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T.M.J stands fro tempromandibular joints, which are the joints that connect the jaws to the head. When the joints malfunction, an imbalance of the jaws occurs which results in facial pain and headaches. These disorders are often referred to as TMJ disorders or TMD

Symptoms of TMD

A variety of symptoms may be linked to TMD. Pain, particularly in the chewing muscles and/or jaw joint, is the most common symptom. Other likely symptoms include:

    1. limited movement or locking of the jaw,
    2. radiating pain in the face, neck or shoulders,

    3. Painful clicking, popping or grating sounds in the jaw joint when opening or closing the mouth. Note though that there is some evidence that jaw clicking leads to serious T.M.J problems. In fact, jaw clicking is fairly common in the general population and may be attributed to a displaced disc- often a harmless condition that does not need treatment. If there are no other symptoms, such as pain or locking, jaw clicking usually does not need treatment.

    4. a sudden, major change in the way the upper and lower teeth fit together.

    5. Symptoms such as headaches, earaches, and dizziness and hearing problems may sometimes be related to TMD.

    6. Chronic, reoccurring headaches

    7. Tired and tight jaws

Causes of TMD:

There are many factors which can cause or contribute to TMJ disorders. They include trauma – any blow to the head or chin, whiplash injury, poor posture, abnormal bite (malocclusion), arthritis and hereditary growth and development factors which contribute to skeletal malformation. Stress at work or home also has an impact on TMJ disorders. Muscle strain and spasm begin when the disc becomes displaced. Early signs of a TMJ disorder usually include clicking or popping noises. More severe displacements can be very painful. If left untreated, permanent change can result.

Diagnosis of TMJ disorders:

Since there are many factors that could cause a TMJ disorder, detailed history and a careful clinical examination, imaging studies of the teeth and jaws may sometimes be helpful as a diagnostic tool. These include: routine dental x-rays and panoramic radiographs, computed tomography (CT or CAT scan), magnetic resonance imaging (MRI), and scintigraphy (bone scan).

Blood tests are sometimes recommended to rule out possible medical conditions as a cause of the problem.


 

Treatment for TMJ disorders:

There is a wide range of treatments for TMJ disorders, it is recommend to strat treating TMJ disorders with the most conservative approaches possible. The range of treatments include

  1. Mild TMD symptoms often resolve with simple at home care such as; soft diet avoiding hard and gummy foods. In addition, Avoid putting undue stress on the jaw joint from yawning widely, resting the phone on the jaw area, holding your jaw with your hand while leaning, or slouching at the computer. If you need to be at the computer for long periods of time, set a timer so that you are moving around and are constantly reminded that posture is important and can contribute to TMJ pain issues. When you need to yawn, place a fist under your chin and press up. This can keep your mouth from opening too wide. Try to remember to keep your teeth slightly apart as often as you can. Keep in mind that it is natural for your jaw to open a little if your lips are closed.

  2. Over the counter pain and anti-inflammatory medications such as ibuprofen could be used to control the pain.

  3. Splint therapy

Splints and night guards are plastic mouthpieces that fit over the upper and lower teeth. They prevent the upper and lower teeth from coming together, lessening the effects of clenching or grinding the teeth. A splint/nightguard is meant as a physiologically correct bite that allows the jaw joint (TMJ) to assume it's most correct and least traumatic position. This position will allow for a stable base that will decrease both muscular activity and damaging forces to the joint.

They allow the muscles & ligaments to relax, therefore ridding the facial muscles of the tension and tightness that bruxism, clenching, or other jaw problems may cause.

  • If the patient grinds their teeth (bruxes), splints may protect them from more wear of the teeth, preventing pain, sensitivity, and jagged edges.

  • If a patients bite (occlusion: the way teeth fit together) is off or not right for his or her jaw joints, a splint may adjust the bite into what many dentists feel is a more optimum position, which then allows for the muscles to rest.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Surgical Approach

Surgical approaches should be reserved for the cases that fail to respond to conservative treatments.

I) Arthocentesis

Arthrocentesis is often the first surgical procedure that will be done for a patient who has a displaced disc. It can be done as an in-office procedure, when it involves merely the placement of two hyperdermic needles into the joint, or as an outpatient procedure in the hospital if it is done arthroscopically. In the office, it can be done either under local anesthesia and IV sedation or general anesthesia. In the hospital, it is generally done under general anesthesia as an outpatient.

Once the joint is numbed or you are put to sleep, the needles or the arthroscope are placed into the joint, and it is flushed with a sterile saline solution or a lactated Ringers solution. The purpose of this procedure is to remove tissue breakdown products and reduce inflammation. The surgeon will generally also manipulate the jaw to remove scar tissue adhesions that may have formed .



II) Arthoscopy

TMJ arthroscopy is a procedure that is a little more involved and invasive than an arthrocentesis done with two hypodermic needles. This procedure is almost always done in an outpatient facility in the hospital. An arthroscope is used to look inside your joint to see what is causing your problems. Some surgeons will not only look inside and wash out the joint, but also perform surgical procedures like removing scar tissue, smoothing the bone and even attempt repositioning the disc.

III) Open joint surgery


There are many types of open joint surgeries. In all of them, the surgeon operates on the TMJ without the use of special equipment like video monitors. Instead, an incision is made just in front of the ear and the joint is operated on under direct vision. Your oral surgeon may suggest this type of surgery if:

  • Your problem cannot be corrected with arthroscopy

  • Your TMJ is degenerating

  • You have tumors in or around your TMJ


 

 

 

 

 

 

 

 

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