Temporomandibular Joint Disorders – TMJ

This post was written by Shawn Phelan on March 9, 2009
Posted Under: Education,General Wellness,headache,Joint issues,Knees,Muscle pain,neck pain,Shoulder,TMJ,Wake Forest Chiropractic

The Importance of Obtaining the Correct Diagnosis for Jaw Pain

Learn more: watch the video or read the transcript below

Transcript of Video:

Let’s look at TMJ or TMJ dysfunction (TMJD or TMD). Temporomandibular joint disorder is a condition that can cause popping, clicking, or pain in the jaw. Other symptoms associated with TMJD are headache, ear pain, ringing in the ears, neck pain, shoulder pain, dizziness and nausea.

There is a significant level of confusion regarding this condition, and the person suffering from jaw pain often wonders whether they have a muscle problem, joint problem, or problems with their teeth.  Many TMJ patients will visit multiple healthcare providers in their search for an accurate diagnosis and the proper treatment. Unfortunately, this is very common, and the process may take years. In turn, the symptoms may become more severe, money and time are unnecessarily wasted, and the patient may become confused and frustrated.

It is crucial to find a healthcare provider who has strong diagnostic skills and an open mind to that can see issues beyond their own specialty.  Once you have a correct diagnosis, your healthcare provider can recommend that you see the proper specialist such as a dentist, an orthodontist, a chiropractor or an oral surgeon.

Image of the tempormandibular joint anatomy

TMJ Anatomy

This image shows the anatomy of the temporomandibular joint. The lower jaw is called the mandible.  Above the joint is the part of the skull referred to as the temporal bone. The joint where the temporal bone connects to the mandible make up the T and the M of the TMJ. The J is simply the joint. Everyone really has two TMJs, one on each side in front of your ears.

What we’re really talking about here is temporomandibular joint (TMJ) dysfunction. What can become dysfunctional in the temporomandibular joint? There are several conditions that can cause TMJD and its symptoms.  Let’s look at them one by one.

As shown, the jaw itself articulates with the temporal bone, and this demonstrates the location of the temporal bone. In between the mandible and the temporal bone is a small fibrocartilaginous disc called the articular disc, which is bonded to the jaw by some ligaments. Popping and clicking can occur if we have a situation where the disc itself becomes disrupted and dislodged from the condyle, or rounded part, of the jaw itself.

Now, you have a situation where the disc can become free floating. Attached to the posterior elements, or the back, of the disc is a material called retrodiscal tissue that produces the synovial fluid which lubricates the joint. This tissue will work to hold the disc in place, but what can happen over time that is the disc can migrate forward and become adhered to the anterior portion, or front, of the temporal bone.

Close-up of TM joint including disc, ligaments, condyle, and muscles

Close-up of a Healthy Tempormandibular Joint (TMJ)

When this occurs, we have a situation where the mandible rotates and translates forward as you open and close it. As it translates forward, it has to climb up and over the disc instead of the disc riding with it. When this happens you will notice that when you initially open your jaw there is no pop but as you open wider, the pop occurs as the jaw slides up and over that disc. Now you understand the first diagnosis, which is disc disruption in the jaw.

A second diagnosis involves the capsule. In the image above, the capsule is illustrated by the thin, light blue area that begins at the back of the TMJ, goes under the condyle, and in front of the muscle.  The capsule is the ligamentous envelope that wraps around the joint itself, and the capsule itself can become inflamed. The person can have perfectly normal open and closing of the jaw and they may or may not experience popping or clicking. The problem is not the disc, even if the disc is dislodged, but the capsule itself is inflamed.  This tissue is the same ligamentous material that holds our ankle together. When you sprain your ankle, it swells, becomes inflamed and uncomfortable. The same thing can happen in that capsule in the jaw. So, if the person has jaw pain, they may automatically assume they have TMJ or TMJD when they really do not. What they have is ligamentous inflammation of the capsule itself.

The third possibility may involve the retrodiscal tissue which we mentioned previously. The retrodiscal tissue is the structure in the posterior elements of the jaw that connects to the disc. The retrodiscal tissue itself can become inflamed.  That will typically happen with people that frequently clench or grind their teeth (called bruxism) while they are sleeping. This contracts the jaw, driving the mandible back up into the temporal bone and squeezing the retrodiscal tissue in between. When the retrodiscal tissue is inflamed, the result is jaw pain.

If the inflammation of the retrodiscal tissue lasts long enough, you will actually start to get adhesions that form in the jaw inside the joint itself. You may have vascularization, or the development of blood vessels, of the adhesions.  The trauma that results from these adhesions and scar tissue can also become a source of pain.

The fourth issue we will discuss is problems with occlusion or with the teeth as the teeth are fitting together. When a person opens and closes their jaw, they may notice that some of the teeth are not lining up properly. What they will notice is that when they close their jaw some of the teeth will land early on one side, and the jaw will then have to settle into a normal closure.

