Temporomandibular joint treatment (TMJ)

What is temporomandibular joint (TMJ) pathology?

Temporomandibular joint pathology, as the name implies, is the pathology that affects the jaw joint. This joint is very special and very characteristic in the organism because it must function bilaterally, the right and left temporomandibular joint must move and rotate at the same time and in consonance so that the mandibular movement is correct. This movement is conveyed by a disc or articular meniscus that carries it to a muscle, the pterygoid. This muscle will pull the disc and move it to facilitate the opening and closing movement. Any pathology of either the articular disc, the mandibular condyle or dental occlusion can affect the temporomandibular joint. This will generate different types of pathologies, different symptomatology and different affectations.

Which people are more predisposed to have temporomandibular joint (TMJ) pathology?

Temporomandibular joint pathology is associated with people who have pathological jaw or joint movements. It has a strong association with anxiety syndromes and stress syndrome and something we call bruxism that generates a continuous and constant joint wear. It is also true that people who have alterations in both the maxillary and mandibular bones are predisposed to suffer from this pathology. It is a very frequent pathology in the general population and can have different types of severity and intensity in its affectation.

What symptoms appear when suffering from this disease?

The most characteristic symptomatology and the one that most patients come to us for is joint pain. What the patient really refers is not a joint pain but a periauricular pain, therefore the first specialist he/she goes to is the ENT specialist who explores the ear canal and discovers that there is no pathology and, therefore, refers him/her to us. This pain is very characteristic, it usually appears first thing in the morning and usually subsides during the day. Another type of symptomatology, also very common, is joint clicking. This auricular clicking, usually audible by the patient and sometimes even audible by the patient’s environment, is usually annoying and uncomfortable because it is usually generated at mealtimes. Another characteristic symptomatology of the temporomandibular joint is joint locking, the difficulty in opening the mouth. This usually appears in a high percentage of patients and characteristically is higher first thing in the morning and decreases throughout the day. Another symptomatology, the most striking that we find and that is mainly of emergencies, is temporomandibular luxation. This dislocation causes the patient to come with the mouth open, making it impossible to close it. This pathology often requires sedation and even emergency treatment.

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What treatments exist to combat the pathology of the temporomandibular joint (TMJ)?

The treatment of the temporomandibular joint must be a multidisciplinary treatment. It will require treatment by the dentist, the physiotherapist and osteopath and the maxillofacial surgeon. The most common and conventional treatment is the treatment by means of unloading splint and physeotherapy. This treatment must be coordinated and requires direct control by the maxillofacial surgeon. Another of the most common treatments is arthrocentesis or joint lavage. What we achieve with this treatment is to free the disc, reposition it and hydrate the joint. We also have the possibility of doing an arthroscopy with which we can do any type of internal treatment in the joint retouching or repositioning the articular disc. The last possibility of treatment is open surgery, which is used in very complex cases and in cases in which we need to completely change the joint.