The temporomandibular joint (TMJ) is the articulation, or joint between the cup- shaped depression in the temporal bone of the skull (called the articular fossa) and knob-like projection of the lower jaw called the condylar head. The two bones are separated by a fibrous disc called the meniscus. The disc is normally held in position by the anterior (forward) band and a posterior band tissue attachments. This joint complex is surrounded by a joint capsule that is lined with special tissue called synovial membrane.
The right and left TMJ’s work “independently together” to allow the u-shaped lower jaw to function in a wide range of motions. The jaw joints have a hinge function, where the jaw opens and the condylar heads rotate and stay in the articular fossae. For wider jaw opening or wide side to side motions, the right and left condylar heads of the mandibles can slide together or independently down the ramp shaped portion of the joint called the articular eminence. The disc normally will remain between the two bones and acts as a cushion between them as the lower jaw moves. The lower jaw bone is movement is controlled by muscles of the head and face called the “muscles of mastication”
This could mean that the meniscus, or disc is slipping, usually forward, as the condylar head starts to rotate in the fossa or slides along the articular eminences. This causes the condylar head to press on the posterior band attachment. Often the disc will resume its position when the jaw closes. This is called anterior displacement with reduction. When the disc slips out of position, this can result in joint noises, inflammation and pain, and difficulty chewing and opening the jaw.
Sometimes the disc is displaced forward and does not return into a normal position. This is called anterior displacement without reduction. Patients with anterior displacement without reduction often are unable to open the mouth fully, or need to move the jaw side to side to get it “unstuck” before being able to fully open. This can lead to pain, inflammation and discomfort.
Sometimes there is a tear in the meniscus, and a patient will note a grinding sound when they move their jaw. Osteoarthritis, the so-called “wear and tear arthritis”, and rheumatoid arthritis can affect the TMJ’s. These are typically painful conditions and can lead to degeneration of the bony parts of the TMJ and loss of function, and changes in the patient’s bite.
Oral habits, such as tooth grinding, jaw muscle clenching, nail biting, and so on can create TMJ pain or make TMJ pain worse. Sometimes these habits can cause spasm and pain in the muscles of mastication
Make an appointment to see Dr. Banks. She will evaluate you and advise whether imaging of you joint, either with CT scan or MRI test is indicated. She may also refer you to your dentist to fabricate a special mouth appliance. Sometimes the symptoms associated with TMJ disc displacement and muscle pain can be relieved or improved by wearing a mouth appliance.
More serious problems may require surgical intervention and should only be performed by a Board Certified Oral and Maxillofacial Surgeon. Examples of TMJ surgical interventions include: Arthrocentesis (sterile procedure to remove inflammatory products from the joint and to inject therapeutic medications); Arthroplasty (open procedure to reconstruct the joint and to restore joint mobility) and Total Joint Replacement ( removal of the natural joint and replace the joint with a custom made prosthetic joint). If surgical treatment is necessary, Dr. Banks will provide surgical management of your problem.
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