Categories: Orthopaedics

Common problems with TM Joint or JAW Joint

The Jaw joint is present next to the ears and the bones that make two parts of the Joint are Skull basal bone (Temporal bone) and the Lower jaw bone (Mandible). The Jaw joint helps in chewing movements and speaking. To a certain extent, TM joint helps in swallowing movements as well.

Common problems with TM joint are a Pain in the joints, restricted movement of the jaw, clicking sounds and joint dislocations. Some of these problems could be sudden in nature whilst others may be long-standing.

Most of the Jaw joint problems could be resolved rather quickly but some problems may persist or recur even after aggressive treatments.

  • Causes of TM joint disorders
  • Traumatic injury
  • Rheumatic arthritis, osteoarthritis
  • Grinding of teeth during sleep
  • Keeping the mouth wide open for lengthy periods, example – while undergoing surgery
  • Wide yawning
  • Infections from adjacent skin, ear infections, rarely from intrinsic TM joint infections
  • Hormonal imbalances, especially in women, is also considered to be the reason
  • A preponderance of TM joint problems

Clinical symptoms associated with TM joint disorders are: Joint Pain, Joint sounds, Restricted Jaw movements

Jaw joint pain is the most common clinical problem associated with Jaw joint disorders. Pain is often felt while speaking or chewing. Often times migraine or other forms of headaches can present themselves clinically as jaw joint disorders, earache, backache, and cardiac-related pain can also be perceived as Jaw joint pain.

Clicking or popping sounds in the Jaw joint sounds can be painless at times. But clicking or joint grating noise in the Jaw joint whilst opening and closing the mouth is a common finding. Joint noises per se may not be associated with any overt clinical pathology associated with Jaw joint, and Jaw joint noises are a fairly common occurrence in the general population with healthy Jaw joints. Medical advice is required when the Jaw joint sounds associates with pain or difficulty in movements of the Jaw joint are experienced.

Restricted jaw movements can result due to the Jaw joint disk-related problems or also due to Jaw joint fractures and rarely due to intrajoint pathoses like a tumour or abnormal bony union between the skull base and lower jaw components.

Treatments:

  • Lifestyle changes that are advised in a mild to moderate Jaw joint disorder are, rest to the joint, soft diet, avoid the clenching or tensing the jaw
  • Mild jaw muscle stretching exercises, hot water fomentation, and gentle massaging the masticatory muscles
  • Appliances to wear in the mouth to restrict major mouth movements

TM Joint lavage

If the Jaw joint pain and other clinical symptoms are due to osteoarthritis or long-standing old injuries, Jaw joint lavage and injection of steroids into the Jaw joint compartments are recommended. The lavage and steroid injections into the Jaw joint can bring relief to the patients within a few days of the procedure.

TMJ Surgery

TMJ surgery is usually taken up as a last resort. Surgical interventions of the TM joint is reserved as the last option in progressive and extreme cases of jaw joint disorders. Joint surgery is recommended when there’s a severe restriction to the normal opening and closing movements of the jaw. The disc of the TMJ could be worn out in chronic osteoarthritic joints and small bony spicules may, in fact, be jutting out of jaw joint surfaces. These internal changes in TM Joint can result in painful grating sounds and associated restriction of mouth movements. Such advanced Jaw joint disorders are recommended for surgical corrections.

TMJ replacement surgery

In extreme cases, the Jaw joint pathology may warrant a joint replacement with an artificial joint. To conclude, most of the TM Joint disorders are not serious in nature most of the time and last only a few months. In many patients, symptoms remain mild in their nature even when the symptoms exist for lengthy periods of time. But in a small percentage of cases, TM joint disorders can be long-standing and extremes of difficulty may be experienced. It is advisable to take enough precautions at an early stage to treat TMJ disorders so that major problems in the future are avoided.

Dr. Jayanth Kesave, Visiting Consultant – Cranio-Maxillo Facial Surgery and Plastic Surgery, Narayana Multispeciality Hospital, HSR Layout

Narayana Health

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