Temporomandibular Disorders

Temporomandibular joint (TMJ) disorders imply impaired functions of the joint secondary to intra-or extra-articular pathologies. Temporomandibular joint disorders affect the system that comprise of teeth, cheek, lip, salivary glands, head and neck muscles and ligaments. TMJ disorders are common in young and middle-aged population, especially in women, and they are manifested by symptoms like crackling in temporomandibular joint, headache, ear ache, jaw pain, chewing problem and difficulty opening the mouth.

Temporomandibular joint problems are a group of diseases that require cooperation of physicians from different disciplines. Surgical treatment for temporomandibular joint disorders is performed by Oral and Maxillofacial Surgeons.

What Is Temporomandibular Joint?

Temporomandibular joint (TMJ) is the most mobile joint immediately anterior to the external auditory canal, which is the junction of the lower and the upper jaws, between the mandibular fossa and the mandibular condyle beneath the temporal bone.

Symptoms Of Temporomandibular Joint Irregularities And Disorders

All conditions that involve masticator muscles and the structure of the temporomandibular joint are considered as temporomandibular joint irregularity. Pain in the joint, limited mouth opening, joint snapping, and deviation in opening the mouth are the most common clinical symptoms of the temporomandibular joint disorders.

Diagnosis Of Temporomandibular Joint Disorders

Clinical and radiographic methods are used to diagnose the disorders of the temporomandibular joint. First, the complaints and the history are reviewed in detail. Both dental problems and muscles are examined on the clinical assessment. Clinical findings inform whether the condition is originating from muscle(s) or an intra-articular disorder. Radiographic studies should be started with X-ray of the jaw bone. For further exam, MRI is primarily ordered, when needed. In some rare cases, computerized tomography is scanned.

Significance Of Treatment In Disorders Of Temporomandibular Joint

Disorders of temporomandibular joint may progress if left untreated. Patients with minimal pain and crackling in front of the ear in the early stage of the condition may experience sudden-onset limited mouth opening and severe pain when they eat hard foods or wake up in the morning. In this condition, called as closed lock, it is required to see a maxillofacial surgeon immediately. In this period, patient should eat soft and liquid foods and take painkiller.

Etiological Factors Of Temporomandibular Joint Disorders

Etiology of temporomandibular joint disorders is not clearly understood. This condition is typically observed in very lean and vulnerable women, while it is rare in men. The disease is caused by grinding and/or clenching teeth, missing teeth, chewing foods by one side of the jaw, parafunctions, bad prosthesis, trauma and orthodontic disorders of the jaw bone. There are also patients with no temporomandibular joint disease, despite presence of such disorders. This shows us that some structural disorders contribute to the development of the temporomandibular joint diseases.

How Are Temporomandibular Joint Diseases Treated?

Treatment of the temporomandibular joint diseases is carried out in the line with the diagnosis made by the maxillofacial surgeon based on clinical and radiographic exams. After the diagnosis is made, possible treatment options are immobilization, diet, exercise, medicines and surgical procedure. The primary target should be to identify and eliminate the underlying cause. Sometimes, a single treatment modality may not be sufficient. In this case, the option should be multidisciplinary approach. Conservative medical or surgical treatment is instituted depending on the diagnosis of the temporomandibular joint diseases.

What Is The Conservative Treatment Of Temporomandibular Joint Diseases?

Medical Treatment, Medications
Various medications, i.e. analgesic, muscle relaxants and antidepressants, are used depending on the type of the joint disorder.

This treatment modality includes physiotherapy procedures, such as hot compress, ultrasound, electrotherapy and acupuncture.

Intra-oral appliances
There are many types of appliances that can be applied to the lower jaw or the upper jaw or the both. Specially designed appliances are made of plastic or acrylic material. Although some types are fixed to the teeth, others are designed in the form of removable appliance. Moreover, there are also extra-oral appliances in addition to fixed appliances.

The maxillofacial surgeon may, sometimes, recommend use of occlusal splint in treatment of the temporomandibular joint diseases. The splints made of clear plastic prevent wearing of the teeth and reduces the muscular contractions and the load born on the joints.

Psychological Treatment
Psychological factors play role in some disorders of the temporomandibular joint. There is a connection between the stress and the physical symptoms. Stress may cause physical problems. A psychiatric interview can be useful especially for patients with muscular problems.

What Is The Surgical Treatment Of Temporomandibular Joint Diseases?

Surgical treatment is preferred for patients with no response to conservative treatment. Principal surgical treatments instituted in diseases of TMJ;

Arthrocentesis, Irrigation of Joints
Sometimes, conservative treatment and medications alone may fail. In this case, maxillofacial surgeon may decide arthrocentesis. For arthrocentesis, fluid is injected into the joint cavity in front of the ear under local anesthesia, and next, a lubricating substance is instilled. Sometimes, it may be repeated several times.

Temporomandibular Joint (TMJ) Arthroscopy
Arthroscopy is, in fact, a diagnostic procedure that aims detailed examination and treatment of the joint cavity. The patient is administered general anesthesia. The risk is low and it is a minimally invasive surgery. Two small incisions are made to expose the diseased site and the surgical intervention is made.

Open Surgeries
Arthrocentesis is reserved for patients, whom conservative treatment and medications fails. Open surgery is performed for patient who do not respond to these non-invasive treatments. Open surgery is required in approximately 5% of the patient with TMJ diseases. Open surgeries of jaw are carried out under general anesthesia and they are performed to correct problems, such as repair of the disc abnormality, reduction of bone, menisectomy and dislocation of the joint.

Prices Of Temporomandibular Joint Surgeries

For detailed information on cost of treatment of temporomandibular joint diseases, please reach us.


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