Temperomandibular joint disorders(TMJ disorders/TMD)

Temperomandibular joint disorders(TMJ disorders/TMD)

Temporomandibular joints are a pair of hinge-like joints in front of the ears, that connect the lower jaw to the temporal bone of the skull. It allows the opening and closing movement and the side to side movement of the jaws.

Temporomandibular joint TMJ disorders of temporomandibular disorders TMD can be caused due to problems associated with the jaw joint or the muscles that control jaw movement resulting in pain.

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What are the causes of TMD?

TMD pain is due to a combination of many factors like

  • Genetics
  • Arthritis like osteoarthritis, rheumatoid arthritis
  • Injury to the jaw or joint or muscles of chewing
  • Movement of the soft cushion or disc between the ball and socket of the temporomandibular joint
  • Clenching or grinding of teeth
  • Chewing on only one side (unilateral chewing)
  • Stress leading to tightening of facial muscles
  • Improper bite
  • Impacted teeth
  • Faulty restorations like fillings, crowns and bridges with high points
  • Sleep apnea

Signs and symptoms of TMD

  • Pain or tenderness of the jaws
  • Pain or tenderness in one or both of the jaw joints(TMJ)
  • Pain or tenderness in and around the ear
  • Ringing sound in the ears (tinnitus)
  • Hearing problem
  • Facial pain
  • Clicking or popping sounds(crepitus) in the jaw joint while opening or closing mouth
  • Difficulty or pain while chewing, speaking or opening mouth
  • Locking of the jaw joint, making it difficult to open or close the mouth
  • Swelling on the affected side of face
  • Headaches or migraines 
  • Dizziness 
  • Neck, shoulder and Postural Pain
  • Pain in Teeth and Gums
  • Deep bites
  • Midline discrepancies
  • V shaped narrow arches
  • Tongue thrusts
  • Numbness or Tingling in extremities
  • Sleep Apnea

How Is TMD Diagnosed?

Smile and glow diagnostic protocol for TMD diagnosis

  • Detailed case history taking
  • Clinical examination
    • Intra oral and extraoral examination
    • Postural examination
  • Intra oral and extra oral photos
  • Radiology
    • Full mouth x-ray (OPG)
    • Lateral Cephalogram
    • TMJ view (open and close, right and left)
    • Airway CBCT 3D Volumetry
    • MRI scan
    • Whole body scan
  • Sleep study (HST –Home Sleep test or PSG – Polysomnograph)
  • Equipment such as Ultra Low-Frequency Transcutaneous Electrical Neural Stimulation (ULF-TENS),  jaw tracker, and MAT Scan will be used to diagnose the exact problem.

T-Scan(Digital occlusal analysis)

Almost all dental procedures performed have an impact on occlusion(bite). A bad bite can adversely affect the quality of life of the patient. T-Scan is a device  that helps to analyse the bite precisely and reveals the amount and timing of force on individual teeth and the occlusal stability of the overall bite. 

Transcutaneous Electrical Nerve Stimulation (TENS) 

Ultra low frequency Transcutaneous electrical nerve stimulation is a technique to relieve pain using an electrical current. Low-voltage electrical impulses are sent to a particular nerve through electrodes placed on the skin.

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Functions of the TENS machine

  • Helps to relax the muscles of chewing 
  • They prevent the pain signals from reaching the brain.
  • They help in the production of endorphins (natural painkillers).
  • They improve blood circulation.

After the muscles are relaxed using the TENS machine, the actual jaw position is recorded.

The expert neuromuscular dentist  will take a detailed case history and do a thorough clinical examination. He will check your jaw joints and its movements and find out whether you have pain or tenderness or any clicking or popping sounds when you move them or if there is any lock jaw. He will analyse your facial muscles for any problems and check your bite using a T Scan. Your dentist will take full mouth x-rays, temporomandibular joint views, MRI scan and CT scan.

The expert neuromuscular dentist and orthodontist at Smile and Glow would diagnose your problem and treat it. He will use a ultra low frequency transcutaneous nerve stimulation device (J5 TENS machine-Myomonitor muscle monitor) to relax the muscles in your face in order to relieve muscle strain that results in signs and symptoms. He may treat you using orthotics, braces or restorations to  ensure that  your teeth, muscles, and joints work harmoniously, thus relieving you of the pain.  In some cases surgical treatment may be required.

Most often the neuromuscular disorders are treated by a team of specialists including a neuromuscular orthodontist, physiotherapist, yoga and breathing specialist, ENT, Pulmonologist and a psychologist.

Authored By : Dr. S. Hemamalathi and Dr. K. S Senthil Kumar

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