Temporomandibular Joint (TMJ) Dysfunction

Temporomandibular joint dysfunctions are a group of disorders affecting the masticatory system and its associated structures including the muscles and the maxilla-mandibular joint.

Temporomandibular Joint (TMJ) Dysfunction

Temporomandibular joint dysfunctions are a group of disorders affecting the masticatory system and its associated structures including the muscles and the maxilla-mandibular joint.

Temporomandibular joint dysfunctions

are a group of disorders affecting the masticatory system and its associated structures including the muscles and the maxilla-mandibular joint. This sound is commonly known as a snore.
These disorders are usually characterised by pain and limitation of the joint functions. These conditions are more likely to be present in young adults, especially women who are four times more likely to suffer from TMJ disorders.

Although TMJ dysfunctions can be present in more than half of the young adult population, they normally are asymptomatic and therefore are the least of the dental consultation causes. It is reported that only 5 – 12% of the people are symptomatic, and their symptoms are commonly associated with pain around the TMJ or surrounding tissues, and in fewer cases, mouth opening limitations or a noisy joint.

The Temporomandibular Joint (TMJ)

The TMJ is formed by the insertion of the mandibular condyle into the temporal bone and other anatomical structures in between, like the articular disc and ligaments in charge of the hinge and slide motion of the jaw. Additionally, the group of muscles in charge of mastication are also part of the TMJ complex and therefore, alterations in their anatomy, range of motion, tone and strength are going to have an impact on the joint.

Thus, two subgroups of disorders will determine the diagnosis and hence the treatment plan when any alteration appears in or around the TMJ. It is important to determine whether the pain is coming merely from the muscles (myofascial pain) or from the intra-articular structures of the joint itself (articular disc and ligaments).

  • Muscular or myofascial disorders: these are the most common causes of TMJ dysfunction. The most common symptom is muscular pain as a result from cumulative pathological tension, fatigue or spasms of the masticatory muscles.
  • Intra-articular disorders: refers to the disruption of the joint functions due to inflammation or mechanic disorders. According to the structures involved, these disorders can be painful or not.

Causes of TMJ dysfunctions

It is difficult to determine the exact cause of TMJ dysfunctions. This is due to the number of aspects that can influence the correct functioning of the masticatory system, including genetics, anatomical, physiological and psychological factors. A combination of these is usually what causes pain and dysfunction of the TMJ.

Disorders of the masticatory muscles are often the result of excessive tension, fatigue or spasms caused by pathological behaviours such as bruxism, teeth clenching and grinding, or adopting an abnormal posture.

Muscular painful disorders:

The most common cause for muscular pain and spasm is unconscious teeth clenching or bruxism, both are associated with psychiatric and psychological disturbances like stress, depression and anxiety. Thus, heavy bruxers might develop severe TMJ pain due to the hyperactivity of their masticatory muscles that results in severely increased muscular tone and tension. Other causes for muscular painful issues are autoimmune pathologies, fibromyalgia and other chronic pain conditions related to the back and neck.

On the other hand, causes of intra-articular pain include:

  • Derangement of the internal joint: the intraarticular disc wears off and produces trauma between the jaw and skull bones.
  • Displacement of the articular disc: the disc does not move along with the condyle during the jaw movements causing a clicking sound or pain.
  • Osteoarthritis.
  • Inflammation of the ligament involving the joint (capsular ligament).
  • Hypermobility.
  • Traumatic injuries.
  • Inflammatory conditions like rheumatoid arthritis.

Symptoms

Typically, patients describe pain within the TMJ or mandible as the main symptom. Signs and symptoms of TMJ disorders may include:

  • Pain or tenderness of your jaw or face.
  • Pain in one or both of the temporomandibular joints.
  • Aching pain in and around your ear.
  • Headaches, otalgia, vertigo and hearing impairment.
  • Difficulty chewing or pain while chewing.
  • Locking of the joint, making it difficult to open or close your mouth.

