Publication date: March 13, 2022.
Information on this page was updated on December 31, 2021.
TMJ dysfunction is a fairly common pathology these days, as it is largely caused by stress factors. Here it can be difficult to understand what is primary and what is secondary, because people with joint dysfunction usually come with bite pathology, pathology of the musculoskeletal system (curvature of the spine, neck). Therefore, joint treatment is a complex story. It happens that the primary pathology is a pathology of the joint, and sometimes it is the musculoskeletal system.
Comprehensive treatment of TMJ
When the doctor has determined the cause of the joint pathology, or causes, he determines the patient's readiness for a comprehensive treatment plan. In addition to the orthodontist, an osteopath or chiropractor may be involved, or even an orthopedist if more complex correction of the musculoskeletal system is required.
The patient should be aware that it is possible to straighten the jaw using a splint or splint, but this will not solve the problem of malocclusion. Orthodontic treatment will be required to correct the bite. If you have already had orthodontic treatment before, then it is more difficult to decide on repeated treatment.
Therefore, first the problem with the joint is solved using a splint or joint splint, then bite correction is carried out, and, if necessary, prosthetics. In parallel, work is underway with an osteopath to restore the muscular corset of the back and neck.
It happens that a patient refuses treatment with braces after the problem with the joint has been resolved. In this case, we warn him about the need to wear a joint splint constantly in order to avoid the recurrence of old problems with the TMJ. After all, a relapse can happen quite quickly due to stress.
Causes
For each patient, the intensity of mechanical impact for the development of the problem is different. In some people, subluxation can develop when yawning, while others suffer serious blows to the jaw without consequences.
In general, there are a number of situations that lead to displacement of the bone structure:
- Road accidents, fights, traumatic sports in which the maxillofacial region suffers.
- Yawning with a wide opening of the mouth.
- Shout.
- Trying to bite off a hard or large piece of food.
- Involuntary muscle contraction during epileptic or convulsive seizures.
Jaw displacement is not always associated with traumatic factors. Pathology often manifests itself against the background of internal disorders in the human body:
- osteomyelitis;
- arthrosis;
- gout;
- rheumatism.
These diseases gradually lead to joint degeneration and loss of functionality. As a result, the shape of the bones changes and the ligaments are weakened.
What may be the symptoms of TMJ dysfunction?
- Tenderness or pain in the area of one or both TMJs at rest or when opening the mouth.
- Crunching, clicking, crepitation and other noises in the area of one or both TMJs when opening the mouth.
- History of TMJ injuries (previous), incl. dislocation, subluxation, chronic subluxation.
- Restrictions in the mobility of the TMJ, restrictions in opening the mouth.
- Excessive tone of the masticatory muscles, bruxism (“grinding” of teeth in sleep, at rest).
- Asymmetry of the chin, lips, lip frenulum, asymmetry of mouth opening, S-shaped opening.
- Suspicion of a forced position of the lower jaw.
Structure of the TMJ
The presence of one or more of the above symptoms may indicate TMJ dysfunction.
Traditional orthodontic treatment does not address TMJ dysfunction. During orthodontic treatment, the severity of dysfunction may not change, decrease or increase. At the moment, in the world scientific orthodontic literature there is no convincing data on the connection between orthodontic treatment and the condition of TMJ. Deterioration of the joint after treatment may have nothing to do with this treatment.
Note! Even in the absence of visible clinical manifestations of joint dysfunction, hidden disorders may occur that require special diagnostics to identify them.
If there is a forced incorrect position of the lower jaw, its position may change during the treatment process with changes and complication of the treatment plan (the need to remove individual teeth, increasing the duration of treatment). A reliably forced position cannot be diagnosed by traditional orthodontic methods; to verify its presence, as a rule, a special analysis is required (manual functional analysis, determination of the central relationship of the jaws), the use of a special articular splint for a period of several months, which, however, does not give 100 % guarantees.
