Temporomandibular Joint

The Temporomandibular joints, also known as TMJs are the joints that connect the jaw (lower jaw) to the skull. These joints are complex because they allow the combination of 2 types of movements – rotation and sliding – which are necessary to perform the opening and closing movements of the mouth that are essential in chewing, swallowing, speaking, smiling, and yawning.

To be able to move the joint, we use the cervicofacial muscles, which through contraction and relaxation allow us to speak and chew.

Temporomandibular dysfunctions – what are they?

Temporomandibular dysfunctions or disorders are a group of pathologies that involve the masticatory muscles, TMJ and associated structures, affecting between 5 and 12% of the population, mainly women between 20 and 45 years old.

Because it is such a complex area of the human body, and because it has a multifactorial origin, it is often difficult to diagnose this type of dysfunction.

Signs and Symptoms

The most common signs and symptoms are orofacial pain, joint noises or crackling, and limitation and deviations in jaw movements, which when left untreated, can compromise patients’ daily activities and quality of life.

Causes

Its cause is rarely unique, and is usually considered to be of multifactorial and individual origin, with sleep disorders, physical, emotional and occlusal stress being considered as etiological factors.

There are several reasons for temporomandibular joint dysfunction, which can be distinct from patient to patient. Among the main causes are:

  • Bruxism – clenching and grinding of the teeth;
  • Muscular tension or emotional tension (stress);
  • Jaw trauma (such as traffic accidents);
  • Joint pathologies (such as arthritis);
  • Occlusion problems;
  • Local or Systemic Infections.

Seek medical attention if you feel pain or high sensitivity in your jaw, or if you cannot open or close your mouth completely.

The diagnosis of bruxism can be made subjectively by self-report of teeth grinding or by the partner, as well as by clinical examination through the evaluation of several signs such as tooth wear, mucous membrane and tongue trauma, among others.

Bruxism

Bruxism is defined as a repetitive activity of the masticatory muscles characterized by clenching or grinding of the teeth and/or compression of the jaw. It has two distinct manifestations: sleep (or nocturnal) bruxism, which are muscular activities that occur during (or daytime), characterized by repetitive clenching of the teeth and/or compression of the jaw. It is one of the main causes of temporomandibular dysfunctions.

The diagnosis of bruxism can be made subjectively by self-report of teeth grinding or by the partner, as well as by clinical examination through the evaluation of several signs such as tooth wear, mucous membrane and tongue trauma, among others.

The difficulty in diagnosing TMJ dysfunctions comes from the fact that the same symptoms are present in several oral pathologies. When we receive you at the Clínica Cerejeira e Leão, we will start by asking you to fill in a form reporting your clinical history, your symptoms and when you started noticing them, followed by a diagnostic exam.

To aid in the initial diagnosis we will need to use certain

Exams, among them:

Orthopantomography;
Computed Tomography of the Temporomandibular Joints;
Magnetic resonance imaging of the joints.

In some cases, the symptoms of Temporomandibular Dysfunction may disappear without treatment. If they persist, Dr. Joana Sardinha, responsible for TMD (Temporomandibular Dysfunction) treatments at Clínica Cerejeira e Leão, can recommend a series of treatments, based on the physical and oral condition of each patient. Among these treatments are:

Use of Occlusal Drops – removable, almost transparent acrylic plates customized to each patient with the goal of altering dental occlusion and preventing movements that can harm oral health;
Occlusal balance (with selective wear, oral rehabilitation, and orthodontic treatment when necessary);
Cognitive behavioral treatment;
Physiotherapy with stretching;
Exercises and massage of the masticatory muscles;
Botulinum toxin application – popularly known as “botox”. This toxin produces a blockage in the nerve endings leading to a reduction in muscle contraction, and is useful for a number of conditions where there is an excess of muscle contraction. It is applied to various facial and masticatory muscles, including the masseter, temporalis, and other muscles that may be associated with TMD, and results can be seen within 48 hours of treatment;
Pharmacological Treatment.

The goal of treatment is to reduce inflammatory conditions, relieve chronic pain, and restore function.

TMJ surgery is reserved for very specific situations.

The best prevention for TMD is to follow a healthy lifestyle and reduce stress levels, thus avoiding muscle tension, which is among the main causes of temporomandibular dysfunction. Other suggestions from Dr. Joana Sardinha is to avoid overloading the joint by reducing oral behaviors such as

placing the tongue between the teeth;
biting the tongue, cheeks or lips
biting objects, such as hair, pipe, pencil, pen, fingers, nails
reduce the use of chewing gum;
pay attention to posture especially in situations that require concentration, painstaking work, excessive time in front of the computer, or too much tension in certain sports.
create all the conditions for a restful sleep.

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