Temporomandibular Joint (TMJ)

The temporomandibular joint (TMJ) is a small joint located in front of the ear, where the lower jaw (mandible) meets the skull (temporal bone). This joint is made up of several parts, including the bones, the cartilage, the disc and the capsule. The inside of the capsule is lined by a special tissue call synovium. The synovium makes synovial fluid, which lubricates the joint. When all these parts are healthy, jaw motion is unrestricted, smooth, noiseless and painless.

The temporomandibular joint is the joint used most often in the body. TMJ disorders are fairly common and range in severity from fairly innocuous to very severe. Many different conditions like disc disorders, arthritis, dislocations and — on rare occasions — tumors can affect this joint. As can be expected, the treatment for each condition is different. The most important step in treating this condition is to make the correct diagnosis.

Common symptoms associated with TMJ disorders are joint noises (clicking, popping and grating), pain, and difficulty opening or closing the mouth. These disorders can also be associated with muscle pain, headaches and ear pain. Three to five percent of Americans seek professional advice annually for temporomandibular disorder (TMD).

Treating and Diagnosing Temporomandibular Joint Disease
The signs and symptoms listed above are not only seen in patients with TMJ problems, but are also seen in patients with others conditions like myofascial pain, fibromyalgia, headaches, bruxism (grinding and clenching of the teeth); therefore, diagnosing TMJ disorders can be complex.

If symptoms of TMJ persist, an oral and maxillofacial surgeon should be consulted for a comprehensive evaluation. This evaluation will include a detailed medical history and physical examination, radiographs and in some instances, an magnetic resonance imaging (MRI) or computed tomography (CT) scan, which will help to develop an effective treatment plan.

There are several courses of action for treating TMJ — from non-surgical medical and dental care to complex surgeries. Based on the diagnosis, the oral and maxillofacial surgeon may treat the TMJ disorder with medications, a bite plate, splint or guard, or may possibly recommend stress management counseling. Other non-surgical treatment options may include resting the jaw, the adoption of a soft diet or applying heat to the muscles. 

However, if there is clear evidence that there is TMJ damage, surgery may be recommended. There are three main surgical options available:

• Arthrocentesis flushes fluid from the joint and gently stretches it.
• Arthroscopy uses a miniature-telescoping instrument to diagnose and repair the joint.
• Arthrotomy is open surgery for more complex cases.