TMJ Disorder

Illustration with detail of jaw and temporomandibular joint, tmj

TMJ stands for temporomandibular joint. The TMJ is the jaw joint.

The upper jaw is fixed to the skull via the facial bones and it does not move. The lower jaw is the moving component and is connected to the temporal bone of the skull at the TMJ. The TMJ is located just in front of your ear canal, in front of the flap of cartilage called the tragus.

The TMJ is a unique joint in many respects. It is the only gingliodiarthroidial joint in the body (It is the only joint that both rotates and slides, and is connected to the joint on the other side of the body [right and left] via the chin.) It has a disc that is made of fibrocartilage and its embryonic origins are unique. Chemically biologically and physically it is different from all other joints. Most importantly it has a special relationship to the teeth, such that the joint will adjust its position to satisfy occlusion (the way the teeth bite together). If someone has a bad bite (occlusion) then that can lead to TMJ problems.


TMJ Pain

The joint is placed under multiple stresses. It is used when chewing, it is used when talking. Throughout the day and night it can also be used for un-natural purposes, what are called parafunctional habits. The classic example is the seamstress who holds pins with her teeth or the carpenter with nails. Other examples are chewing pens, pencils, fingernails, gum or tobacco. Even more insidious is clenching and grinding of teeth that is subconscious and may be brought on or worsened by stress.

Pain in the area of the TMJ is classified under the broader category of TMD (temporomandibular disorders) which encompasses TMJ (joint) problems plus musculoskeletal disorders such as myofacial pain dysfunction syndrome (MFPDS), migraines, sinus disease, temporal arteritis and anything else that could cause pain in the area of the temples, ear and jaw joint.

A thorough exam including special x-rays and sometimes CT or MRI of the joint are necessary to distinguish the cause of TMD pain. Patients are often seen by more than one specialist and visits to the oral surgeon can be to simply “rule out” joint problems.

Some of the problems under TMD can be dealt with by conservative, non-invasive methods in other words without surgery, such as Botox injections in the tempomandibular region (See Botox Page). 



TMJ Devices

There are different types of appliances used for different purposes:

  • Splint– A splint is a special type of mouth guard that helps with TMJ problems. Don’t buy a commercial over the counter TMJ device. They almost always make things worse. A TMJ mouth guard or occlusal splint can only be properly made by someone who understands the TMJ and occlusion. The splint is a device worn on the upper or lower jaw, covering all of the teeth. It causes changes in the way you bite to relieve TMJ pain. It is made of hard acrylic not soft rubbery material. Splints are sometimes worn all day long but often just at night.
  • Night Guard- A night guard helps you stop clenching or grinding your teeth and reduces muscle tension at night and helps to protect the cartilage and joint surfaces.
  • Anterior Positioning Appliance– 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/day or just at night to move your jaw into proper position. Appliances also help to protect from tooth wear.

Do You Have a TMJ Disorder?

  •  Are you aware of grinding or clenching your teeth?
  •  Do you wake up with sore, stiff muscles around your jaws?
  • Do you have frequent headaches or neck aches?
  •  Does the pain get worse when you clench your teeth?
  •  Does stress make your clenching and pain worse?
  • Does your jaw click, pop, grate, catch, or lock when you open your mouth?
  • Is it difficult or painful to open your mouth, eat, or yawn?
  •  Have you ever injured your neck, head, or jaws?
  •  Have you had problems (such as arthritis) with other joints?
  •  Do you have teeth that no longer touch when you bite?
  • Do your teeth meet differently from time to time?
  • Is it hard to use your front teeth to bite or tear food?
  • Are your teeth sensitive, loose, broken or worn?