What is TMJ?

Many people use the term TMJ to refer to the problems they are having! The term TMJ is actually shorthand for temporomandibular joint and refers to the joint between the condyle of your mandible (lower jaw) and the glenoid fossa (skull base). The joints are unique in that they both function together at the same time to open or close your mouth. In addition, TMJs are ginglymoarthroidal joints as they hinge open (the initial bit of opening) and then slide forwards (allowing you to open fully). In between the two surfaces of the joint is an articular meniscus or disc made out of cartilage.

What are the symptoms of TMJ problems?

Symptoms of TMD vary from person to person (and depend upon the causative pathologies), but common ones include:

• pain;
• limitation of mouth opening (trismus);
• jaw locking;
• crunching, grinding and/or clicking noises;
• associated headache.

I have a click at my TMJ. What’s going on?

Remember that disc in the joint? In some people this can slip a little further forward in the joint, a phenomenon known as anterior disc displacement (ADD). This is not uncommon and it is important to note that if you have a painless click, you require no treatment! The disc has no innervation centrally, but at the back (the retrodiscal tissues), there are pain receptors……so anterior disc displacement can be painful. The click is caused by the disc reducing or being “recaptured” by the condylar head of the lower jaw as it slides forwards in the socket. Some people call this anterior disc displacement with reduction (ADDwR).

My jaw feels locked and I can only open a fraction of what I could previously. What’s going on?

Sometimes the disc cannot be recaptured. This is called anterior disc displacement without reduction (ADDwoR). This is when the initial rotation movement in the joint can take place, but the translation component is impossible as the disc is stuck! So, a little bit of opening is possible but not all the way. Some people may have had preceding symptoms of clicking and pain that gradually progressed to this point, or it can happen out of the blue.

I have “crunching” at my TMJ and pain over the joint with difficulty opening. What’s going on?

Some people have arthritis of their joints. Like any other joint in the body, the TMJ can become inflamed and ultimately start to degenerate. This may be due to “wear and tear” (osteoarthritis) or it may be due to a co-existing inflammatory arthritis (e.g. rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, etc.). People with inflammatory arthritides are often best managed in conjunction with a rheumatologist to see what medical management can offer (e.g. disease modifying drugs, biologics) before resorting to surgery.

My joint and the side of my face aches all over in the mornings and after eating chewy foods. I get headaches in combination with this. What’s going on?

Remember the muscles around the joint? Sometimes they are more of an issue than the joint itself! This is often the case in people who habitually clench and/or grind their teeth. You may not be aware that you are doing this, as it is often not a conscious habit and can happen during sleep (often your partner will pick it up before you do!). This causes myofascial pain and accompanying headaches with relatively little contribution from the joint itself.

What are the treatment options for my TMJ problems?

As TMD is multifactorial in terms of the underlying causes, treatment is similarly often multimodality and may be done in a stepwise fashion according to response. Common treatments include:

• TMJ physiotherapy and exercises;
• Medication;
• stress relief;
• occlusal appliances (splints);
• TMJ arthroscopy;
• open TMJ surgery (TMJ arthroplasty);
• total prosthetic (alloplastic) TMJ replacement.

What role do TMJ exercises have in treatment?

The majority of patients with TMDs will respond to simple treatments. I will often ask patients to imagine they had an issue with their knee…..if you saw an orthopaedic surgeon and he or she recommended surgery without trying some simple things you might start to worry! Simple things will usually include the following:

• TMJ physiotherapy exercises that can be either self-directed or under the guidance of a physiotherapist with a specific interest in the TMDs;
• analgesia (pain killers) and I will usually recommend topical ibuprofen 5% gel to minimize systemic side effects;
• avoiding hard or chewy foods (if you had a problematic knee, you might not run a marathon, so you might need to give steak a miss for a while);
• resting the joint whenever possible;using a warm compress for relief.

I will often ask patients if they wish to try a lower occlusal appliance (commonly referred to as a “splint” rather erroneously). This is a device to be worn at night times. Opinions are divided on the efficacy of these and the mechanism of action, but I often find it is worth attempting on the basis that everything should be tried before proceeding to irreversible and/or invasive treatments. I have some patients who have found immense benefit from their occlusal appliance.