Between the Condyl Head and the Glenoid Fossa there is a “saddle-like” disc consisting of dense fibrous tissue with cellular elements known as the intra-articular disc. This disc is connected to the back of the joint space by a slightly loose ligament allowing it to move forwards with the condyl during opening and returning back when the condyl slides backwards on closing.
WHAT CAN GO WRONG
Due to the instability of such a complex joint, overloading forces can result from abnormal movements or damaging habits including both tooth clenching and tooth grinding. There are several injuries that may occur to the TMJ. The disc can be squashed, fragmented, or misplaced in the joint space. Furthermore the ligaments attached to the TMJ can be stretched adding to the laxity or looseness of the joint. Such a loose joint means that the condyl movement forward on opening can become uncontrolled and this may allow a “dislocation”of the TMJ.
WHAT IS DYS-FUNCTION
When a TMJ does not function normally we refer to the condition as “TMJ Dys-function”. There can be so many different injuries and combinations of problems that the presentations of injuries are extremely variable. For example, the joint may click, crack or pop either on opening, on closing or both opening and closing. Such joint noises may be accompanied by pain. The joint can also dislocate, lock open or even lock partially closed with TMJ therapy required.
CAUSES OF DYSFUNCTION
The common reasons for TMJ Dysfunction are:
- Extensive opening as in biting a large hamburger or a sudden excessive yawning movement
- Blunt trauma to the lower jaw as in a punch or contact sports impact
- Habitual clenching of the teeth (damaging to the joint and the associated structures)
- Habitual grinding of the teeth (damaging primarily to the teeth)
- Long term wear and tear with arthritic changes
CLINICAL EXAMINATION AND ASSESSMENT
The clinical examination of a patient presenting with TMJ therapy problems should involve an assessment of the joint opening and closing. This must involve assessment of muscles that are associated with the movement of the jaw. The principal muscles include the paired left and right muscles called the Temporalis and Masseter muscles. Smaller muscles can also be examined by gentle finger pressure at points within the mouth, these being the Pterygoid muscles. The overall aim is to identify any muscles that are either tender to pressure or tight. It is also usual to check the movement of the jaw when opening and closing to full extent making sure the movement is smooth and not jerky and that the jaw does not slew to one or other sides during the opening and closing movement. The patient should also be asked if they are aware of any noises in the ears during opening and closing.
Additional examination of the joints by the use of X-rays may prove useful. TMJ views can be taken that may include tomography and Cone Beam CT scans. The latter is of far greater benefit as 3D imaging allows the joint to be viewed from any aspect without any distortion of the image.
TREATMENT OF TMJ DYSFUNCTION
Once the TMJ therapy problem has been identified a treatment plan must be formulated. This usually involves the use of “splints” of various designs. These may be worn on the upper or lower teeth and can either cover just a few teeth or all the teeth.
Splint therapy usually achieves improvement but may not always achieve complete resolution of symptoms. Sometimes it may be necessary to supplement the splint therapy with alternative techniques including Dry Needling Therapy aimed at releasing the muscles. Remedial massage can also play a part in supporting resolution of inflammation in the muscles and ligaments. In a few cases surgical management may be required including the injection of steroids into the TMJ joint space to assist in the resolution of inflammation in the joint affecting the ligaments attached to the intra-articulate disc. However, surgery is always the last resort.
contact the friendly team at NQ Surgical Dentistry today on (07) 4725 1656 or call in to see us at 183 Kings Rd, Pimlico QLD 4812
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