TMJ Disorders

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. Bourget can help you have a healthier and more comfortable jaw.
What is TMJ?
The temporomandibular joint, or TMJ, is a small joint located in front of the ear where the skull and lower jaw meet. This joint allows the lower jaw, called the mandible, to move and function. It is used in talking, chewing, swallowing and many other functions, which are a necessity of everyday life and therefore, inevitably, could lead to irritation of the joint.
The TMJ is a “ball and socket” joint, the round end, or “ball” portion, is called the condyle; the socket is called the articular fossa. Between the condyle and the fossa is a disc made of cartilage that acts as a cushion to absorb stress and allows the condyle to easily move when the mouth opens and closes. The teeth may also generate stress (or habits), if they don’t fit together properly, that may displace the condyle and damage the disc, ligaments and muscles. Teeth grinding, called bruxism, may occur without the patient being aware, causing uneven wear on the teeth. It also can result in locking of the jaw joint causing the patient to either not be able to close or open their mouth completely.

Do You Have a TMJ Disorder?

TMJ symptoms can usually be related to a specific cause either structural, physiological, or congenital. For example, the clicking or popping of the joint is caused by a lack of cartilage at the rear hinge point. The grinding sound that a person hears could be due to an abnormality in the smooth bone surface at the rear hinge point. Ringing in the ears is brought on by abnormal pressure on the ear canal or inflammation. Other causes of TMJ symptoms can be:

  • Stress on the surrounding muscles
  • Teeth clenching or grinding (especially at night)
  • Stress, poor posture/body alignment
  • Abnormal jaw growth
  • Missing teeth
  • Injury such as whiplash or a blow to the face
  • Degenerative diseases such as arthritis
  • Muscle tension
  • Excessive gum chewing or nail biting
  • Displacement of the discs that cushion the joint
  • Hormonal changes

In some cases of TMJ disorder, the disc is displaced, which removes the cushioning effect between the “ball” and “socket” and can result in tenderness and pain. Presence of some of the signs and symptoms could also indicate a specific type of disorder known as myofascial pain dysfunction syndrome or MPD. This disorder is accompanied by muscle pain and tenderness, limitation in a range of jaw motion, and local pain usually limited to one side of the face. A form of degenerative joint disease, or arthritis, can develop in the TMJ. This can lead to pain tenderness and limited jaw movement. If the disorder goes untreated for great lengths of time it can lead to permanent damage and psychological disorders. As with other chronic pain conditions chronic TMJ can lead to depression, anxiety disorder, and interference with daily activities or careers. The best treatment for any chronic pain condition is prevention. The most effective way to prevent the disorder is to identify the risk factors. In order to find the origin of your pain, during your consultation you should be prepared to complete a thorough medical history. Dr. Bourget will be inquiring about the following:

  • Duration and character of any pain you are having
  • Joint noises (such as clicking, popping or cracking)
  • Range of motion of the lower jaw
  • Trauma to the head or neck
  • Stress and anxiety
  • Repetitive habits (grinding, nail biting, etc)
  • Any related discomforts
  • Previous or current treatments

A physical examination of the head and neck area is part of the process to diagnose TMJ disorders. A variety of tests may be used to confirm or eliminate a diagnosis of a TMJ disorder. These tests may include x-rays; magnetic resonance imaging (MRI) to produce images of soft tissue; computerized tomography (CT scans) to identify bone problems; and arthrograms, which use conventional x-ray techniques with a radiopaque material injected into the TMJ to study joint function. Your teeth will also be examined, and models or molds may be made of your teeth so the surgeon can determine if your bite is contributing to your TMJ problem. If necessary, referrals to other dental or medical specialists such as an orthodontist, restorative dentist, psychologist, neurologist, or physical therapist, may be suggested.

There are various treatment options that Dr. Bourget can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, Dr. Bourget 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:
  1. Resting your jaw.
  2. Keeping your teeth apart when you are not swallowing or eating.
  3. Eating soft foods.
  4. Applying ice and heat.
  5. Exercising your jaw.
  6. Practicing good posture.
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 a 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. Bourget does not consider TMJ surgery unless the jaw can’t open, is dislocated and nonreducible, has severe degeneration, or the patient has undergone appliance treatment unsuccessfully.