Treatment of the temporomandibular joint (TMJ)

Sometimes the destruction of teeth, their absence, occlusal pathology, general health, instability of the endocrine system and other factors can cause certain changes in the joint apparatus.

How the temporomandibular joint works

The temporomandibular joint is one of the unique joints in the human body because it works in pairs. It is a complex system of bone structures, ligaments and a disc, which in combination with the masticatory muscles provides the movement of the lower jaw and the closure of the teeth.

Any violation of the coordinated work of this system causes dysfunction of the temporomandibular joint.

The main signs of TMJ dysfunction:

• clicking or crunching in the TMJ when opening and closing the mouth;
• pain or discomfort in the TMJ or in the masticatory muscles during chewing, wide mouth opening;
• change in the position of the lower jaw, observable face asymmetry;
• uncomfortable closing of teeth, toothache when chewing;
• reduction of the mouth opening width;
• headaches, dizziness, neck, back pain, pain or ringing in the ears;
• change of the face oval.

What are the most common causes of TMJ dysfunction?

These can be injuries of the temporomandibular joint, prolonged absence of masticatory teeth, constant or periodic clenching of teeth (bruxism), chewing on one side, and others.

The most common cause of TMJ dysfunction is bruxism, which is manifested by symptoms such as tight teeth, tapping and gnashing of teeth mostly during sleep.

The causes of bruxism can be mental or physical tension, stress, disturbances in the closure of the teeth, which are transformed into excessive activity of the masticatory muscles - the strongest muscles in the human body.

The consequences of bruxism are manifested not only by pathological abrasion of the teeth, but also by the destruction of the elements of the joint, pain in the ear and in the masticatory muscles.

Subsequently, in the absence of proper treatment, significantly impaired jaw movements, there is a strong tension in the muscles of the neck and back, there is osteochondrosis, headaches, worsening sleep and mood. These unpleasant symptoms can eventually develop into psychological problems.

How we diagnose before treating TMJ diseases

At the initial consultation, the doctor gets acquainted with the patient, clarifies in detail his complaints, life history and details of specific diseases. The specialist assesses the patient's posture and functions such as breathing, swallowing, chewing. This is followed by a clinical dental examination to determine the dental status. The nature of the closure of the teeth at different positions of the mandible, as well as the condition of the masticatory muscles is studied.

Based on this data, a plan of diagnostic examination of the patient is made. In most cases, it is:

• X-ray examination: orthopantomography, CT, TRG with cephalometric analysis of the facial skeleton
• A series of intra- and extraoral images
• Manufacturing of diagnostic models of jaws.

Manual functional analysis, including::

• listening to noise in the TMJ (crunch, click, etc.)
• determination of the lower jaw movements range;
• palpation of the TMJ, masticatory and facial muscles, neck muscles;
• functional tests;
• assessment of mandible trajectory and correctness of interdental contacts..

As a rule, the treatment of temporomandibular joint dysfunction is carried out comprehensively by dentists of various specialties.

Treatment is difficult because patients are often treated with irreversible changes. Treatment of such pathologies by a gnathologist is selected individually, considering the cause of the pathology, analyzing MRI, CT, TRG, muscle tone.

Treatment of TMJ dysfunction is based on the following principles:

• elimination of pain in the masticatory muscles/joint;
• normalization of mouth opening width;
• relaxation of masticatory muscles;
• restoration of occlusion height, number of teeth, forming correct teeth closing..

Methods of treatment of the temporomandibular joint:

• limitation of the lower jaw motion range, diet, appointment of special exercises to correct muscle tone, masticatory muscles massage;
• muscle balance splint from Vasyl Vasyliiovich

In the process of splint treatment, relaxed masticatory muscles ensure the correct position of the TMJ elements. The severity of the click in the TMJ gradually decreases, or it is completely eliminated.

When treatment with a splint is finalized, for the cases of teeth abrasion, malocclusion or loss of teeth it is necessary to conduct orthodontic treatment or install prosthetics. Sometimes comprehensive treatment involves both methods.

The purpose of this stage is to fix the correct position of the mandible and the relationship of the TMJ elements by means of multiple symmetrical contacts between the jaws at the desired bite height. This allows the dental apparatus function to be stable and long-term.

Test for self-diagnosis of TMJ dysfunction:

• Do you grit your teeth during the day and/or at night?
• Do you have limited mouth opening?
• Do you have any sound phenomena in the temporomandibular joints (clicking, crunching) when moving the jaw?
• Do you have pain in the temporomandibular joints?
• Do you have muscle pain?
• Do you have posture problems?
• Are your teeth sensitive?
• Do you have ringing or tinnitus?
• Do you often have seals and crowns damaged/chipped?
• Has the oval of the face changed lately?
• Do you have worn teeth?
• Has the position of the jaw changed lately?

If at least two questions you have the answer "Yes" - you need to see a specialist for examination of the temporomandibular joint and masticatory muscles.