Temporomandibular joint disorders are generally due to a disturbed interaction of teeth, temporomandibular joints and jaw muscles. About 70 percent of Germans are affected by pain of varying degrees in the neck, head and face, which in many cases can be attributed to dysfunction or disease of the temporomandibular joint.
What are temporomandibular joint disorders?
Temporomandibular joint disorders (also known as craniomandibular dysfunction) are various malfunctions in the interaction of the lower and upper jaws that can be attributed to dysfunctions of the teeth, temporomandibular joints, and/or jaw muscles. Malfunctions of the temporomandibular joint can be manifested by pain in the cheek and eye area, restricted jaw opening, teeth grinding (bruxism), speech problems, migraine, headaches and pain in the limbs, jaw (joint) pain, Cracking of the jaw joint, ear pain and tinnitus, neck tension, hardened muscles, blockages of the spine, swallowing difficulties, shoulder pain to dizziness, poor concentration, fatigue and sleep disorders manifest.
Causes
In many cases, temporomandibular joint disorders are multifactorial and can be attributed to a dysregulated interaction of muscular, bony as well as neural structures. Orthopedic malpositions affect the entire statics of the human body and can additionally trigger temporomandibular joint disorders. Misalignments of the back, knee or ankle joint as well as leg length differences and pelvic obliquities can lead to temporomandibular joint misalignments. Similarly, rheumatic or wear-related (osteoarthritis) impairments as well as nerve pain (including trigeminal neuralgia) or neuropathies can cause temporomandibular joint disorders and corresponding pain symptoms. Psychological factors such as stress, stressful living conditions and/or tension are in many cases discharged via the teeth and cause increased clenching of the teeth and (nocturnal) teeth grinding (bruxism) in those affected. Poorly fitted bridges or crowns, deficient fillings, misalignment of teeth or the jaws, loss of tooth substance (abrasion) due to caries can also result in temporomandibular joint disorders.
Symptoms, complaints and signs
Diseases of the temporomandibular joint can cause quite different symptoms and discomfort. Generally, there is jaw pain that is localized in the area of the affected joint and may radiate to the ears. Furthermore, there may be difficulty swallowing, grinding of the teeth at night, and increased salivation. The eyes may also be affected, resulting in vision problems and eye pain, for example. Temporomandibular joint disorders can also cause dizziness, poor concentration, sleep disturbances and drowsiness. Severe diseases are accompanied by restricted movement. Sufferers can then move the jaw or neck only to a limited extent, with each movement causing pain. If the disease is not treated, serious complications can develop. For example, persistent teeth grinding can lead to chronic toothache and eventually abrasion of the teeth, often resulting in nerve damage and problems with food intake. A misalignment of the teeth can, in addition to the physical consequences, also cause psychological complaints such as inferiority complexes. A temporomandibular joint disorder is usually not visible externally. Inflammations, however, are manifested by visible swellings and redness, rarely cysts are formed, or tooth misalignments occur. Fractures can be recognized by a visible malposition of the jaw.
Diagnosis and course
Clinical symptoms provide initial clues to possible temporomandibular joint disorders. A clinical functional analysis and somatic (physical) examination of the jaw musculature, temporomandibular joints as well as jaw opening allow statements on possible malfunctions as well as on the interaction of teeth, temporomandibular joint, jaw and musculature. A panoramic radiographic image of the entire jaw can be used to determine the causes of temporomandibular joint disorders. Within the framework of instrumental functional analyses, the temporomandibular joints can be precisely measured and then accurately fitting models of the jaws can be made.With the aid of an axiograph, the mandibular movements and joint positions can be precisely analyzed in order to simulate the optimal position of the jaw and teeth of the specifically affected person using an articulator (masticatory simulator) based on the measured values. In addition, questionnaires are used to determine possible psychosocial factors influencing the temporomandibular joint disorder. With consistent and, if necessary, interdisciplinary therapy (including self-therapy), temporomandibular joint disorders can be treated well and show a favorable course with significant symptom improvement within a few weeks.
Complications
First and foremost, TMJ disorders can lead to tinnitus or other noises in the ears. These ear noises have a very negative impact on the quality of life and can usually also lead to sleep disturbances in the patient. Furthermore, it is not uncommon to experience pain in the ears or jaw and furthermore also swallowing difficulties. During the night, many patients also suffer from so-called teeth grinding, which can lead to various complaints of the teeth. Likewise, there is dizziness or a general tiredness and fatigue. Patients suffer from visual disturbances and concentration problems. In some cases, the patient also experiences movement restrictions. Misalignment of the teeth may cause aesthetic discomfort and limitations, which not infrequently lead to psychological discomfort or inferiority complexes. Temporomandibular joint disorders can be treated relatively well with the help of operations or therapies. As a rule, there are no complications. Often, the treatments are carried out in childhood, so that there are no complaints in adulthood. Life expectancy is not reduced by TMJ disorders.
When should you see a doctor?
Pain in the area of the teeth, gums or jaw must be clarified by a doctor. Since spontaneous healing does not normally occur in this region of the body, a visit to the doctor should be made as soon as possible. If there are irregularities in the chewing process, problems with the crushing of ingested food or abnormalities in phonation, a doctor is needed. Irregularities in the wearing of braces or inserted dentures should be checked and corrected. If food or liquid intake is refused, hypersensitivity to food develops, or jaw misalignment occurs, a doctor is needed. A visit to the doctor is also advisable as soon as existing pain spreads to other areas of the upper body. If headaches, painful ears or eyes occur, a doctor should be consulted. Sleep disorders, tension in the neck or shoulders, and concentration disorders should be examined and treated. If deformities of the face or discoloration of the facial skin are noticed, a physician should be consulted. Swelling of the mouth, changes in the mucous membranes, and disturbances in saliva production are indications that should be evaluated by a physician. Bleeding, pus formation or blisters and pimples in the mouth require medical treatment. If the symptoms develop slowly and gradually, they indicate a disease that needs to be treated.
