Temporomandibular joint is the joint which connects the mandible to the skull. Temporomandibular disorder refers to a set of inflammatory problems in the area, which are as yet not clearly defined. The medical community itself is divided about the reasons for the problem and its modes of treatment.
Temporomandibular disorder, also known as TMD, is a fairly common complaint, with more than 10 million people in America having had the problem at one stage or other. Women, especially those in the age group of twenties and thirties, appear to be more prone to it.
The problem of TMD is not a single problem. It is a group of conditions, with slightly differing symptoms, which affect the temporomandibular joint. These conditions hardly ever lead to complications. Most of the time, the problems gets rectified on their own, or are amenable to treatment. Still, it can create problems in a small percentage of people, and for them it could be persistent and painful.
The temporomandibular joint
The temporomandibular joint, or TMJ, refers to the jaw joint and the muscles connected to it, which control the jaw movement and thereby that of chewing. It is one of the ball and socket joints in the body. The ball, in the case of TMJ, is known as condyle, and the socket is glenoid fossa. Every time the jaw is opened, this condyle slips out of the socket, and slides back when it is closed.
In between the ball and the socket is a soft disk that minimizes friction during the jaw movements, especially continued movements like chewing. The movement of jaw is supported by a set of muscles that connect the lower jaw, or mandible, to the skull.
Human jaw has to move when a man talks, drinks, eats, bites, chews, swallows, or yawns. It is the temporomandibular joint that controls all these jaw movements in different directions. The muscle movement while the jaw is in action can be traced by keeping one’s hand against the cheek, in the area adjacent to the ear. It is this area, which controls the jaw movement, that is affected when a person has got temporomandibular disorder.
The problem can be any one of the three types below:
- Temporomandibular problems that affect neck and jaw muscles
- Those that affect the cartilage and bones within the same area
- Those that affect muscles, cartilage and bones
People may be affected by TMD of just one group or by those of two groups.
Symptoms of temporomandibular disorder
Diagnosis of the problem is often made difficult because there are hardly any symptoms that are exclusive to TMD. A very common symptom of the problem is pain in the temporomandibular area and this can be the manifestation of some other oral or ear problems as well.
Besides the pain, other symptoms that could be indicative of TMD are the following:
- A grating sound that accompanies the jaw movement. Sometimes it may be a clicking or popping sound
- Patient is unable to open the mouth widely
- Pain around the shoulders, neck, and face
- A fatigued appearance on the face
- A sense of disproportion between the upper teeth and lower teeth, resulting in sudden, uneasy bites
- Facial swelling around the affected area
- Headaches, earaches, toothaches, dizziness, or a ringing sound in the ears could also be symptoms of TMD
Probable reasons for developing TMD
Though the exact reasons for developing TMD is yet to be affirmed, several factors have been found to be conducive to having the problem.
- Any injury to the jaw, or the temporomandibular area in general could lead to TMD. Such an injury could result from a fall, a motor accident, a fight, or even an attempt to open the mouth wide enough to bite or chew something a bit too large to be bitten.
- Frequent clenching of teeth or grinding of teeth
- Dislocation of the soft disc within the ball and socket joint of the jaw.
- Any form of arthritis like rheumatoid arthritis or osteoarthritis.
- Stressful situations, in general. This may result in a person tightening jaw muscles and clenching teeth.
As symptoms cannot be traced directly to the causes, the probable causes of TMD are still a slightly grey area in the dental treatment field.
The right diagnosis
There is no foolproof test that can be administered in the case of TMD to confirm the problem. Some of the symptoms that can be attributed to TMD can be attributed to neuralgia or a migraine problem. Because of it, dentists usually rely upon a combination of several factors, including the patient’s medical history, to establish whether the symptoms could be traced to TMD.
The followings are the factors that dentists will rely upon for proper diagnosis:
- The symptoms of the problem
- Starting time of any of the symptoms
- Duration of the symptoms
- The effect of any of these symptoms on daily life
- Other existing medical conditions like arthritis
- Any medication that the patient is taking
- Any event in the patient’s life that could have caused him stress
Physical examinations that a doctor may do will involve the following:
Much of the time, some of these tests may prove conclusive and the doctor will diagnose the problem and prescribe the treatment based on the test results. At times, a panoramic x-ray of the temporomandibular joint may become necessary for confirming the problem. Such an x-ray will exclude the possibility of other diseases as the possible cause.
Where these tests are not sufficient to confirm TMD, a doctor might use MRI or magnetic resonance imaging to get a more accurate image of the area and assess the bone health better. Occasionally, where even these are not enough, he may resort to better imaging techniques for the right diagnosis.
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