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The
temporomandibular joint (TMJ) connects the lower jaw, called the mandible, to
the temporal bone at the side of the head. If you place your fingers just in
front of your ears and open your mouth, you can feel the joint on each side of
your head. Because these joints are flexible, the jaw can move smoothly up and
down and side to side, enabling us to talk, chew and yawn. Muscles attached to
and surrounding the jaw joint control its position and movement.
When we
open our mouths, the rounded ends of the lower jaw, called condyles, glide
along the joint socket of the temporal bone. The condyles slide back to their
original position when we close our mouths. To keep this motion smooth, a soft
disc lies between the condyle and the temporal bone. This disc absorbs shocks
to the TMJ from chewing and other movements.
Medical
research has not yet defined all the causes of the various TMJ
diseases/disorders. Some patients report having TMJ symptoms following dental
procedures, the insertion of a breathing tube prior to surgery, trauma, or oral
habits such as clenching or grinding the teeth. Conditions that occur in other
joints in the body, such as arthritis, can also precipitate or aggravate TMJ
pain and dysfunction.
Normal
Jaw Movement: Internal derangement is when the piece of cartilage (or disk)
that is normally between the two bones of the upper and lower jaws becomes
dislocated out of its normal place. The disk most often is dislocated
anteriorly and this results in clicking or popping sounds. When the disk has
been dislocated anteriorly for a very long period of time, the ligaments may
become stretched or torn. This allows the disk to slide even further forward
and then the clicking goes away. Rather than the problem self-correcting, it
just has gotten worse. Now the disk is permanently out of place and the bones
are free to rub against each other.
Clicking Jaw Movement: In a clicking joint the disk has
slipped in front of the condyle. When the mouth opens, the condyle moves down
and forward, finally jumping back into its normal relationship with the disk.
This jumping back into place causes the clicking sound. When the mouth closes
another click occurs when the condyle slips back off the disk. The possible
causes for this are muscle spasms, bad bite, condyle position off center, and
ligament or cartilage damage.
Locking
Jaw: In a locking jaw, the cartilage (or disk) has been pushed in front of
the condyle for so long that the ligaments are stretched permanently. Rather
than jumping back onto its normal place on the disk, the disk remains in front
of the condyle which stops it from moving all the way down. This results in a
person not being able to open wide.
Headaches: Headache is one of the most common symptoms of a
TMJ problem. Usually the TMJ headache is located in the temples, back of the
head, and even the shoulders. Clenching and grinding of the teeth, both of
which may be TMJ symptoms, produce muscle pain which can cause headache pain.
Also, a displaced disc in the TMJ may cause pain in the joint which is often
referred into the temples, forehead or neck. These headaches are frequently so
severe that they are confused and treated (with little success) for migraine
headaches or abnormalities in the brain.
Teeth
Sensitivity: The teeth may become sensitive because of jaw activities such
as clenching of the teeth or grinding of the teeth when the disc of the TMJ is
displaced. Patients often see their dentist with the complaint of pain in the
teeth and usually the doctor can find no cause. Frequently (and very
unfortunately), unnecessary root canals and even tooth extractions are
performed in an attempt to help a suffering person. What's worse, after these
invasive and non-reversible procedures, patients still have their pain, only
now it has increased!
Facial
Pain: Often, pain will be felt in the shoulders and back due to muscle
contraction, a condition called myofascial pain dysfunction
syndrome.
Equilibrium Impacted: Dizziness, disorientation and even
confusion are also seen in some people who suffer with TMJ.
Emotional Issues: Depression is common with TMJ. This may be
due to the fact that no one really believes there is a problem causing such
pain and suffering. Also, plenty of scientific evidence shows that chronic pain
patients (which nearly all TMJ patient can claim) have changes in chemicals in
the brain (termed neurotransmitters) as result of the pain. These chemicals can
and do produce depression. Along with depression comes an inability to get a
good night's sleep. This may be due to TMJ pain itself or, changes in the
brain's neurotransmitter chemicals which produce stimulation even though the
TMJ sufferer is asleep. Sufferers usually wake feeling like they never slept or
at least, did not sleep well. This lack of sleep not only makes their pain seem
worse, but also adds fuel to the fire of depression.
Ear
Issues: Due to the close anatomical relationship of the TMJs to the ears,
an injury to the TMJ often causes various ear symptoms. Some of the symptoms
may be ear pain, fullness or stuffiness, and even a loss of hearing. That's why
so many TMJ sufferers first see their family doctor and an ear specialist
before even considering seeing a dentist for a possible TMJ problem
Light
Sensitivity: TMJ patient may also suffer with photophobia, or light
sensitivity. A dislocated TMJ may produce pain in and behind the eye which can
cause sensitivity to light.
Vision
Problems: Blurred vision and eye muscle twitching are also common in TMJ
patients.
Tinnitus: A final common symptom is ringing (termed tinnitus)
in the ears. This sound may be caused by many different problems (such as,
working around loud noises or taking too much aspirin or ibuprofen).
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