Temporomandibular Joint

Temporomandibular joint disorders are poorly understood and often difficult to manage. Disorders of this joint are common and not just associated with age. Popping, clicking, locking and pain are some of the most common complaints and can be managed if diagnosed properly. Other more subtle issues include asymmetrical growth, a chin moving to one direction or a retrusive jaw/chin. These conditions can be insidious or be the result of a traumatic injury. Thanks to advancements and miniturisation of technology the joint space can now be visually inspected and arthroscopic surgery performed.

Disorders are frequently divided into the following categories
  • Myofascial Pain (Muscular in origin)
  • Internal derangement (Disc and Joint space abnormalities)
  • Degenerative disorders (Wear and tear like any other joint)
  • Growth disturbances and asymmetry (Over growth or resorption of the condyle)

What steps are involved?

Most TMJ disorders are self resolving requiring routine pain relief, soft diet, massage of the associated muscles and habit avoidance. Your Dentist, orthodontist, GP or an Oral Medicine specialist such as Anita Nolan are a good first point of call before exploring surgical options. Progressive or persistent issues do require further investigation.

Frequently an MRI is used to assess the soft tissues, cartilage and to accurately visualise the disc, a Conebeam CT or Medical CT is used to assess the bone quality for any evidence of pathology or arthritis. Nuclear medicine scans (Bone scan, Single Photon Emission Computed Tomography or Positron Emission Tomograpy) are used to objectively measure active growth within the joint space. Frequently investigations will also include a blood test.

Treatment options of common conditions include injection of medications into the joint, joint arthroscopy or arthrocentesis, open joint surgery, orthognathic surgery or total replacement of the joint itself.

Things have changed

Temporomandibular joint dysfunction and its management has progressed significantly over the past 10 years due to the advances in technology. Historically patients and clinicians have been frustrated by poorly supported treatment modalities and technologies resulting in avoidance of active treatment. As with any joint issue the anatomy of the temporomandibular joint is the cornerstone to understanding therapeutic options, their applications and importantly their limitations.