One of the main challenges facing dentists and maxillofacial surgeons at dental practices is diagnosing TMJ disorders. Patients with TMJ disorders often suffer from a variety of clinical symptoms, such as chronic ear pain, anxiety, frequent headaches, and clicking sounds while opening or closing the mouth or even at rest. These symptoms may impact patients’ quality of life, especially if they persist for long periods.
As dentists, we must understand how to diagnose TMJ disorders accurately, comprehend their underlying causes, identify their types, and educate our patients about their symptoms and what habits they need to change to improve the treatment’s outcomes.
This blog will discuss all aspects of TMJ disorders, including exploring the diagnostic process and treatment approaches to help empower you to establish the best personalized treatment plans for patients presenting with TMJ disorders in your practice.
Understanding the Underlying Causes of TMJ Disorders
The temporomandibular joint (TMJ) is a hinge-type synovial joint connecting the condylar process of the mandible to the mandibular fossa and articular tubercle of the temporal bone. The TMJ is unique since it contains an articular disc that divides the joint into superior and inferior compartments.
Additionally, the TMJ is surrounded by the primary muscles of mastication, including the temporalis, masseter, medial pterygoid, and lateral pterygoid muscles. Therefore, the pain in the TMJ region may arise from the joint or surrounding muscles.
Consequently, TMJ disorders often depend on a wide variety of factors. Some factors directly impact the TMJ, while others are often linked to pathological conditions that induce significant changes in the patient’s masticatory system.
Certain factors increase the likelihood of developing TMJ disorders. These factors include the following:
Occlusal Abnormalities
Patients with misaligned or crowded teeth or those with abnormal occlusion (such as sagittal class III) may be at increased risk of developing TMJ disorders due to altered occlusion. Other occlusal factors are also associated with TMJ disorders, including excessive overbite, posterior cross-bites, and an overjet or overbite exceeding five millimeters.
Psychological Factors
Stress has been identified as a predisposing factor for TMJ disorders. Several studies have revealed that patients with psychological dysfunction often present with a TMJ disorder, which could be due to excessive jaw clenching during stressful situations.
Consequently, substantial and frequent forces could be exerted on the masticatory muscles, leading to persistent episodes of muscle fatigue and spasms.
Severe Trauma
When someone is subjected to a severe injury, especially to the head and neck region, perhaps in the event of bicycle or roll-over accidents, they are at risk of developing a TMJ disorder.
Parafunctional Habits
These habits are known to be predisposing causes for TMJ disorders since they contribute to functional TMJ alterations. They include bruxism, teeth grinding or clenching, as well as excessive and frequent gum chewing. Research has revealed that the vast majority of patients with bruxism usually present with articular disc displacement.
Arthritis
Arthritis, or osteoarthritis, occurs as a result of subchondral bony erosions and is often linked to internal derangement of the articular disc, potentially leading to TMJ dysfunction as well as pain. The degree of internal derangement ranges from mild to severe, depending on the stage of arthritis and related bony changes. Consequently, some patients might develop painless clicking, while others may have intolerable pain with a restricted mouth opening.
Diagnosing Patients with TMJ Disorders
Clinicians often face challenges in diagnosing TMJ disorders due to the absence of a particular cause or factor attributed to such conditions. Cases with myofascial pain conditions often present to the office with similar symptoms, making it difficult to differentiate between both conditions. Therefore, the following key steps are recommended:
Taking a detailed medical and dental history
- Obtaining a medical and dental history enables the clinician to detect any underlying causes of TMJ disorders. For example, patients with systemic disorders such as rheumatoid arthritis may develop degenerative joint changes.
- Collecting all information on past pain, parafunctional habits, prior orthodontic treatments, or previous trauma is essential. Additionally, the clinician should also assess the psychosocial aspects of each patient.
Physical Examination
After obtaining the history, the clinician should conduct a comprehensive clinical examination to include:
- Assessing the pain location and whether it occurs over a localized or larger area of the face.
- Palpation of masticatory muscles
- Mandibular movements, range of mouth openings, and the presence of any crepitus or clicking sounds
Imaging
MRI is the gold standard imaging technique used to assess TMJ conditions. It provides insights into the status of the cartilaginous disc, ligaments, muscles of mastication, and other bony structures, enabling the clinician to determine the disease stage and develop the best treatment plan.
Managing Patients with TMJ Disorders
While developing a personalized treatment plan, clinicians aim to restore jaw functions and relieve pain. Moreover, there is a preference for applying non-invasive or conservative approaches, including behavioral changes and patient education, to help patients reduce the risk of developing TMJ disorders.
Conservative Approaches
Clinicians often implement these options at the early stages of the disease since they are safer with fewer complications than surgical interventions. They involve prescribing analgesics, NSAIDS, and antidepressants, along with applying warm compresses (ice in trauma cases) and jaw resting.
All these methods help reduce inflammation and pain. Occlusal splints may also be utilized at night to reduce teeth grinding.
Minimally Invasive Approaches
These are often applied to cases that have not improved with conservative treatment. TMJ arthroscopy is a minimally invasive surgical intervention utilized as a more conservative approach than open joint surgery.
TMJ arthroscopy enables the surgeon to remove the inflamed tissue and reposition a displaced disc, often used for patients with arthrogenous TMJ disorders.
Open Joint Surgery
This approach is invasive and is a less popular approach that is currently only used for specific cases of TMJ ankylosis or neoplasms.
Resources
1- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000442/
2- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4689239/#:~:text=Etiological%20factors%20include%20occlusal%20abnormalities,and%20exogenous%20estrogen%20%5B3%5D.
3- https://onlinelibrary.wiley.com/doi/10.1111/adj.12593
