Introduction
Pain in the area of the temporomandibular joint can be caused by:
- The bony structures or the joint capsule or
- The muscles responsible for chewing and speaking
Malpositioned teeth and an asymmetrical jaw closure in particular can put increasing strain on the joint and provoke jaw joint pain. Furthermore, worn or poorly fitted dentures can lead to problems in the temporomandibular joint.
Causes of temporomandibular joint pain
The causes for the occurrence of temporomandibular joint pain can be manifold. However, since the treatment of this problem should be strictly dependent on its cause, it is important to pay close attention to when temporomandibular joint pain occurs. Furthermore, it is important for the treating dentist to know under which conditions the affected patients experience relief and which processes aggravate the pain symptoms.
In most cases, the occurrence of temporomandibular joint pain is caused by the so-called CMD syndrome (Craniomandibular Dysfunction). This disease is a malfunction of the jaw parts themselves. Severe tooth misalignments that have not been orthodontically treated or have received inadequate orthodontic treatment are the most common trigger of craniomandibular dysfunction, which leads to the patient’s perception of temporomandibular joint pain.
In addition, this disease often occurs after the wisdom teeth have erupted. This is due to the fact that the size of the jaw has greatly decreased over time and therefore no longer offers enough space to accommodate 32 teeth. Therefore, after the wisdom teeth have broken through, the temporomandibular joint is often incorrectly loaded.
Typical accompanying symptoms of craniomandibular dysfunction are frequently occurring earaches, chronic headaches and back pain (in most patients the neck is affected), as well as visual disturbances. In addition, unilateral stress during chewing is considered a cause of temporomandibular joint pain. Many affected patients also report that they tend to grind their teeth in particularly stressful situations.
As a result, these patients notice severe temporomandibular joint pain as soon as they get up. In addition, bacterial or viral infections can lead to inflammation in the area of the temporomandibular joint and thus provoke the development of pain. On the one hand, back and neck pain is usually one of the most common concomitant symptoms that occur in the course of temporomandibular joint pain, on the other hand, such problems in the spine area can also be the cause of temporomandibular joint pain itself.
Other possible reasons for such a pain problem are
- Tension of the chewing muscles (also in the context of a jaw lock)
- Cysts in the upper or lower jaw,
- Diseases in the area of the ears or the paranasal sinuses and in rare cases also various heart diseases
Pain as well as functional problems in the area of the temporomandibular joint can occur when it is inflamed. One of the most common causes of an inflamed temporomandibular joint are problems during the eruption of the wisdom teeth. In people who do not have enough space in the jaw to accommodate eight teeth per quadrant, inflammation of the bone, gums and temporomandibular joint capsule can occur during the growth of the wisdom teeth.
In some cases, this problem can be easily corrected by removing the affected gum section. However, many patients who suffer from an inflamed temporomandibular joint due to growth difficulties of the wisdom teeth are not spared the removal of these teeth. In order to ensure a regular sliding of the individual parts of the temporomandibular joint, there is a cartilage disc (discus) in the temporomandibular joint.
Since the temporomandibular joint is one of those joints that are stabilized to a large extent by ligaments, the cartilage disc can slip when the joint is heavily overloaded (disc displacement). In principle, the disc can slip forward (ventral), backward (dorsal) or sideways (lateral). In dentistry, a distinction is made between complete disc displacement and incomplete cartilage disc displacement.
The latter occurs in many cases during the wide opening of the mouth, but remains without consequences except for an audible crackling, since the disc slides back to its original position relatively quickly. A complete disc displacement without independent reduction is usually indicated by an obstruction of the regular mouth opening.A comprehensive dental functional analysis is performed to diagnose disc displacement. In addition, a radiographic image or an MRI of the temporomandibular joint may be useful.
If the findings are uncertain, a so-called arthroscopy (joint endoscopy) often leads to a reliable diagnosis. During the arthroscopy, in most cases a temporomandibular joint lavage can already be performed to remove possible adhesions from the cartilage disc. In addition, inflammatory cells that may have migrated into the joint can be flushed out of the joint chamber.
For patients who suffer from a disc displacement with independent reduction, the fabrication of a bite splint is usually the treatment of choice. Wearing this splint regularly prevents the teeth from clenching firmly together and causes the chewing muscles to relax. In this way, overstressing of the temporomandibular joint is reduced and further displacement of the discus is prevented.
In severe cases, manual treatment in combination with special temporomandibular joint physiotherapy can also be helpful. A bite splint can also be useful for patients who suffer from disc displacement without reduction. In addition, surgical reduction of the cartilage disc may also be necessary to stabilize it in the long term. In general, affected patients should be careful not to consume any foods that are too hard in the future, as this can put a lot of strain on the temporomandibular joints during chewing.
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