Treatment and therapy
In the case of temporomandibular joint disorders, therapeutic measures correlate with the underlying causes in each case and aim to achieve permanent and long-term freedom from symptoms. Customized occlusal splints (bite splints or grinding splints) are often used to coordinate bite and body statics and to relieve the masticatory muscles and temporomandibular joints. Physiotherapeutic measures are used to reduce muscular tension, specifically strengthen the masticatory musculature and eliminate malpositions and/or dysfunctions of the temporomandibular joint. Within the framework of holistic orthodontic therapy approaches such as bionator therapy, tooth and jaw misalignments, impaired tongue and swallowing functions, and insufficient lip closure are corrected, whereby these are usually treated simultaneously with possible misalignments of the spine and pelvis. For this purpose, additional massages, stretches and exercises to strengthen the neck, shoulders and back are used.In addition, soft food, cold and heat applications as well as independently continued stretching and relaxation exercises are recommended as part of self-treatment, especially in the case of a psychosocially induced temporomandibular joint disorder. In some cases, analgesic and anti-inflammatory and/or muscle relaxant medications are required to prevent pain chronification. Electromedical measures such as transcutaneous electrical nerve stimulation (TENS) can additionally contribute to muscle relaxation and pain reduction. Furthermore, trigger point therapy to eliminate myofascial hardening is discussed for the treatment of TMJ disorders. In contrast, extensive and far-reaching surgical or orthodontic interventions (including single-loop therapy for occlusion disorders, arthroplasty or resection of the condyle for osteoarthritis deformans, locking surgery for luxations) should be considered only when strictly indicated for TMJ disorders.
Outlook and prognosis
The prognosis of TMJ disorders depends on many factors. These include the age of the affected person and the degree of severity of the condition. Patient cooperation is also important. For example, a malocclusion is often the result of TMJ disorders and the patient is given a bite splint or similar forms of correction to wear. These can only work properly if they are placed in the mouth regularly. Thus, the therapy is closely linked to the prognosis. The same is true for CMD (craniomandibular dysfunction), in which malocclusion of the jaw can trigger other complaints such as back pain, headaches, neck tension and grinding of the teeth at night. A malocclusion can trigger bad postures that may require muscular training. In this case, not only regular visits to the physiotherapist by the patient are necessary, but also cooperation in regularly continuing to practice what has been learned at home in order to make the training as successful as possible. Here, too, the prognosis is clearly dependent on the regularity and quality of treatment. Since many TMJ disorders develop in childhood and adolescence, the prognosis also depends on early and regular visits to the dentist. The pediatric dentist can refer to the orthodontist if necessary. Early treatment when the jaw is still growing is promising and associated with a good prognosis.
Prevention
Temporomandibular joint disorders can be prevented by, for example, bite splints or grinding splints, as these reduce abrasive wear (loss of substance of the teeth). In addition, relaxation techniques and improved management of psychosocial stress protect against bruxism (teeth grinding). Likewise, rheumatic or wear-related diseases as well as body static misalignments should be treated early and consistently to prevent temporomandibular joint disorders.
Aftercare
In most cases, the measures of an aftercare for the temporomandibular joint diseases are severely limited, so that in the first place a doctor must be consulted quickly for these diseases. An early diagnosis usually always has a very positive effect on the further course of this disease and can thereby also prevent further complications and other complaints. A self-healing can usually not occur with the temporomandibular joint disorders, so that those affected by this disease should definitely see a doctor. In most cases, patients with temporomandibular joint disorders are dependent on surgical intervention, which can permanently alleviate the symptoms. In any case, the patient should rest and take care of his body after the operation. In this regard, efforts and other stressful or physical activities should be refrained from. When taking antibiotics, care should be taken that they are not taken together with alcohol. In general, many exercises for relaxation can also alleviate TMJ disorders and thus also significantly increase the quality of life of those affected again. Life expectancy is also not usually reduced by these complaints.
What you can do yourself
Temporomandibular joint disorders cover a wide range of possible complaints, so that options for relief vary in each individual case. Basically, temporomandibular joint disorders often lead to tension and pain, against which measures can be taken independently.Exercises to strengthen the muscles in the area of the jaw are considered. The patient trains the exercises under the guidance of a physiotherapist and is then able to integrate them into his or her daily routine at home. As a result, pain sometimes decreases or the temporomandibular joint disorder worsens less quickly. It is also important to deal adequately with stress in everyday life, as mental tension often results in tension in the jaw and, in some people, manifests itself in nighttime teeth grinding. If such grinding cannot be avoided, appropriate splints should be worn as a preventive measure in accordance with a doctor’s prescription. Those affected by temporomandibular joint disorders can relieve pain and reduce tension in the jaw area through external as well as internal applications. Ointments with warming or cooling effects can be used for application. Warm teas and drinking them slowly relax the jaw and have a positive effect on the sensation of pain, at best for a short time. Even if the teeth are not affected by TMJ disorder, thorough oral hygiene is particularly important for patients to prevent inflammation in the jaw area.