Temporomandibular Joint (TMJ) Awareness Month is observed in November to bring attention to TMJ disorders that affect the health and well-being of millions of individuals.
The temporomandibular joint and its surrounding muscles and ligaments allow for a range of movements necessary for crucial actions, including speaking and chewing.
There are more than 30 disorders associated with this complex joint, resulting in an estimated 11-12 million adults in the United States experiencing pain and dysfunction.
Below, Dr. Eber Steolo, assistant professor in the West Virginia University School of Dentistry Department of Oral and Maxillofacial Surgery, provides information about the temporomandibular joint and its diseases and treatment.
WVU Dental providers offer comprehensive general dentistry and specialized treatment, including TMJ evaluation and treatment. WVU Dental is the clinical practice component of the WVU School of Dentistry offering care from faculty, resident and student dentists.
Temporomandibular Joint (TMJ): Normalcy, diseases and treatments
by Eber Steolo, DDS, EdS, PhD, Oral and Maxillofacial Surgeon
The temporomandibular joint (TMJ) is the main structure for a normal and functional mandible. It is a complex joint that is located on both sides of the face, where the mandible connects to the skull base. Because of that, it becomes susceptible to various conditions.
The TMJ allows two main movements – rotation and translation. Rotation is characterized by moderate mouth opening and closing. Translation is when the mandible moves forward and backward with maximal mouth opening. This combination of muscle actions allows for a wide range of subsequent movements that are essential for chewing, speaking, deglutition, whistling and other oral functions.
This articular structure is made up of bones, muscles, ligaments and articular discs which work together to ensure proper mandible functioning. The key component of the TMJ is a fibrocartilaginous tissue named articular disc, and its anatomical position is covering the condyle, seating on its top. It acts as a shock absorber, allowing separation between the condyle and joint cavity which are formed by bones, regulating the normality of the entire internal joint structure. In addition, the ligaments and muscles around the TMJ play essential role in moving and stabilizing the joint. The TMJ is considered a synovial joint, which means it has a capsule that produces synovial fluid, facilitating the smooth movements of this structure. A disease inside the TMJ will modify this fluid for inflammation, causing swelling, redness, heat, pain and loss of function.
Diseases that affect the TMJ can cause pain, discomfort and functional changes, significantly altering one’s quality of life.
When there is pain involving the structures related to the TMJ, it is necessary to identify the possible causes of joint dysfunction and implement the indicated and effective treatment. This joint dysfunction is called temporomandibular disorder (TMD), and it can be manifested in a variety of ways. TMD symptoms range from mild to severe and can include chronic TMJ pain, discomfort of the facial and neck muscles, headaches, difficulty chewing and joint noises, such as popping or crackling, difficulty opening or closing the mouth completely and a feeling of jaw locking. In more severe cases, there may be swelling and tenderness around the TMJ and ear. Additionally, some people may experience dizziness, tinnitus and hearing problems.
The causes of TMD can be multifactorial, including trauma, dental malocclusion, stress and parafunctional habits such as teeth grinding (bruxism). Patients with systemic autoimmune diseases and/or connective tissue disorder are more prone to joint diseases, in general, and may require surgical procedures for joint treatment.
Computed tomography (CT) and magnetic resonance imaging (MRI) of the TMJ may be ordered to evaluate bone and soft tissue structure, respectively. MRI can show disc positioning, arthritic or osteoarthritic conditions. Treatment is personalized for each patient depending on the severity of the joint disease.
In the very early stages of TMD, one to five years of its onset, and when there is neither articular disc displacement, nor maxillomandibular bone discrepancy (condition that generates malocclusion), non-steroidal anti-inflammatory medication, warm compresses, botulinum toxin and orthodontic treatment can help with signs and symptoms. However, when there is a dentoskeletal deformity and/or articular disc displacement from its anatomical position, treatment may be surgical.
Systemic diseases that habitually rupture the normality of the joints and/or dislocated articular discs for five to ten years, determine moderate to advanced TMJ diseases, and surgical treatment is recommended. It can be a less invasive procedure called TMJ disc repositioning and posterior ligament repair or a radical one with total reconstruction of the TMJ with customized prostheses.
Professionals involved in TMJ treatment must have in-depth knowledge of this structure, which is crucial for the diagnosis and treatment of dysfunctions.
Case studies and research on TMJ provide valuable insights into the effectiveness of different treatments and better explain the complex nature of TMJ dysfunctions. Clinical case reports document the experiences of patients with TMD and the results of the treatments implemented. These studies help to identify common patterns, challenges and successful strategies in the management of TMJ dysfunctions. Continuous research is essential for the development of new techniques and improvement of existing therapeutic approaches.
Sharing this knowledge among healthcare professionals who are dedicated exclusively to TMJ treatment improves clinical practice and promotes better patient outcomes.