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Introduction |
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| Temporomandibular
joint (TMJ) disorder is a broad name given to various problems related
to the TMJ area. While some people have problems
involving the joint itself, others have normal, healthy joints and
experience
symptoms in areas adjacent to the joints. Occurrences of TMJ disorder
are often intermittent with episodes of discomfort punctuating periods
of relief. The severity of the condition varies. Some people have
occasional minor problems while others experience progressively
severe symptoms
that recur with increasing frequency. Sometimes people experience
TMJ disorder as a persistent cyclic condition which begins with
clenching
or grinding of the teeth. The cycle continues with fatigue and muscle
spasm, and eventually leads to stiffness and pain. Then the resulting
pain triggers a new round of clenching, thereby perpetuating the cycle. |
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Diagnosis |
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Certain
symptoms, such as pain and limitation of jaw movement, are typical
for
patients with TMJ disorder. However, considerable variation exists
in the intensity, duration, and number of symptoms that individual
patients
experience. For example, some patients have a smoldering problem which
flares up from time to time, while others have a single, acute
episode.
Some patients are minimally bothered by symptoms of pain and stiffness,
yet, other patients have profound discomfort and severe limitation
of
jaw movement. Since so much variation exists, a thorough description
of each of the symptoms is important. In order to assess a particular patient's condition, determine its cause, and formulate a plan of treatment, certain specific information may be gathered. Typically, this is done using a variety of diagnostic methods which include discussion, examination, and testing. For example, the patient may be asked to describe the present condition, reporting time of onset, duration, and intensity of the pain in the area. Limitation of movement and joint sounds are reported, if present. Any previous episodes, injuries, or treatments are reported. Also, general health questions, which relate to the TMJ disorder, may be asked. In addition, an examination may be carried out to observe the pattern of jaw movement and to detect joint sounds and tenderness to pressure. Biting relationships of the teeth may be recorded using marking paper or wax indexes. Laboratory tests may be performed using plaster models of the teeth on mechanical jaw simulators. Furthermore, a clinical trial of plastic bite wafers may be recommended to asist in evaluating the condition. In selected cases, additional diagnostic methods may be employed. These may include electronic measurements of muscle activity as well as visualization of the joint by x-ray, dye enhanced images called arthrograms, and by computer assisted scanning methods. |
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Treatment |
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Treatment of TMJ disorder may include a broad range of therapies. Selection of a particular mode of treatment depends upon an assessment of that therapy that is likely to be most sucessful for a specific patient's condition. Often, during acute episodes of pain and restricted jaw function, direct intervention is prescribed to interrupt the self-perpetuating muscle pain cycle. This frequently gives some measure of relief and allows a degree of normal function. These measures may include the use of a plastic wafer or bite splint, worn between the teeth in order to quickly interrupt clenching or grinding activity and to allow for a more comfortable, relaxed jaw position. Medication, moist heat, message, and transcutaneous nerve stimulation may be prescribed to relieve painful symptoms. Also, the patient may be encouraged to rest the jaw by eating a soft diet, limiting extreme jaw movement, and avioding clenching or grinding behavior. In some cases, interruptive measures are adequate and no further treatment is needed. However, in many cases, relief is temporary and additional treatment is necesary to successfully resolve the problem. When indicated, additional treatment may be undertaken once the acute symptoms subside.
Other measures include elimination of bite interferences by altering the shape or position of the teeth. If minor discrepancies exist, equilibrium or selective grinding on the chewing surfaces of the teeth may be adequate to improve the bite. Other problems may require reconstruction of certain teeth or minor orthodontic treatment in order to eliminate bite interferences. More involved bite and dental alignment problems may require comprehensive orthodontic therapy. Sometimes, this is done in conjunction with reconstruction and equilibration of the teeth. In severe cases, involving significant mismatch of jaws, degenerative changes in the TMJ, or derangement of internal joint structures, surgical intervention may be prescribed. |
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Recovery |
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When
the dysfunctions are identified and treated early, the cure rate
is
remarkably high--about 90%. If left undiagnosed, however, and after
it becomes chronic, the cure rate drops and the patient may remain
with
some permanent symptoms, although at a greatly decreased level. Early
identification and treatment is essential for the immediate and
future
well-being of each patient. |
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In
general, additional treatment measures are undertaken in an effort
to eliminate bite interferences and establish harmony of the tooth,
joint, and muscle functions. For example, prolonged use of a bite
splint may be prescribed for bite interferences by preventing the
teeth from touching together. By keeping the teeth apart, chewing
muscles
may begin to relax and injured joint tissue may be allowed to rest,
realign, and heal. Once healing has taken place, the bite splint
may
be discontinued or may be worn whenever symptoms reappear.