UNDERSTANDING ANATOMY

The temporomandibular joints (TMJs) are two joints of the jaw. These unique joints can move in a hinge and sliding motion and are critical to the functions of eating, speaking and swallowing. 

The temporomandibular joint is formed by bony articulations of the mandibular condyle and the glenoid fossa of the temporal bone at the base of the skull. In between the condyle and the fossa is a dense, fibrous connective tissue called the articular disc. This divides the joint into a superior and inferior compartment which do not normally communicate with each other and acts as a shock absorber and load distributor. 

The disc is in a normal anatomic relationship when located above the condyle when the mouth is closed and the teeth together. It is attached to the neck of the condyle by soft tissue attachments. The joint is surrounded by a fibrous capsule and has multiple ligamentous attachments that provide stability.

GETTING THE RIGHT DIAGNOSIS

Temporomandibular joint disorders are notoriously difficult to diagnose and can seem quite mysterious. An accurate diagnosis is essential for a comprehensive treatment plan. Unfortunately, these entities are poorly understood and many clinicians label these with a generic term - temporomandibular joint disorder(TMD) which is incorrect. TMD is a collective, nonspecific and therefore non-diagnostic term.

Broadly, TMDs can be classified as extra articular which can be of muscular or myofascial origin or intra-articular with problems of the joint itself. Often these two entities can manifest together making diagnosis difficult. There may be underlying psychological reasons which contribute to a patient’s pain and dysfunction. Symptoms may radiate from the TMJ to the surrounding structures masquerading as other disease processes.

Temporomandibular joint dysfunction would be any anatomical issue that disrupts the normal function of the joint i.e. an intra-articular disorder.

An adequate diagnosis would involve a detailed clinical exam, radiological imaging usually in the form of an MRI and/or CAT scan and possible local anesthetic diagnostic injections.

Common signs and symptoms include but are not limited to:

-          isolated pain to the jaw joint

-          difficulties with eating and yawning

-          difficulties with opening the mouth

-          locking of the jaw in either an open or closed position

-          pain radiating to the jaw muscles and temple

-          auditory symptoms such as tinnitus can also be associated with TMJ dysfunction

Common reasons include normal wear and tear, bruxism (grinding of teeth unconsciously), idiopathic(unknown), osteoarthritis and trauma.

The most common problems in my practice are internal derangement, osteoarthritis and recurrent dislocations.

WHERE TO START

Often your medical practitioner or dentist can guide initial treatment. Traditionally, nonsurgical measures have been instituted as a first port of call which may include a custom bite guard/appliance, long acting nonsteroidal anti-inflammatories, tricyclic antidepressants(for pain control)and physiotherapy. In severe cases of internal derangement, these treatment modalities are used as palliative measures.

Your dentist may be able to organize fabrication of an intra-oral appliance either at their office or technicians laboratory. General medical practioners may be able to help manage analgesic regimes which can include tricyclic and non-steriodal anti-inflammatory medications. 

We work closely with an oral medicine specialist – Anita Nolan. She is a qualified physician with degrees in both medicine and dentistry. She’s an excellent clinician to initiate nonsurgical measures for these disorders.

Referrals can be made via your treating clinician. We also accepts self referrals on a case by case basis.