TMJ disorders can also cause a clicking, popping or crepitus sound or grating sensation when you open your mouth or chew. But if there’s no pain or limitation of movement associated with your jaw clicking, you probably don’t need treatment for a TMJ disorder.

Diagnosis

As every other dental and orofacial diagnosis, to diagnose a TMJ disorder takes a full oral and facial examination. After following the patient’s history, a physical examination is conducted paying particular attention to the site, onset, character of the pain (what triggers, soothes or exacerbates it), radiation (to scalp or neck), duration and associated symptoms. The dentist will also look at your joint health, looking for ranges of motion of the mandible, pain during opening or closure, abnormal movements, tenderness or signs of bruxism.

If your dentist suspects a problem, you may need:

  • Dental X-rays to examine your teeth and jaw.
  • CT scan to provide detailed images of the bones involved in the joint.
  • MRI to reveal problems with the joint’s disk or surrounding soft tissue.
  • TMJ arthroscopy is sometimes used in the diagnosis of a TMJ disorder. During TMJ arthroscopy, your doctor inserts a small thin tube (cannula) into the joint space, and a small camera (arthroscope) is then inserted to view the area and to help determine a diagnosis.

Management

The majority of patients can be managed with a conservative approach. Almost 40% of symptomatic patients report spontaneous resolution of their symptoms and do not require treatment. This is particularly seen in patients whose symptoms are related to stressful life periods. In addition, more than half of the patients with a TMJ dysfunction diagnosis respond well to conservative measures.

Non-Pharmacological Treatment

  • Raising and reassuring awareness: these can include referrals to psychotherapy (stress and anxiety management) physiotherapists and pain management specialists.
  • Lifestyle changes: softer diet, rest (sleep hygiene, stress reduction).
  • Warm compress over the affected region.
  • Stretching and jaw exercises
  • Splints: there have been benefits reported with the use of custom-made splints for patients with severe bruxism. These splints also help in preventing secondary effects such as severe dental abrasion and joint dysfunction.

Pharmacological Treatment

  • NSAIDs: Unless contraindicated, the use of anti-inflammatory medications help relieve the pain associated with TMJ during the acute phase (no more than three days after the beginning of the painful episode).
  • Muscle relaxants: are useful to release chronic spasms, especially in bruxers.
  • Medications like tramadol or topical gels of diclofenac (voltaren) have shown little to no effect on TMJ pain management.

Referral to a maxillofacial surgeon should be considered in patients unresponsive to conservative treatment, patients with severe pain and/or dysfunction of the TMJ, and patients with a history of trauma or fracture of the TMJ complex. Furthermore, patients with persistent or worsening pain, or those with other red flag symptoms with no identifiable source, should be referred to specialist care for further investigation.

    References

    Broken Tooth

    Chipped or broken teeth are very common and are more likely as you grow older.

    Bruxism

    Bruxism is characterised by the clenching/grinding of the teeth due to repetitive jaw-muscle activity

    Cracked Tooth Syndrome

    A broken tooth that doesn’t necessarily look broken.

    Crowded Teeth

    Crowded teeth occur when the size of your jaw is not accommodating to the size of your teeth.

    Dead Tooth

    It may surprise you, but teeth do actually have living tissues.

    Dental Anxiety

    Dental anxiety is quite common and there are ways that it can be managed.

    Dental Erosion

    Dental erosion can be defined as the irreversible loss of tooth enamel caused by acids   without involving bacteria.

    Dry Socket

    Dry socket also known as Alveolar Osteitis, is a common complication associated with tooth extractions.

    Failing Old Silver Filling

    Older filling also known as amalgam filling, have been used over years and are still being used today.

    Gingivitis

    In simpler terms, it is an inflammatory disease of the gingiva.

    Gum Disease

    Gum disease is treatable and can be prevented by maintaining good oral hygiene

    Gum Recession

    Gum recession occurs when the tissues around the teeth start to recede/pull back.

