The temporomandibular joint (TMJ) is located just in front of the ear. This joint is made up of the lower jawbone (mandible) and the temporal bone of the skull. The condyle of the mandible is that portion which fits into the joint space. This condyle has a disc composed of cartilage that sits on top of the condyle. The disc prevents damaging bone-to-bone contact during normal functioning of the TMJ. People who suffer from a temporomandibular disorder (TMD) may have this protective disc made up of cartilage displaced off the condyle:

Normal Joint	Displaced Disc

In such cases, the TMD sufferer often has clicking, popping, or grinding noises that can be heard during normal functioning of the TMJ. People with these symptoms should never go untreated as continual degeneration of the TMJ will occur, possibly bringing debilitating pain.

Persons suffering from TMD may also have a disorder which differs from the displaced disc described above. This type of disorder occurs when the condyle of the mandible posteriorly positioned in the joint space:

Normally Positioned	Posteriorly Positioned

To understand why this creates the painful syndrome of TMD, let us briefly explain the tissues that exist in this joint space posterior to the condyle. Blood vessels, nerves, and connective tissue are abundant in this area. The external carotid artery, a large blood vessel carrying blood from the heart to the brain, passes through this area. The temporal-auricular nerve is one of a number of nerves existing in this area as well. When a condyle is posteriorly positioned in the TMJ, it compresses and damages these tissues of nerves, blood vessels, and connective tissue. Many persons with a condyle, which is posteriorly compressed against these delicate soft tissues, will develop frequent headaches. With the passing of time, these headaches increase in frequency and intensity.

This is why it is extremely important that all youngsters with a deficient or retruded jaw be treated with the functional appliances when they are young. These functional orthodontic appliances will position the jaw so that the TMJ’s are not damaged during normal functioning. Early interceptive functional orthodontic treatment of these cases helps create healthy temporomandibular joints. Historically, treatment has often involved bicuspid extraction or the use of cervical headgear. These classical methods should rarely be used because of the likelihood of trapping the mandible posteriorly, setting the stage for painful disorders of the TMJ in later life.

Causes of TMJ

• Lower jaw trapped back in a posterior position
• An improper bite
• Direct blow to the jaw or head
• Whiplash injury from a rear end collision
• Extraction of back teeth
• Missing back teeth
• Excessive clenching or grinding of the teeth
  

A whiplash injury, which occurs by a collision from the rear, is one cause of TMJ disorders. Unique to this injury is the absence of a direct blow to the head or jaw. In this situation, the mouth opens excessively wide as the head is snapped back. The joints of the jaw dislocate if the collision from the rear is sufficiently forceful. In addition, the soft tissues posterior to the condyle (blood vessels, nerves, and connective tissue) are compressed and damaged. Research by Arrington and Garcia documented that 95% of their research subjects suffered TMJ abnormalities after sustaining a whiplash injury. In a similar study, Pressman found that 88% suffered TMJ abnormalities.

Excessive clenching and grinding of the teeth when dealing with tension and stress often cause TMD. This type of TMJ disorder first begins in the jaw muscles. The clenching and grinding tire the muscles and trigger spasms. This produces pain and ultimately a TMD. Myofacial pain dysfunction is the term used to describe this set of circumstances.

Because TMD mimics many other medical problems, the TMD symptoms often go undiagnosed. If your physician finds no underlying conditions for symptoms such as frequent headaches, eye pain, or ear pain, he could consider the possibility of a TMJ disorder. Your physician can recommend that you consult a dentist who is properly trained in diagnosing TMD and non-surgical treatment of TMD. Surgical treatment is to be avoided as it builds scar tissue in the TMJ. This scar tissue creates more compression against the delicate soft tissues(blood vessels, nerves, and connective tissue) posterior to the condyle, which will in turn eventually increase the intensity of the headaches and other symptoms of TMD. The famed Mayo Clinic no longer allows surgical treatment of TMD in their clinic because of this reason.

Symptoms of TMJ

• Clicking or popping noises in the TMJ
• Chronic Headaches
• Ear pain or ringing in the ears
• Jaw pain
• Eye pain
• Facial pain
• Difficulty in chewing or opening the mouth
• Jaws locking closed or locking open
• Neck/shoulder pain
• Misaligned teeth
• Dizziness

It is estimated that more than 40 million Americans suffer from one or more of these symptoms. Most sufferers will not usually exhibit all these symptoms. Some persons may not have symptoms severe enough to justify treatment. However, about one of every eight Americans suffer frequent headaches and pain severe enough to disrupt their normal daily routine. If you suspect that you have a TMD and need help, contact Fletcher Dental and TMJ Clinic. There is hope for you!

Treatment of TMJ

TMD sufferers most severely damage their TMJ’s while eating and sleeping. In order for healing to occur in the TMJ’s, the condyles of the lower jaw must not be allowed to compress the soft tissues posterior to the condyles while eating or sleeping. Treatment progresses through two phases.

Phase I treatment is accomplished through the use of two different orthotic appliances. The daytime appliance allows the TMD sufferer to eat without damaging the tissues in the posterior joint space. The nighttime appliance is designed so that the tissues in the posterior joint space are not damaged during movements of the jaw during sleep. These two appliances must be worn 24 hours a day for about nine months. These appliances place the jaw and its condyles in a new pain-free position. This nine-month period is necessary in order to allow healing of the damaged tissues in the posterior TMJ space.

Phase II treatment occludes the lower and upper teeth together with the lower jaw in the new pain-free position. Phase II treatment is best done by orthodontic or prosthetic methods. If orthodontics is the chosen phase II method, approximately 18 months treatment time is needed. The treatment time for the prosthetic method is much shorter. It can involve the placement of up to 20 crowns on the upper and lower teeth. The goal of phase II treatment is to stabilize the bite in the new pain-free position so that the teeth, muscles, and joints can work together without strain. Drs. James and Matthew Fletcher have the training and experience to provide phase II treatment using both the orthodontic and the prosthetic method.

What should I do if I suspect TMD?

If you suspect that you suffer from TMD, call Fletcher Dental and TMJ Clinic. There is hope for you. Drs. James and Matthew Fletcher have received their training through the American Association of Functional Orthodontics, American Academy of Cranialfacial Pain, and the TMJ Institute of America.