To conduct a detailed articular diagnosis, explain the specifics of your case, and further manufacture an articular splint, you can make an appointment with an orthodontist who deals with the issue of TMJ dysfunction.
TMJ dysfunction is a chronic condition that can be compensated, but not cured (i.e., it is possible to eliminate symptoms, however, pathological changes in the joints, if they have already occurred, will most likely persist).
Diagnosis of TMD
This disease is difficult to diagnose. Moreover, difficulties in making a diagnosis occur not only among dentists, but also among doctors of other specialties. Very often, for this reason, the disease is detected late, and treatment becomes lengthy and quite difficult.
Based on the fact that the symptoms of TMD are closely related to occlusion and prosthetics, diagnosis and treatment should be carried out by a dentist specializing in this field: a gnathologist or a neuromuscular dentist.
To make a correct diagnosis, consultations with several specialists in different areas of dentistry will be required.
What happens if TMJ dysfunction is not treated?
If the dysfunction is not treated, the compensatory capabilities of the body may sooner or later be exhausted, the symptoms will worsen, the pathology will begin to progress, causing greater discomfort (sometimes for several years), thereby affecting the deterioration of the function of the dental system.
In order to try to prevent this and carry out treatment taking into account the individual characteristics of the structure and functioning of the temporomandibular joints, patients are usually offered the following approach.
Treatment method for TMJ dysfunction
1. Diagnosis of TMJ dysfunction.
- When diagnosing a joint in the clinic, a series of measurements and tests are carried out, all sensations in the joint area are recorded (discomfort, clicks, pain, deviation of the jaw when opening and closing), the difference in sensations in the right and left joint.
- The orthodontist also takes impressions of the jaws and takes photographs of the face and intraoral photographs, and also performs three-dimensional computed tomography of the face (3D CT); if necessary, the doctor can give a referral for an additional study - magnetic resonance imaging of the TMJ (MRI).
- Often, the orthodontist, in addition to manual functional analysis, conducts a visual assessment of: posture, symmetry of the shoulder girdle, shoulder blades, hip bone structures, etc., performs the necessary tests and photographs. Based on the results, it is possible to schedule a consultation with an osteopath or chiropractor to jointly manage the patient. Related specialists (orthopedist, surgeon, periodontist) can also be involved in drawing up a treatment plan.
What exercises are prescribed to patients to normalize the work and relax the masticatory muscles?
Exercise No. 1
Draw a vertical line on the mirror with a marker, stand opposite so that the line divides your face into the right and left halves, place your fingers on the area of the articular heads, lift your tongue up and back, open and close your mouth along the line (it may not work right away), 2-3 times /day 30 repetitions. There is no need to open your mouth wide (a comfortable width), the main thing is symmetrically (so that the jaw does not “move” in any direction). If there is a click, open until it clicks.
Exercise No. 2 (cycle)
Do it whenever possible, for example, in front of the TV, at the computer, or in a traffic jam while driving. Open and close your mouth without closing your teeth for 30 seconds, then alternately reach your right and left cheeks with your tongue for 30 seconds. Open - close your mouth again, then for 30 seconds move your tongue in a circle inside the vestibule (behind the lips), first in one direction, then in the other direction (clockwise - counterclockwise), open again - close your mouth, etc.. For this a half-hour cycle, the teeth should not touch, the lips should be closed. If you want to close your mouth or swallow, place your tongue between your teeth. Repeat the cycle for 20-30 minutes 2-3 times/day
Surgery
Surgical intervention is more often prescribed for old injuries, when the joints have had time to change and become thinner under the influence of negative internal or external factors. Surgeons use several treatment methods.
Lindemann method. The purpose of the operation is to increase the size of the tubercle. Teflon materials are embedded into it and secured in place with metal seams. In addition, the articular notch is deepened. After Dindeman's operation, recurrence of dislocation is rarely observed.
