Temporomandibular disorders (TMDs) are very common and most people have symptoms at some stage during their life. Fortunately, most spontaneously recover but for some, these problems can be long-term. TMD is a generic term and represents a broad group of jaw joint and muscular disorders. Oral and Maxillofacial Surgeons mostly treat TMJ dysfunction and pathology of TMJ.
The temporomandibular joints (TMJs) are the 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 TMJ is formed by bony articulations in the mandibular condyle and the glenoid fossa of the temporal bone in 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 acting as a shock absorber and load distributor. It is similar to a knee joint.
TMD is very common and nearly half of the population has symptoms at some stage in their lives. Fortunately, for most patients, recovery is anticipated but for some, jaw joint problems can be very distressing and long-term therapy is required.
TMDs are notoriously difficult to diagnose and can seem quite mysterious. An accurate diagnosis is essential for a comprehensive treatment plan. Broadly TMDs can be classified as extra articular which can be of muscular of 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.
An adequate diagnosis involves a detailed clinical exam along with radiological imaging usually in the form of an MRI.
Common signs and symptoms include but are not limited to:
- Isolated pain in 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.
- Swelling associated with the joint.
Jaw joint problems have many different causes. For example, a blow to the jaw or an awkward jaw movement may be enough to alter the position of the jaw joint disc. Tooth grinding or habits such as finger nail chewing, may cause TMD, and prolong recovery. There is good evidence that psychological problems such as stress, anxiety and depression may also make jaw joint problems worse. The jaw joint can also be affected by different forms of arthritis. It is rare for your bite (the way in which your teeth meet together) to cause jaw joint problems.
The treatment offered will depend on what your surgeon feels is wrong with the jaw joint and recovery may take many months. Most of the time, conservative treatment is sufficient, by identifying what might be causing the problem. Often a bite splint, rather like a mouth guard, may be constructed. You may be given some muscle exercises to do.
For some specific jaw joint disc problems which do not settle with simple treatment, surgery may be beneficial. This might be a jaw-joint washing out procedure, key hole surgery or occasionally a small cut is made to get better access. For jaw joints showing extreme arthritis, jaw joint replacements may be offered, rather like artificial knee and hip joints for arthritis of those joints.
Your surgeon may also work with a team of health professionals, all specialising in various aspects of jaw joint problems, such as oral medicine specialists, physiotherapists, psychologists and pain specialists.
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Note: The information covered within this web page and across this website is not intended as a substitute for professional medical or dental advice, diagnosis, or treatment. It is listed to provide you with a general overview to help you communicate effectively when you seek the advice of an oral and maxillofacial surgeon.