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TMJ TMJ disorders are problems related to your jaw joint. TMJ stands for Temporomandibular Joint, which is the name for each joint (right and left) that connects your jaw to your skull. Symptoms like pain or a "clicking" sound of the jaw joint are common with TMJ problems. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important. Treatments vary depending on the symptoms and problems that are identified. Some problems require additional testing and imaging. MRI examination is common in cases when the joint health is in question. Sometimes treatment involves physical therapy or medications or both. A splint is often required when the teeth don’t fit well together or clenching or grinding is suspected. Your dentist may be contacted to provide the splint if one is needed for your treatment. Unfortunately, some problems can only be corrected with surgery to the joint. If this is the case, Drs. Noble, Charles, Jacobs, Morris, Beehner, and Suden are extensively trained in various surgical therapies. No one treatment can resolve TMJ disorders completely and treatment takes time to become effective. Drs. Noble, Charles, Jacobs, Morris, Beehner, or Suden can help you have a healthier and more comfortable jaw. Trouble with Your Jaw? TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. You may have a damaged jaw joint due to injury or disease. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. As a result, the disk, which is made of cartilage and functions as the “cushion” of the jaw joint, can slip out of position. Whatever the cause, the results may include a misaligned bite, pain, clicking or grating noise when you open your mouth or have trouble opening your mouth wide.   Do you have 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? The more times you answered "yes," the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they are treated. Treatment There are various treatment options that Drs. Noble, Charles, Jacobs, Morris, Beehner, or Suden can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, the doctor will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care joined with professional care. The goals of treatment are to decrease symptoms and restore function. Usually this means relieving the muscle spasms and joint pain, which will allow normal function to return. Medications such anti-inflammatory medications or a muscle relaxant may be prescribed. Steroids can be injected directly into the joints to reduce pain and inflammation. Self-care treatments can often be effective as well and include: 1.          Heat and massage to sore jaw and neck muscles to relieve stress and tenderness. 2.          Avoiding clenching and grinding when you are awake. 3.          Use of a night guard to avoid clenching and grinding when you are asleep (see below). 4.          Soft non-chew diet. 5.          Avoiding muscle stimulants such as caffeine and nicotine. 6.          Taking over the counter medications that relieve inflammation, like Advil. 7.          Exercising your jaw. 8.          Practicing good posture. Stress management techniques such as biofeedback or professional physical therapy may also be recommended, as well as a splint your dentist can make for you. A splint or nightgaurd fits over your top or bottom teeth and helps keep your teeth apart, thereby relaxing the muscles and reducing pain. There are different types of appliances used for different purposes. 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. These appliances also help to protect your teeth from wear. What about bite correction or surgery? If your TMJ disorder has caused problems with how your teeth fit together, you may need treatment such as bite adjustment (equilibration), orthodontics with or without jaw reconstruction, or restorative dental work. Surgical options such as arthroscopy and open joint repair are sometimes needed but are reserved for severe cases. Drs. Noble, Charles, Jacobs, Morris, Beehner, and Suden do not consider TMJ surgery unless all other options have failed and jaw function cannot be restored without surgery. What is TMD? Temporomandibular Disease Now that we have established our bearings let's sort out what this problem that we call TMJ or TMD is all about. I am sure that everyone can reflect on someone whom they know that has stated, “I have TMJ”. This is an understandably amusing statement considering the fact that we all have two temporomandibular joints (TMJ's). However, understanding what was really wrong with that person is where our confusion begins. For the sake of discussion we will attempt to simplify in a very unscientific manner what are actually the most common maladies comprising TMD. As it affects the vast majority of patients, TMD can be broken down into two fundamental conditions. The first is a muscular disorder where related symptoms and jaw dysfunction are primarily a result of muscular spasm in the muscles of jaw function. This condition is more precisely described as myofascial pain dysfunction or MPD. The second condition is primarily an anatomical disorder whose symptoms and dysfunction result predominantly from anatomical dysfunction of the temporomandibular joint (TMJ). More simply put this form of TMD results from a failure of the gears or parts of the joint to work smoothly or in harmony with one another. In a rare moment of simplistic brilliance, the medical community has named this problem Internal Derangement. Now, on the surface it would seem pretty simple for someone to figure whether they were suffering from MPD or Internal Derangement. Unfortunately, as you may have guessed, this is not always so. Both conditions present with very similar symptoms which can include but are not necessarily limited to the following: jaw pain, difficulty with jaw opening, earaches, headaches, pain behind the eyes, jaw joint popping and clicking, dizziness, and difficulty chewing food or closing your teeth together. Already you can begin to see the dilemma with which the misinformed patient and doctor may be presented. We have at least two different conditions that the patient and some doctors have lumped semantically into the single term TMJ or TMD. Whereas two patients claiming to have TMJ may have very similar clinical signs and symptoms, they may actually present with very different physical conditions. To complicate the situation further, as you may have suspected, the two