Rauer's method. During the intervention, the articular tubercle is enlarged using grafts. Rib cartilage is used as the implanted material. Additionally, the joint capsule is reduced for better fixation in the jaw apparatus.
Self-reduction of a dislocated jaw is only possible if the victim or his relatives are trained in the technique of inserting the joint. Inept actions lead to fractures of bone structures, damage to soft tissues and nerve endings. The consequences of this require surgical intervention.
Prevention of the problem includes avoiding opening objects with your mouth and minimizing the consumption of hard foods. If you are prone to jaw loss, you should undergo regular dental examinations and diagnostic measures.
Occlusive therapy for TMJ dysfunction
After diagnosis, the patient is scheduled for an appointment with the orthodontist to determine the central relationship of the jaws (“true” position of the lower jaw, the position in which your joint and chewing muscles will be most comfortable).
In order to more accurately establish and fix this position, an occlusal splint (splint) will be individually made for the patient from a special plastic, which is erased as it is worn. The splint must be worn constantly (sleeping, talking, eating in it if possible) - this is the meaning of occlusion therapy, which will help the joint and masticatory muscles rebuild into the most comfortable functional state.
Cleaning and caring for the splint is very simple - after eating (as well as while brushing your teeth), brush with a soft brush with toothpaste or soap.
Installation of a brace system for a patient with TMJ dysfunction
Installation of a brace system on the upper jaw is carried out on average after 3 months of occlusion therapy. The splint is adjusted once every 1-2 weeks, or at the discretion of the doctor, until the main complaints from the TMJ are eliminated (in parallel with the alignment of the teeth in the upper jaw), then a brace system is installed on the lower jaw with partial reduction (grinding) of the interfering parts of the occlusal tires, or complete removal. Here the patient needs to be patient - the process may take several months.
At the same time, the new position of the lower jaw is monitored: repeated manual functional analysis, photometry, bite registration is possible, computed tomography of the face during treatment, continuation of orthodontic treatment with a brace system.
Upon completion of orthodontic treatment, final monitoring of the position of the lower jaw follows (manual functional analysis, photometry, bite registration, 3D CT scan of the face upon completion (after) treatment).
Joint splint
Joint splint with braces
Pain syndrome and restrictions in movements of the lower jaw
Before
Frontal photograph of the bite
Lateral photograph of the bite (right). Absence of tooth 4.5, absence of tooth 1.4 are noted with replacement of the defect with a removable partial apparatus
Lateral bite photograph (left)
MRI slice of the left TMJ. There is a structural change in the shape of the joint head. Anterior disc dislocation without reduction (without restoration)
After
Frontal photograph of occlusion after joint surgery
Lateral bite photograph (right)
Lateral photograph of the bite (left). There is a rise in the height of the bite on the operated side
MRI section of the left TMJ after surgical reduction of the articular disc. The correct position of the disc is noted
Frontal photograph of the bite in the mouthguard (Splint)
Lateral photograph of the bite in the mouth guard (Splint) (right view)
Lateral photograph of the bite in the mouthguard (Splint) (left view)
Specialists:
Nazaryan David Nazaretovich
Description:
A typical complaint for patients with TMJ problems is pain and restrictions in the movements of the lower jaw. Such complaints were also present in this clinical case. The entry MRI of the TMJ shows a pronounced structural change in the shape of the head of the left joint and an articular disc displaced forward without the ability to restore its position.
We carried out preliminary Splint therapy in preparation for joint surgery (we made a transparent rigid mouthguard for the lower dentition) and assessed the result over time with a series of control MRIs of the TMJ. Using the example of a section from one of these studies, one can clearly compare the picture before and after surgery. The patient also noted positive dynamics regarding pain symptoms already at the stage of wearing a mouth guard. In the postoperative period, pain was no longer observed. The range of movements of the lower jaw was restored. Of course, the closure of the teeth changed after placing the disc in the correct position. We will require orthodontic and orthopedic treatment to support the stability of the TMJ.
