoral appliances

  •  Oclussal Splint

PHYSICAL TREATMENT

• Thermo therapy: cold / hot

• Freezing sprays

• Physiotherapy

  • Massages
  • Exercises
• Transcutanius electrical nerve stimulation (TENS)

• Ultrasound

DRUG TREATMENT

• Painkillers

• Antiflammatories

• Anesthetics

• Muscle Relaxers

• Anxiolitics

• Antidepressives

PSYCHOLOGICAL TREATMENT

In those cases where the contributing factors are psychic based (anxiety, depression) are very important to examine the case thoroughly and dominate the syndrome.

OCLUSSAL SPLINT

In the cases where the habit of tightening or grinding the teeth (bruxism) is observed exists as a contributing factor, then mouth molds are taken and an intraoral appliance, called a oclussal splint, is built with acrylic resin.

This oclussal splint is then, generally, adjusted to the patient's upper arch.

TMJ DYSFUNCTION PREVENTION

The best prevention against temporomandibular dysfunction is high control on the contributing factors.

All cases must be individualized and personalized, but in general terms and according to the contributing factors present there are several options:

• Dental Malocclusions: orthodontic treatments

• Presence of wisdom teeth: surgical extractions

• Bruxism: daily habit control or nightly oclussal splint

• Anxiety, stress, depression: relaxation, psychotherapy, psychiatric treatments and drug treatments

• Postural Habits: postural habits modification

• Sleep disorders: study and treatment

A very important key is the premature diagnosis of the contributing factors

In cases where ATM dysfunction is already installed the following techniques are recommended: