The Temporomandibular Joint or ATM

TEMPOROMANDIBULAR JOINT

Do you suffer from chronic jaw, face, head, neck or shoulder pain?
This pain can be caused by TMJ disorders

TMJ disorders (source ADC and ADF)
Temporomandibular joint dysfunction syndrome (TMJ) is a musculoskeletal pathology, characterized by clicking noises and pain in the temporomandibular joint with sometimes a limitation of the mouth opening and / or craniomandibular pathology .

WHAT IS TEMPOROMANDIBULAR JOINT?


The temporomandibular joint (TMJ) is the joint that connects the lower jaw to the temporal bone of the skull allowing the jaw to move up and down and from left to right, and this allows us to speak and to chew. The main muscles of chewing are: temporal, masseter, internal pterygoid, and lateral pterygoid. It is located directly in front of the ear on each side of the head where the upper jaw (maxilla) and the lower jaw (mandible) meet. The TMJ is one of the most complex joints in the human body.

anatomy of the temporomandibular joint (source ADC)

The movable part of the temporomandibular joint, is called the condyle.
The place it occupies in the temporal bone is called the joint fossa. Between the condyle and the pit there is a meniscus or cartilaginous disc which acts as a cushion to absorb stress and allows a smooth movement when the mouth opens and closes.
Most problems with the temporomandibular joint are related to the dislocation or lesions of this meniscus between the two jaws, while fewer cases are related to the muscles ensuring the movement of the temporomandibular joint (TMJ).

TMJ SYMPTOMS


Signs and symptoms of TMJ include pain and tenderness in or around the ear, jaw joint, jaw muscles, face, or temples. Other symptoms include difficulty opening or closing the mouth, and cracking or squeaking noises when chewing, yawning or opening the mouth. TMJ disorders can lead to neck pain and headaches. In the presence of one of these symptoms, it is important to consult your ENT or specialized dentist trained in TMJ management like Dr Benguira.

After a thorough examination and appropriate x-rays, if necessary, Dr. Benguira may suggest a treatment plan for your TMJ disorder. This treatment plan may include relaxation techniques, the recommendation of a physiotherapist, a chiropractor or a behavior therapist to help you relieve muscle pain. Other treatment options include pain relievers, anti-inflammatories, and muscle relaxants. If you can't sleep well, there are different ways to improve sleep.

Dr. Benguira may recommend that you wear a device during the night called an occlusal plate which is made of transparent acrylic. It attaches to the occlusal surface of the teeth of the lower or upper jaw, and allows biting on the plate rather than on the teeth. This device promotes relaxation of the joints and muscles of the jaw.

Dr. Benguira has followed more than 100 hours of continuous training in facial pain and treated patients within the subspecialty clinic of Pain and Oral Dysfunctions (DDBF) of the University of Montreal.

An occlusal bite plate (also called an orthotic plate) is made of plastic and covers the occlusal surface of the teeth of the lower or upper jaw.

WHAT DOES DOCTOR BENGUIRA EXAMINE DURING AN IN-DEPTH EXAMINATION OF THE TMJ?


Pain in the TMJ: The main clinical sign is usually the pain in the TMJ related to chewing.
This TMJ pain most often occurs when the temporal joint itself or the muscles around it are contracted due to intense or continuous stress.

Tinnitus: Hearing problems like fullness of the ear, noise or ringing in the ears (tinnitus) can also be symptoms.

Earache (ear pain): Ear pain, in front of or below the ear, but without any sign of infection (hearing loss or leaking of the ear).

Headache, Facial or cervical pain: Dental or cervical pain, shoulder pain and / or dizziness. Headache, which worsens when the mouth is opened and closed.

Anatomical forms:
1. Displacement of the condylar head
2. Anterior disc displacement
3. Posterior capsulitis

Joint cracking noises, joint sounds: They can be linked to a malocclusion (misalignment of the teeth or a problem with the bite plane), when the teeth of the upper and lower jaws are not aligned correctly. Malocclusion can cause uneven pressure on either side of the jaw, which puts muscles and TMJ under stress.