conditions, about which we have spoken, often require different modalities of treatment. TMJ or TMD Myofacial Pain Disfunction MPD May Have Both Internal TMJ Derangement True TMD A Muscular Disorder   An Anatomical Disorder SYMPTOM: Facial Pain Difficulty with jaw opening Headaches Neck Pain Overlap SYMPTOM: Facial Pain Jaw joint pain Joint clicking or noise Difficulty with jaw opening Earaches Headaches TREATMENT: Soft diet Bite Splints Anti-inflammatory medications (Advil, Motrin) Muscle relaxants Physical Therapy Surgery never indicated   TREATMENT: Soft diet Bite Splints Anti-inflammatory medications (Advil, Motrin) Physical Therapy Surgery may be indicated   How Do We Treat TMD? As you have learned from our above discussion, the treatment of TMD depends on what form of TMD that you have. Therefore, it is imperative that we, as doctors, must learn specifically if you have TMD and, if so, what kind of TMD do you have. Following a thorough medical history and physical examination, the clinician, whether that is your general dentist or your oral and maxillofacial surgeon, is likely to suggest any or all of the following: Jaw rest Muscle relaxants and/or anti-inflammatory medication A bite splint or night guard That you have x-rays taken (Panorex, Arthrotomograms or MRI) That you seek the assistance of a registered physical therapist. All of these modalities are aids in establishing a diagnosis and sometimes assist in rendering definitive treatment. A patient responding to the use of bite splints, muscle relaxants and physical therapy is likely to be suffering from the muscular disorder MPD. Moreover, a patient with the anatomical condition (Internal Derangement) will sometimes receive relief from his/her symptoms with these simple and conservative measures. On the other hand, a patient not responding to these treatment measures may be suffering from a more refractory form of Internal Derangement, which may require confirmation through more sophisticated diagnostic measures such as x-rays and/or MRI. In the event that these diagnostic modalities confirm anatomical disease and the patient continues to suffer from disabling pain and dysfunction your doctor may at this time suggest a surgical approach. What actually is Internal Derangement or Anatomical Disease? All of us are born with a natural cushion built into most of the joints in our body for the purpose of absorbing shock. This cushion called a meniscus or disc has different characteristics in different joints but, when injured, can be a source of mechanical failure in all joints. The temporomandibular joint (TMJ) is no different in that respect and is even more complex than most other human joints. Through a feat of Mother Nature we are capable of virtually unhinging the joint at its usual point of rest in order to move our jaws from side to side or to affect a wider opening. This complex movement during function necessitates a harmonious move by the disc to maintain its protective position. Unfortunately it is not infrequent that this disc can become damaged or displaced.  As the disc is damaged or slips from its original position, the individual may experience clicking in the joint as well as joint locking, as the disc malfunctions and becomes an obstruction to normal joint movements. This condition often becomes painful due to sensitive tissues becoming inflamed and swollen. Moreover, nerves associated with these tissues are capable of referring pain to areas away from the original site of the injury resulting in symptoms such as earaches and headaches. About TMJ Surgery Although the term surgery is frightening to us all, it is sometimes the most efficient and effective treatment modality. Surgery, however, should not ever be taken lightly and should not be considered a panacea. As you have learned from our discussion above, there are certain forms of TMD, specifically MPD, which should never be treated with surgery. On the other hand, surgery can mean tremendous relief in the patient suffering from intractable anatomical disease or internal derangement (when the discs of our joints are functioning improperly). Surgery can take many forms including: Arthroscopic Surgery - A procedure performed through a small instrument with a tiny camera attached. The operator may merely loosen some stickiness in the joint or in some cases reposition a displaced disc with the assistance of a laser and operative or surgical arthroscopic techniques. Open Arthroplasty - A procedure performed by making an incision most often in a skin crease in front of the ear. This procedure is normally aimed at repairing or repositioning a displaced disc but sometimes can result in disc removal (menisectomy). If a disc is removed there are many techniques used today to attempt replacement. Total Joint Replacement - A procedure performed by sometimes making two incisions, one in front of the ear as in open arthroplasty and one just under the angle of the jaw. This procedure is reserved for more severe and chronic conditions that will not respond to other surgical treatment modalities. The decision as to which of the above procedures the patient requires, is a decision made by the oral and maxillofacial surgeon. Additionally, some of these decisions cannot be concluded until the surgeon has observed the existing joint pathology in the operating room. Surgery of the TMJ is almost always performed in a formal operating room as an ambulatory procedure. It is rare that patients require an overnight admission unless a more complicated procedure was indicated or medical evaluation dictates that staying overnight is a prudent thing to do. Most patients will easily return to work in three to five days and suffer only moderate discomfort in the early post-operative period. All are generally restricted to a soft diet for six to eight weeks. Surgical Outcome The results from well-performed temporomandibular joint surgery have been statistically proven to yield a significant restoration of joint function as well as an increase in overall patient comfort. As with all medical treatments, however, the outcome of surgery is dependent upon proper patient selection, proper surgical technique, and appropriate post-surgical follow-up. It is important to emphasize that surgery alone is not a cure for this form of TMD and that physical therapy and close monitoring of the dental occlusion (bite) are imperative in all cases. A team approach is universally necessary .