1. The TMJ is a synovial joint consisting of 2 bony parts, separated by a meniscus. The meniscus separates the TMJ into 2 compartments filled by fluid, called synovial fluid. The meniscus does not consist of nerve fibers, and cannot cause pain. Most of the problems we encounter in the TM joint arise from the meniscus.
2. The joint consists also of a capsule surrounding the joint, with ligaments supporting the joint. The inner epithelial lining produces the synovial fluid, lubricating the joint.
3. Articulating cartilage covers the bony ends, and in cases of osteo arthritis, this cartilage cover is worn down, exposing the bone ends rich in nerve fibers, resulting in extreme joint pain. This is called osteo- arthritis.
4. The TM joint is a translatory, and not a rotatory joint, and in mouth opening needs to translate anterior. Mouth opening = translation. Limited mouth opening occurs if the joint does not translate
5. The meniscus, in the normal joint, stays positioned between the bony ends in translation or mouth opening.
6. In the clicking joint, the meniscus is dislocated anterior in the closed mouth position, and in translation, or mouth opening, the meniscus clicks posterior to create a clicking sound. This is usually not painful, and most patients are only concerned about the noise or clicking sound during chewing.
7. In the locking jaw, or closed lock situation, the meniscus which is dislocated anterior, does not click posterior with mouth opening or translation, resulting in limited mouth opening and pain. The meniscus forms an obstruction for the condyle of the lower jaw to translate anterior.
Reasons for Dislocated Meniscus
Chronic stress and tension
Abnormal bite (Class II or Class III bite).
Impacted wisdom teeth.
Hormonal imbalances (Eg. Thyroid hormone deficiency, Estrogen deficiency, menopause).
Orthopedic problems/ postural problems. (Eg. back, neck problems / injuries).
Injuries to the joint (Eg. fractures).
Missing teeth and ill fitting dentures. This results in an abnormal chewing pattern, resulting in chewing only on one side of the mouth.
Results of Chronic Cleansing
1. Chronic headache. Due to the clenching and grinding during the night while sleeping, the patient wakes up with a headache in the morning. The headaches can be in the temporal area of the head, or even posterior in the neck and back.
2. The click can disappear, resulting in a limited mouth opening, and pain with chewing or mouth opening.
3. Chronic neck ache and back ache, with no physical abnormalities in the back or neck.
4. Painful teeth resulting in a traumatic occlusion.
5. Painful joint.
6. Blocked and painful ear. Chronic sounds in the ear ( tinnitus)
7. Balance disturbances
1. Bite plate therapy.
For protection of the joint in the painful joint, a full occlusal plate is recommended . The patient sleeps with this plate. This plate also serves to centralize the joint in cases of an occlusal discrepancy (slide in the bite when biting together). For headaches only, the NTI bite plate is recommended. To avoid changes in the occlusion, any bite plate therapy must not last longer than 3 months at a time.
2. Physical therapy. To help relieve the muscle spasms associated with clenching. Physical therapy is also applied to the neck and back muscles.
3. Correct the underlying problem. If the bite is abnormal, orthodontic treatment. For a discrepancy in the bite, an occlusal adjustment is performed by a prothodontist. For an Estrogen deficiency, consult your Gynecologist. In the case of chronic stress and tension, see a Psychologist. Most patients on anti depressant drugs, suffers from TM joint pain and related headaches. For neck and back problems consult an orthopedic surgeon.
4. Arthrocentesis. A procedure of rinsing the joint space and simultaneous depositing of cortisone in the joint. Can be performed under local anesthetic.
Surgery Of the joint
Due to the extensive examination and coordination with other disciplines in this field, we find it very seldom necessary to operate the TM joint. The conservative measures are repeated, and the underlying causes are illuminated.
Any operation in the joint is to either correct the position of the meniscus (placation procedure), or to remove the meniscus (menisectomy). The ear cartilage would be a suitable replacement substance in the menisectomy procedure. For advanced osteo – arthritis, the patient will need a joint replacement.
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