For the same reason, chewing on one side of the jaw can cause TMJ problems. Changing the occlusal surfaces of the teeth during dental treatment (if not done correctly) can also lead to malocclusion problems and cause symptoms of TMJ.

Bruxism (gnashing of teeth and clenching of teeth). This can cause malocclusion, but also increase wear and tear on the cartilage of the temporomandibular joint.

Malocclusion and bruxism are the most common causes of TMJ disorders. Stress is often the underlying cause of a TMJ disorder, as it can contribute to people either consciously or unconsciously contracting the muscles of the face and jaw or clenching their teeth (bruxism).

Trauma to the temporomandibular joint, jaws, teeth, facial bones or muscles are also causes of TMJ disorders.

DIAGNOSTIC


Because many other disorders can cause symptoms similar to ATM.

Dr. David Benguira will review your medical history and perform a careful clinical examination to determine the cause of the symptoms by:

Physical examination of the temporomandibular joints and their movements.
Examination of the teeth for signs of malocclusion.
Palpation of the muscles.

In some cases, the diagnosis of TMJ may require additional examinations:

Dental x-ray, to check the structural problems of hard tissue.
Three-dimensional tomography of the TMJ (CBCT available at our clinic - see technologies section)
Magnetic resonance imaging (MRI), to also check the soft tissue of the ATM. The MRI provides information on the state of the disc.

diagnosis and identification of causes is very important in deciding the appropriate treatment for symptoms of TMJ disorders.

TREATMENT


The TMJ treatment plan may include pain relieving medication, jaw relaxation, TMJ exercises, physiotherapy, orthotic treatment (different styles of occlusal splints or plates), orthodontic treatment, or sometimes TMJ surgery.

At first

1. Reduction of stress
2. Avoid certain chewing habits: clenching ...
Physiotherapy can help relax the muscles and increase the flexibility of the joints. It is often used in conjunction with other ATM treatments.
3. Joint rest: avoid tension (Eliminate the causes of peri-articular muscle tension), change eating habits, avoid abnormal movements of the TMJ (treat possible nervous tics) light, chopped or semi-liquid diet, do not chew.
4. Drug treatment: Anti-inflammatory drugs (NSAIDs), Muscle relaxants: to “relax” the muscles of the jaw, Analgesics to relieve pain in the temporomandibular joint
Pain relief is normally the first thing to do before any other TMJ treatment, especially if the TMJ pain is so strong that even small jaw movements become difficult.
Drugs such as pain relievers, anti-inflammatory drugs, and muscle relaxants are usually enough to relieve the pain of TMJ. Ice and heat bags can also help reduce muscle tension and relieve pain.
5. Especially a correction of a malocclusion by orthodontic treatment or wearing occlusal splints or plates at night

Relaxation of the jaw relieves muscle tension and the temporomandibular joint. To "relax" the jaw, the patient must stop bad habits and eliminate the aggravating factors by chewing gum.

Avoid chewing hard, crunchy foods or foods that require you to open your mouth widely.

Help the patient to stop bruxism with:
• Stress management is essential for bruxism (psychological support, medication).
• Orthotics and occlusal splints , a kind of mouth guard, are the best treatments to protect against grinding your teeth and they are also the most widely used treatment for TMJ and jaw muscle problems. It is a thin piece of hard plastic which is placed on the upper teeth. They are made from the impressions of your teeth in order to adapt them perfectly.

In summary, occlusal treatment of TMJ can be summarized:

• Correction of occlusion problems
When chewing with uneven teeth, this can affect the ability of the temporomandibular joint to close properly, causing TMJ disorders. Treatment for TMJ problems should aim to restore and maintain a normal relationship between the jaws (maxilla and mandible).

• Orthodontic treatment: mandibular repositioning devices move the jaw in a better position. If the occlusal surfaces of the teeth have been damaged due to gnashing of teeth, tooth decay or trauma, correct occlusion can be restored by modifying the occlusal surfaces of the teeth.


• Monitoring: Always try conservative treatments first: behavior modification, orthodontic treatment, drug treatment, stress reduction then, in case of failure, propose surgical intervention by TMJ arthroscopy, (repositioning of the disc or ablation if it is destroyed) by an ENT or Maxillofacial surgeon.