The temporomandibular joints (TMJs) are found where the lower jaw meets the skull, just in front of the earlobes. Temporomandibular disorders (TMD) are a group of conditions that affect these joints, the jaw muscles, and nerves. Symptoms associated with TMD include chronic facial pain, headaches, and neck pain. The jaw may twist during opening and closing, and often the joint makes popping and clicking sounds when opening and closing the mouth. Sometimes, the jaw even locks.
What are the most important symptoms I should be concerned about?
Pain, and/or jaw “locking” episodes.
What is a “locking” episode?
A “locking” episode can occur during an opening or closing movement. What happens is that the patient experiences an interruption of jaw movement â€“ called a “catch” or a “stop” â€“ and in order to complete the movement, must jiggle or self-manipulate the jaw in some other way.
Why does it happen?
Within the joint, the articular disk, which rides on top of the condyle head, is getting stuck in the wrong place and is preventing the condyle head from moving.
If I can jiggle my jaw and reduce the dislocation, why should I be concerned?
Each time your jaw locks, more damage occurs to the tissues in the joint and the tissues controlling the articular disk. As a consequence, there is the risk that if the problem is not addressed by appropriate treatment, one day you will be unable to reduce the dislocation yourself, and you will require an emergency visit to a TMJ practitioner, if one is available in your community, or an oral surgeon. In severe cases, reduction can only be accomplished under general anesthesia.
What is a limited range of opening?
If you open your mouth as wide as you can, and then place the last three fingers of your hand (middle, ring, and pinky) perpendicularly (with your thumb pointing to the ceiling) between your upper and lower teeth, you have a normal range of opening, provided that you can do that without pain and strain. In general, two fingers or less is a limited range of opening.
I can get four fingers in. What does that mean?
Not much. You may either have thin fingers or slight hyper-extension. In the absence of pain and other symptoms, not to worry.
I can only get two fingers in. Does that mean I need treatment?
Here comes a typical doctor’s answer â€“ “that depends.” And it depends on several factors. The most important is the degree to which your restricted jaw function affects your quality of life. If you have no pain, and it is the ONLY symptom you have, and you never think about it, and you can eat anything you want without pain and strain, the answer is â€œno.â€ Otherwise, the answer is â€œyes.â€
I hear a lot of noises in my TM joints when I move my jaws. Sometimes there is a kind of click, and sometimes there is a crunching or grinding sound. What’s happening?
Probably lots of things. Joint noises during jaw movements are a sign that the functional elements are not working smoothly. Crunching grinding noises are called â€œcrepitus,â€ and they are associated with hard tissue contact during movement. In order to explain clicking, you have to first know that the articular disk has a depression in the middle of it. That depression and the condyle head are supposed to move together in sync. When they don’t, and the condyle head passes over the outside ridge of the depression, you get a click.
Is the presence of these joint sounds serious?
In the absence of other symptoms, no, BUT these joint sounds are a sign that the joint is not functioning smoothly, and each sound’s occurrence is a micro trauma to the joint tissues. This means that as time goes on, a full blown TM joint disorder may develop. The correct approach, if you have TM joint sounds during jaw movements in the absence of any other symptoms, is to tell your regular family dentist about them, and he or she will keep your condition under observation.
Why are ear symptoms associated with TM joint disorders?
Ear tissues are located close to the TM joint. It is not uncommon to find on x-ray that the condyle head is improperly positioned in the joint space such that it is in intimate contact with the tympanic bone. The consequence often is ear pain in the absence of infection, a sense of fullness or stuffiness in one or both ears, and sometimes ringing in the ears. If you go to the “X-Ray Views” page, you can see these reasons graphically.