TMJ Disorders

TMJ (temporomandibular joint) disorders are a family of problems related to your complex jaw joint. If you have had symptoms like pain or a "clicking" sound, you'll be glad to know that these problems are more easily diagnosed and treated than they were in the past. These symptoms occur when the joints of the jaw and the chewing muscles (muscles of mastication) do not work together correctly. TMJ stands for temporomandibular joint, which is the name for each joint (right and left) that connects your jaw to your skull. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.

No one treatment can resolve TMJ disorders completely and treatment takes time to become effective. Dr. Braly can help you have a healthier and more comfortable jaw.

Trouble With Your Jaw?

TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. You may have a damaged jaw joint due to injury or disease. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. As a result, the disk, which is made of cartilage and functions as the “cushion” of the jaw joint, can slip out of position. Whatever the cause, the results may include a misaligned bite, pain, clicking, or grating noise when you open your mouth or trouble opening your mouth wide.

Do You Have a TMJ Disorder?

• Are you aware of grinding or clenching your teeth?
• Do you wake up with sore, stiff muscles around your jaws?
• Do you have frequent headaches or neck aches?
• Does the pain get worse when you clench your teeth?
• Does stress make your clenching and pain worse?
• Does your jaw click, pop, grate, catch, or lock when you open and/or close your mouth?
• Is it difficult or painful to open your mouth, eat or yawn?
• Have you ever injured your neck, head or jaws?
• Have you had problems (such as arthritis) with other joints?
• Do you have teeth that no longer touch when you bite?
• Do your teeth meet differently from time to time?
• Is it hard to use your front teeth to bite or tear food?
• Are your teeth sensitive, loose, broken or worn?

The more times you answered "yes," the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they are treated.

Treatment

There are various treatment options that Dr. Braly can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, Dr. Braly will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care joined with professional care.

The initial goals are to relieve the muscle spasm and joint pain. Self-care treatments can often be effective and include:

• Resting your jaw
• Keeping your teeth apart when you are not swallowing or eating
• Eating soft foods
• Applying ice and heat
• Exercising your jaw
• Practicing good posture

Stress management techniques such as biofeedback or physical therapy may also be recommended, as well as a temporary, clear plastic appliance known as a splint. An anterior repositioning splint (worn in daytime only) fits over your top teeth and moves your jaw forward, relieves pressure on parts of your jaw and aids in disk repositioning, it also reminds you not to clench, thereby relaxing the muscles and reducing pain. Rarely, a nightguard might be used to help you stop clenching or grinding your teeth and reduce muscle tension at night and help to protect the cartilage and joint surfaces.

What About Bite Correction Or Surgery?

If your TMJ disorder has caused problems with how your teeth fit together, you may need treatment such as bite adjustment (equilibration), orthodontics with or without jaw reconstruction, or restorative dental work. Surgical options such as arthroscopy and open joint repair restructuring are sometimes needed, but are reserved for severe cases. Dr. Braly does not consider TMJ surgery unless the jaw can’t open, is dislocated and nonreducible, has severe degeneration, or the patient has undergone appliance treatment unsuccessfully.

Arthroplasty (disk repositioning surgery) is used when the protective cartilage disk has slipped out of place inside the TMJ.  This condition often creates the “popping” noise inside the joint, and can cause damage to the joint and the supporting ligaments can become stretched and inflamed, leading to destruction (degenerative osteo-arthritis).  Nerves surrounding the TMJ may also be pinched by a slipped disk, causing considerable pain and even inflammation. In some cases, the articular eminance (part of the “socket” portion of the TMJ) can be too deep or too steep.  This can result in excessive forces being placed on the condyle (the ball portion of the joint). 

Arthroplasty surgery is usually performed on an outpatient basis at a local hospital.  An incision is made along the contour in front of the ear (same location as a facelift incision), making it cosmetically acceptable.  Dr. Braly then moves the disk back into its original position and stitches it in place, tightens the posterior ligament, and smoothes the articular eminance to improve range of motion and lessen pain.  The small incision is then sutured closed, and the sutures are removed one week later back at our office.