The temporomandibular joint is the "jaw joint" that connects the lower jaw to the base of the skull. This joint, is uniquely complex, and has been identified with a number of related disorders, often inappropriately grouped together as "TMJ" disorders.
The TMJ (temporomandibular joint) is one of the most complex joints in the human body. This joint, separates the U shaped bone of the lower jaw from the skull. It has upper and lower joint compartments, filled with a lubricating fluid (synovial fluid). The compartments are separated by a disk, shaped like a mushroom cap.
This joint, unlike any other joint, moves in four degrees of freedom, around all three axes, and translates forward and back. It is this complex motion that is required for the jaw to function properly. If the disk is positioned incorrectly, either due to disease or injury, or the muscles create tension, or the synovial lubricating fluid becomes diseased, then the joint will not work properly, and the patient will experience symptoms.
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TMJ or temporomandibular joint disorders, are a group of problems related to pain and difficulty in function associated with the TMJ.
There are many conditions that may case TMJ problems. Each condition requires an accurate diagnosis and specific treatment. Among the various problems that can lead to TMJ pain and dysfunction are
Myofascial (myo=muscles, fascia =the thick covering tissue over a muscle) pain dysfunction is the proper term for what is often erroneously referred to as "TMJ". The patient experiences difficulty in the normal opening and functioning of the lower jaw. Speaking, eating and opening the mouth widely are difficult. The problem may wax and wane throughout the day, typically becoming worse after eating or speaking for long periods. Patients are often young females, often involved in a stressful job or personal situation. Other patients may have a history of night grinding or clenching of the teeth. This pain in turn leads to even greater contraction of the muscles, thus setting up a vicious cycle. Occasionally, an existing bad bite, or malocclusion, of the teeth may aggravate the problem.
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The cornerstone of treatment is conservative therapy.
The National Institutes of Health recommends early conservative, reversible treatment. Conservative treatments do not invade the tissues of the jaw, face or joint and are as simple as possible. They provide temporary relief of pain and muscle spasms but do not "cure" TMD. Self-care practices such as a soft foods diet, application of heat or ice packs and avoidance or reduction of extreme jaw movements (wide yawning, loud singing, gum chewing) are potentially useful in reducing or eliminating MPD symptoms.
Also useful are physical therapy approaches to muscle stretching and relaxing, the use of short-term muscle relaxants and anti-inflammatory drugs, and behavioral and educational techniques for reducing stress. Prosthetic plastic splints or bite plates that fit over the upper and lower teeth can also help reduce masticatory muscle tension that comes from clenching and grinding.
Unfortunately, many patients, desperate for a fix, succumb to expensive, needless treatments such as grinding of the teeth, orthodontics, allergy treatments, chiropractic treatment, postural treatments, "cranio-mandibular" treatments, dental reconstruction and the like in search of a solution. There is no evidence that these treatments are effective.
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Many general dentists and dental specialists are well trained and capable of treating many TMJ disorders. However, Oral and Maxillofacial Surgeons are the only dental specialty specifically accredited for the treatment of facial pain disorders.
It important that your doctor understand all the conditions that may cause your facial pain. This includes the ability to diagnose and treat headache, neuralgias, arthritis, infections, muscle spasm and joint problems. Oral and Maxillofacial Surgeons receive extensive training in the diagnosis and treatment of all facial pain conditions.
Dr. Orden trained at the University of Illinois Facial Pain Research Center, the largest center of it's kind in the United States, and conducted research on degenerative joint disease and facial pain.
There is no recognized medical or dental specialty called " TMJ Specialist". Patients should be cautious about any person portraying themselves as a "TMJ Specialist" or "Cranio-Mandibular" specialist. These individuals often have no more than weekend courses or wall plaques testifying that they are specially trained and often portray themselves as having "advanced" degrees or "board certification" that are not recognized by any approved accrediting organization.
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Arthritis is a degenerative condition of the joint. Arthritis can occur in a chronic, low-grade form or an acute inflammatory form. In addition, it can occur as a degenerative condition, associated with either overuse or aging, or it can occur as a auto-immune disease, such as juvenile rheumatoid arthritis. Most cases are chronic degenerative joint disease and are successfully treated with non-surgical management.
The cartilage of the jaw is specifically designed to absorb and cushion the stress associated with movement and chewing. In some patients, the cartilage may lose it's elasticity and become stiff. This can occur due to premature aging of the joint or as a result of overuse, such as a patient who grinds their teeth.
When degenerative arthritis occurs the cartilage may then splinter and fracture. Once this occurs the joint will gradually become stiff and painful. The patient will often hear noise or grinding in the joint and may feel a roughness or grating. Joint noise indicates that the cartilage and the disk are beginning to lose their normal smooth contour. Pain in the joint often indicates progression of the disease leading to destruction of the joint components.
In the early stages, medical management, through the use of anti-inflammatory agents is effective. In later stages, depending on the severity of the condition, surgery may be indicated to relieve pain or increase function.
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