What is temporomandibular joint pathology (TMJ)?

The term “temporomandibular joint (TMJ) pathology” encompasses a large number of disorders, not only of traumatic, neoplastic, autoimmune, infectious origin… but also those derived from alterations of its complex structure. The TMJ plays a fundamental role in chewing, swallowing, phonation and facial expression, which makes it indispensable for both the basic needs of feeding and for the patient’s social life. It is involved in facial development and growth and it is an anatomical area where the pathology often produces a great physical disability with psychological sequelae.

What is the most frequent pathology?

The most frequent pathology is the so-called “dysfunction or internal disorder of the TMJ and masticatory musculature”. It is a very frequent entity, 75% of the population has had some sign during their lives, and 33% have had some symptom. The estimated incidence in our environment is 1 ́8-3 ́9 new cases per 100 people per year. Signs appear equally in both sexes. However, women have symptoms 3 times more frequently, and the demand for treatment is 9 times higher for them, possibly due to a different perception of pain. It has a minimal incidence in children. In Spain, 5% of the population, 700,000 males and 1,400,000 females, require treatment, but less than 1% request it.

Types of TMJ disorders

The most common TMJ disorders are usually of 3 types:

1. Inflammatory, such as arthritis.

2. Joint dysfunction, the meniscus, a pad that is normally placed between the jaw and skull, is displaced.

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3. Muscle pain, such as myofascial pain, which affects the mobility of the jaw , as well as can also be located in the neck and shoulders.

What are the symptoms of a joint problem?

They usually produce pain in the jaw and neighboring muscles, limiting facial expressiveness, speech, chewing and swallowing. It can also produce pain in other parts of the face, headaches, in the ear, as well as at the level of the neck, shoulders or back. Episodes of blockage, inability to open or close the mouth. Limitation or discomfort when trying to open the mouth normally. Noises in the joint. Changes in the way of biting.

The causes that produce the alterations of the articulation are still not well known, being able to be the result of a combination of multiple factors. Sometimes they are triggered after some dental procedures, or operations with general anesthesia. Other times after suffering trauma. Habits such as gum chewing, teeth grinding or clenching may be associated. Playing certain musical instruments, such as the violin, or forced positions in the workplace may also be involved. Diseases such as arthritis and osteoarthritis, known to affect other joints in the body, can also affect the jaw joint.

Your doctor will take note of any discomfort you report, take a medical history and may order additional tests: X-rays, MRI, etc. Initially, a number of diseases should be ruled out as the cause of your symptoms. Once this has been verified, the nature of your disorder will be explained to you and if some type of treatment may be advisable.

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How should this pathology be treated?

Nowadays, the management of TMJ pathology must be managed in a multidisciplinary way, involving maxillofacial surgeons, odontostomatologists, dental technicians, physiotherapists, psychologists and, if necessary, pain units.

It is known that many people with TMJ disorders do not need any treatment. Often there are certain instructions that will be useful, such as: avoid excessive mouth opening, do not eat hard or excessively large foods, perform regular jaw exercises, apply cold or heat to the area, perform relaxation exercises or take painkillers in a controlled manner.

Certain treatments may be suggested, such as the use of a relaxation splint, which may relieve joint or muscle pain.

There are other treatments, such as arthrocentesis, arthroscopy or an open approach to the joint, which your doctor will consider if they might be helpful to you.