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TMJ

What does TMJ mean?

TMJ stands for Temporomandibular Joint. The TMJ is a complicated hinging and sliding joint located where the upper and lower jaws meet. There is a joint on each side of your mouth. These joints are part of a large interelated group of muscles, ligaments, and bones that work together as a system.

When this system is working properly, all normal functions like talking, chewing, and yawning can be done with comfort and ease.

There are three major components at work for these normal functions:

  • Muscles contract and relax to open and close the joint.
  • A disk absorbs pressure in the joint which allows the joint to move smoothly when the jaws open and close.
  • Ligaments help to support the joint and connect the jaw bones to the skull.

What kind of problems encompass Temporomandibular Joint Disfunction (TMD)?

The TMJ and the nearby components make a complex, closely connected system. A problem in one area can affect any or all of the adjacent areas. Common problems associated with TMD would include tight muscles and inflamed or damaged joints. Another consideration could be symptoms that may be related to how the teeth fit together and function.

  • Myofascial pain occurs in soft tissue such as muscles. Extreme muscle tension can cause areas to become trigger points for referred pain. Referred pain can cause a part of the body to experience discomfort other than the source of the pain. So, for example, tooth pain or other facial pain can be a result of pain that stems from the TMJ.
  • Inflamed joints can cause pain, swelling, redness, burning sensation, and loss of function. Certain tissues surrounding the TMJ can become inflamed. This can result in pain which increases with jaw movement. If ligaments of the TMJ are injured or become inflamed, the ligaments are unable to support the joint properly. Arthritis is also a consideration. Arthritis is a joint disease which can lead to inflammation of the TMJ.
  • Damaged joints are another factor. Clicking and popping that occurs when the jaw moves, coupled with pain may indicate joint damage. The disk can sometimes slip out of place when opening or closing. As the disk slips a clicking sound may be heard. The jaw may also become locked if the disk gets stuck in one position. Another consideration is damage from Arthritis, which is a degenerative disease that can wear away the TMJ.

What are some other contributing factors?

  • Bruxism (grinding)
  • Clenching of teeth
  • Malocclusion (poorly aligned teeth or bite)
  • Missing teeth
  • Poorly fitting dentures or partial dentures
  • Anatomic joint abnormalities
  • Previous joint injuries
  • Degenerative joint disease or Arthritis
  • Chronic stress
How is a TMJ problem evaluated?

Dr. Pitts will see you for an initial evaluation, at which time your joint function, joint and muscle pain, and possible contributing dental factors will be fully evaluated. The TMJ evaluation is more involved than a regular dental evaluation and usually will take about an hour.  At that appointment, a Panorex x-ray will be reviewed to determine if there are any bony abnormalities.  If necessary, Cone Beam CT Scans will be taken of the joints to allow for more detailed visualization of the bone (condyles).  In most cases, you will then be referred for an MRI Scan of both joints. MRI Scans can be performed at many outpatient facilities. You will be given a copy of the MRI Scan to bring with you to a follow-up appointment with Dr. Pitts. Dr. Pitts will review the MRI Scan with you prior to determining the best course of treatment for your problem. 

What treatment options are available?

Dr. Pitts has a very conservative approach to treatment of the majority of TMJ problems. Most TMJ pain can be treated without surgery or other invasive procedures. Treatment usually involves a course of therapy which requires several modalities, and compliance with recommended treatment is considered essential. Treatment is considered a collaborative effort on the part of Dr. Pitts and the patient.
Treatment options may include:
  • Anti-inflammatory medications
  • Mild muscle relaxants
  • Diet restrictions (maintaining a soft diet)
  • Physical therapy (moist heat or massage therapy)
  • Fabrication of a bite splint, and continued splint maintenance
  • Stress management or behavioral therapy
  • Botox injections of involved muscles
  • Arthrocentesis of joints (a minimally invasive procedure performed in the office)
  • Reconstructive open joint surgery
If it is found that degenerative or anatomic abnormalities in the joint are severe, a referral to a treatment center that provides specialized care such as Arthroscopic surgery of the joints or total joint reconstruction may be necessary.
 
If I need a bite splint, what can I expect?

If Dr. Pitts prescribes a bite splint, it will be made by Dr. Pitts. Impressions of your teeth are taken for fabrication of a bite splint at a separate appointment. It is a thin clear acrylic splint that fits over your upper teeth. After insertion and initial adjustment, you will need to wear it every night and during the day as much as possible until your symptoms improve. Most patients then find that wearing the splint only at bedtime is adequate to maintain relief of their symptoms. You must return for regular adjustments of your splint as prescribed. Failure to return on a regular basis may result in shifting of your teeth or a change in your bite. If compliance becomes an issue during your splint therapy, you may be released from care by Dr. Pitts.  

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