    Halitosis

    Halitosis is an unpleasant odour emitted from the mouth.

    Impacted Wisdom Teeth

    Third molars, commonly known as wisdom teeth, are located at the back of the mouth

    Missing Teeth

    Missing teeth can make you self conscious and stop you from smiling often.

    Sensitive Teeth

    A common dental condition that involves discomfort  and pain when exposed to certain foods and temperatures.

    Snoring

    A partially obstructed airway during sleep causes parts of the throat or nose to vibrate as the air passes through a narrowed airway.

    TMJ Dysfunction

    Temporomandibular joint dysfunctions are a group of disorders affecting the masticatory system.

    Tooth Brush Abrasion

    Tooth brush abrasion  is the most common cause of dental abrasion.

    Tooth Decay

    These damaged areas can eventually form into holes or tiny openings.

    Toothache

    Toothache, or dental pain, is the most frequent oral pathology

    Yellow / Discoloured Teeth

    Tooth discoloration/yellow tooth is an abnormal colour of the tooth, is one of the common dental conditions for any age grouped people.

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    22:45 26 Jun 19
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    08:36 30 Jun 19
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    07:36 14 Jul 19
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    04:30 20 Aug 19
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    02:56 26 Aug 19
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    02:32 08 Sep 19
    Dr Tazeen is that rare kind of person that exudes professionalism but also is genuinely caring, and goes out of her way to advise you on what is best for your own personal dental health. In a situation where most of us are nervous and (with suction, etc in our mouths) unable to speak!) Dr Tazeen intuitively knows when to check in on you, and adjust any procedure to make you instantly more comfortable. The practice, in general, offers top quality work without the 'posh people' prices, and they stay away from sales pitches and hard-sells, while offering clear information and solid support. Highly recommended.
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    Excellent service and extremely friendly staff prices are also excellent
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    06:58 03 Oct 19
    How much do you charge for braces for teenagers?
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    03:07 21 Oct 19
    A great place for all your dental care. I went there on a Sunday and was seen straight away by a great dentice. Very clean and new place.will always go there.
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    18:56 21 Oct 19
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    Dr Ramneek Kaur is brilliant. After we moved home from Sydney, Dr Kaur took over and completed my daughters orthodontic treatment with a great plan and price. She has great interpersonal skills and very accommodating. Online appointment booking as also a plus!
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    Comfortable and nice experience. Very professional. Thanks so much friendly Doc and staff.
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    18:02 20 Dec 19
    Dr Tazeen Khan, was very professional and so kind and thoughtful right from the start, I was super nervous in seeing a Dentist. I wanted to see a female Dentist, she put my worries at ease, cared about my feelings, she worked without any breaks and always che led to see how I was feeling. Dr Khan worked so fast and had everything done in the same day, she did moulds done all in one day and her assistant was very professional as well. I've never felt so cared for in such a kind and caring way. I would recommend her to everyone.
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    05:54 03 Jan 20
    DrTazeen Khan was so kind and caring, both her and her assistant were very professional, they put me at ease as I was very nervous regarding dentist's. Easy access to parking, affordable dentistry. Dr Kahn did exceptional work, she did a replacement tooth so very fast, she talked me through everything she wanted to do for the future with me. I would recommend her to anyone who needed any work done. Thank you Dr Tazeen Kahn for all you have done.
    Debbie Cochrane
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    06:11 03 Jan 20
    Great Service, Friendly Staff, Quality Work and Very Reasonably Priced. Very pleased with the result and service received by the dentist Mr Hassan Ahmed. Not a fan of going to the dentist but this is the place to go when that time comes.
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    03:47 09 Jan 20
    Convenient location, easy parking. Excellent service. Highly recommended.
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    09:04 12 Jan 20