Another problem with occlusion can be an under bite. We have heard of people who close their lower jaw and their lower teeth are actually too far forward, and they have to move their jaw backward in order to close fully. That can cause problems with the TM joint as well.

The last problem that we can see with the temporomandibular joint is really somewhat external. This involves the musculature that runs the joint and the muscles that open and close our jaw, move it from side to side, and forward and back. These are very big powerful muscles which are inserting on the jaw itself. These muscles can become short and tight, and like anywhere else in our body with short, tight contracted muscles, they are going to cause pain sooner or later whether it’s in our necks or in our backs or in our jaw.

To summarize, there are five possibilities when we have temporomandibular joint dysfunction:

  1. Issues with the disc
  2. Inflammation of the capsule
  3. Inflammation of the retrodiscal tissue
  4. Alignment of your bite, or occlusion
  5. Tightening of the musculature of the jaw

When we see you in our office, we will typically begin an examination that allows us to arrive at an accurate diagnosis. We can treat some of these conditions in our office in Wake Forest, NC. There are some that we do not treat, and for those we will refer you to an experienced specialist for the proper treatment.

If there is a problem involving retrodiscal tissue inflammation, capsulitis or musculature that’s hypertonic, short and tight, that is probably something that we can help with here in the office. Approximately 70 percent of the people that I see with a diagnosis of TMJ dysfunction fall into this category, and we have the ability to treat them.

The other condition that would not respond as well to conservative care would be a disc problem where the disc is dislodged. Often, if you can treat the inflammation in the retrodiscal tissue and the capsule, and balance the musculature, the person can go on and live normally with a disc that’s displaced.  There should be no pain, but there may be a little popping once in awhile. These people are not necessarily surgical candidates. This is a non-surgical or a “leave alone” condition unless the jaw is locking and not allowed to open or close.

Once you have an accurate diagnosis and you know exactly which one of these structures is the problem, then you are in a situation where it can be treated. A good diagnosis and directed care, either in our office or at the appropriate orthodontist, dentist or surgeon is the pathway out of chronic temporomandibular joint dysfunction.

If you would like further information on TMJD, jaw pain or jaw problems, please go to our website, http://wakeforestchiropractic.com.  To make an appointment to be examined at our office, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.

Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587
919-562-0302

March 09, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.

Reader Comments

Hello,
I have had symptoms of TMJ for quite a while, with jaw clicking and catching. It became a problem when last Wednesday morning I couldn’t open my mouth more than an inch. It hurts when I try, but there is no other pain. Besides being frustrating when trying to eat, I feel normal. My research brought me to your video on You Tube, and then I went to your web site. Your informa-tion about TMJ was very helpful. I’d like to see a chiropractor in my area who was recommended by another TMJ patient, and my regular dentist recommended an orthodontist. Do you have any advice as to which one might help me more in my case?

#1 
Written By Barbara Harshner on October 19th, 2009 @ 8:32 am

I had my second molar pulled last year september 1 09 and went into seclusion with pain. Lower left face was affected. The dentist said I had a bee sting or herpes zoster knowing I didn’t but she said I signed a release to let them do the dental work and ran like a cockroach to the light.
Misdiagnoses of Trigeminal nuralgia came in by Neuro until I went to Duke and saw Neuro surgeon and he said the dentis screwed my mouth up.
Everything has come to the TMD after a year of searching and two oral surgeons missed the diagnoses or were to lazy to try.
I am in PT now after I got dentures placed, titrated off of 60 mg of morphine so far and went for 30 mg more and got trapped again as my neck and upper back had no range of motion and went to PT and he got it unstuck.

The self care is helping but not the fix as headache ear pain ringing and now sore muscles in jaw are prevelant with back and neck pain and fire in the back of my capsula to the disc slipping per DPT.

I had to get the detures the hard way as UNC would not see me to help and I went back to original dentist and was pain free until I titrated off of 30 mg morpine and was put back on three days later and it really is no help as the PT manipulated to light up the nerve and my nerves started up with pain.

Neuro said i was going deaf in my left ear so I said fine and could hear them all talk and TMD came up but again I couldn’t hear ha so I looked it up with every other acronam they said and this fit the closest to what I am going through as a self diagnoses.

NC is the worst for doctors to me at the momment other then my family doctor as he has me in PT for TMD now after a year of the wrong way as my dentists boss the owner called after I was too far gone.

What do you think I should do? This self adjusting is taking up my day and need answer a year ago as the onset came after my second molar was broken and then dug out causing this effect as that was the blow to my face.

I will come to you as i know where you are abd you can do the measurements if you want but this is crazy to live with all of this frustration and pain and anxiety.

Can you help?

Mike Brittain

#2 
Written By Michael Brittain on September 12th, 2010 @ 8:13 am