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The normal anatomy of the TMJ consists of three major components. A. The
glenoid articulating fossa B. The mandibular condyle and C. The articular disc.
Temporomandibular Joint problems (TMJ) are diversely classified as intracapsular and
extracapsular conditions. Intracapsular being in the joint structures like the mandibular
condyle, the articular disc and the glenoid fossa. Extracapsular being in the muscles,
tendons and ligaments surrounding and connecting to the TM joints and mandible itself.
INTRACAPSULAR
These disorders are featured by structural alterations of the temporomandibular joint
which interfere with the form and function and frequently produce pain. They are made up
of four groups of disorders.
Developmental Disorders: These problems occur as a result of abnormal development of the
joint.
Diseases: These consist of degenerative arthritis, rheumatoid arthritis and neoplasms.
Injuries: These occur when trauma is induced to the jaw directly or indirectly like in
Whiplash.
Internal derangements: These occur when the physiologic relationship of the condyle, disc,
and fossa have been lost. Internal problems constitute the vast majority of this group.
In a typical derangement the disc assumes a position forward of the
condyle due to a problem with the discal attachment. When this is present, a click is
heard during opening movements and usually a softer click is heard in the closing of the
mandible. If this is left untreated, it may result in a closed lock and alterations in
form occur and the onset of degenerative osteoarthritis usually occur. With this comes the
onset of pain often severe, and the likelihood of surgical intervention becomes more
probable.
EXTRACAPSULAR
These are problems associated with an abnormal bite due to various reasons like tooth loss
or movement, improper or inaccurate dental restorations, cogenital malocclusions or trauma
that alters
the relationship of the way that the teeth fit together. These symptoms can be as follows:
HEADACHE:
Headache is the most common symptom of a TMJ problem. Although any area of the head may be
affected, usually the TMJ headache is located in the temples and back of the head. Also, a
displaced disc in the TMJ may cause pain in the joint and is referred into the temples,
forehead or neck. They can be so severe that they are treated with little relief for
migraine headaches.
EAR PAIN:
Due to the close location of the ears and the TMJs, an injury to the TMJ caused ear
problems. Symptoms like pain, fullness, stuffiness or even hearing loss can occur even
though medical evaluation of the ear is normal.
FACIAL PAIN:
Facial pain can show on our faces even though the TMJ does not hurt. Facial pain may be
deep or on the surface in the skin. The skin might even become sensitive to the touch or
air blowing acrossed it. Neurologists are usually contacted in these instances.
EYE SYMPTOMS:
There can be pain behind the eyes or pressure build up and no evident eye problem detected
from the eye doctor. Also there can be unusual eye deviations to the left, right, up or
down that occur.
TEETH:
A damaged TMJ may cause tooth pain due to the change in the bite or fit of the teeth. The
teeth may become sensitive to temperature changes especially cold. Patients see the
dentist and no cause can be found and frequently unnecessary root canals and extractions
are performed to rid a patient in pain. But now the pain is still there and has gotten
worse. Now is the time to ask yourself, am I suffering from TMJ? Positive answers to some
of the following may urge you to seek advice from a TMJ expert.
- Do you have frequent headaches?
- Do you have sounds in your joint(s) when you chew?
- Do you have stuffiness or pressure in your ears?
- Do you have buzzing or ringing in your ears?
- Are you dizzy a lot?
- Do your jaws lock open or closed?
- Is your mouth stiff to open?
- Do your teeth ache or sensitive to cold?
- Are your facial muscles tight or sore?
- Do you grind or clench your teeth at night?
- Do your ears hurt?
- Does your neck, back of your head, or shoulder hurt?
- Have you had a jaw injury?
- Have you had a whiplash injury?
- Do your jaws tire easily or ache after eating?
- Are you under a lot of stress?
- Have you been diagnosed with fibromyalgia?
- Have you seen a neurologist, psychologist or psychiatrist for unexplained head pain?
If you have answered yes to one or some of these then you may very well need the expert
help of a dentist specifically trained in the treatment of TMJ problems.
By: Ronald
Neer, DDS E-mail: ronneer@nemonet.com