    Service is spot on because the receptionist is very kind and understanding. The dentist is very professional and friendly so I felt at ease once I met him. The place feels like home and the music is very soothing to listen to in the waiting room. I would definitely recommend this dentist to anyone else.
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    22:45 13 Jan 20
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    04:40 15 Jan 20
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    05:44 15 Jan 20
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    07:37 05 Feb 20
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    22:54 10 Feb 20
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    08:49 20 Feb 20
    Awesome Experience, From the kind and welcoming receptionist to the very experience dentists every one is amazing !!! Great staff. Love how its state of the art clinic. The dentist was explaining things so thoroughly and I felt so at ease. The environment is so relaxed. Would definitely come here next time . I would highly recommend Max Care Dental.
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    21:27 20 Feb 20
    Highly recommended. Great prices and very helpful staff.
    Anne Huynh
    Anne Huynh
    22:37 17 May 20
    I would like to express my gratitude for your wonderful dentist finding the infection that wasn't presenting on the 19th when I came for a review. I am very relieved now I returned so soon as I have been very unwell since the implant failure months ago and I am looking forward to becoming well again. I found his technique and skills outstanding and I will be referring people to your clinic to see him.I would also like to share that I thanked Lydia the dental assistant today. I have never thanked an assisting person before but she did an amazing job. I normally find suctioning extremely uncomfortable and usually the fluid still runs down the back of my throat causing me to gag. I would say she would be the best dental assistant I have ever experienced with excellent technique. Finally I would like to mention Anna she is always very friendly and helpful.I wanted to share my personal feeling toward your staff I encountered today and to let you be proud of them especially in the current difficult situation all New Zealanders and all businesses are facing.you have an outstanding Team working for you Rating 5/5
    Paula Hollinshead
    Paula Hollinshead
    02:41 27 May 20
    Had some dental work done with Dr Hassan Ahmed, very professional and pleasant experience 🙂
    Aini Su
    Aini Su
    00:14 16 Jun 20
    Went to Maxcare Dental today for a scale and polish (found them through groupon) and the dentist I saw was great. Not only did he do the scale and polish but also addressed other concerns I had too. Will definitely be back 🙂
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    04:08 17 Jun 20
    AAA+ reasonable charges. Good service, friendly staff. Introduced and recommended to my friends.
    Atiq ur Rehman
    Atiq ur Rehman
    19:50 20 Jun 20
    First experience at the clinic. Staff was friendly knowledgeable. Dr Hassan listened to my problems and quickly diagnosed the issue. We have made a plan going forward.
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    Trevor Marshall
    03:19 24 Jun 20
    We good and friendly service. I would highly recommend this guys
    Amit Sami
    Amit Sami
    02:00 22 Jun 20
    I have never enjoyed going to the dentist since young age and had struggled for a long time to find a dentist that I felt comfortable with until I visited Maxcare Dental. From the very first phone call with Anna at reception through to my visits with Dr Hassan Ahmed, they have shown sincere kindness and support throughout. They really do look after their customers and provide excellent work on your teeth! (really happy with mine!!). Will highly recommend them to all my family and friends.
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    Ck Fabricius
    11:07 07 Jul 20
    Great service, friendly staff. I used a Groupon deal which made my visit much cheaper!
    Sheryl Main
    Sheryl Main
    23:42 09 Jul 20
    Maxcare Dental Staff was incredibly professional, friendly and very helpful.Doctor Mohammed Thank you so much for making our experience a wonderful and pleasant one.Your clear instructions made it an easy breeze first time experience.100% Recommended👍
    Mosman Tessa Gelling
    Mosman Tessa Gelling
    04:58 11 Jul 20
    You have done an amazing job into ensuring that I have been well cared for. I have no other means but to thank you for the great and professional serviceWell appreciated and recommended!!
    Emz T
    Emz T
    03:40 28 Jul 20
    Excellent service and friendly staff. Husband had fillings done and he was very ecstatic about it. Second, got my little girl check up for braces and we were given good options and great informations too. Keep up good work. Thank you..😊👍🏻
    Tiffany Yape
    Tiffany Yape
    23:35 03 Aug 20

    Get in touch with Maxcare today!