The jaw joint (TMJ - Temporomandibluar Joint) articulates or joins the top of the mandibular condyle (top of the lower jaw) and the cranium (head) to each other.  This TMJ is a one of a kindtype of joint. It moves in one plane (rotates in one spot) with small mouth opening and translates (actually moves out of the particular fossa or socket) with wide mouth opening.  This makes this joint very susceptible to injury from any deviation from a normal bite or use.

TMJ dysfuction occurs when the condyle (top of lower jaw) is not seated or placed in a perfect position - the cartilage that is between the two bones (cranium and mandible) is no longer between the bones so the bones have no cushion(cartilage).  After using the jaw without the in-between cushion or cartilage, the muscles of mastication (eating) become painful and finally cartilage and bone damage occurs producing an arthritic condition. Symptoms can range from a small soreness in the joint (in front of the ear), clicking or popping noise in the joint (cartilage movements), to difficulty in opening/closing the mouth, to severe muscle spasm/pain that can radiate in the temporal region, eyes, cheeks, lower jaw and sinus. After this dysfunction has been present for awhile, the patient will recognize other muscles becoming painful and stiff (neck, shoulders, lower back).

The dentist is uniquely qualified to diagnose and treat this condition becausemany of the reasons for TMJ dysfuncion occur due to the dental occlusion or bite abnormalities - which may have been caused by missing teeth not replaced, the anatomy of the jaws (too narrow/wide), poor fabrication of dental treatment (fillings, crowns, bridges, dentures) causing irregular bite, trauma (sports injury, car accidents, etc.) or overuse of muscles (grinding/clenching) and in conjunction with diet.

Treatment modalities - your options for treatment:

• If symptoms have only recently been noted - bite analysis by the dentist, soft diet, anti-inflammatory medications (NSAIDS), ice packs - treat like a swollen ankle, discomfort can be alleviated in this reversible condition.
• If symptoms have occurred from over-use --- bite analysis by the dentist, discontinue chewing gum, soft diet, NSAIDS, ice packs - if this does not help, an intra-oral device (nightguard - discussed below ***) can be used with the proper bite. the bite guard (only contacting the anterior teeth) may always be needed to be worn to keep symptoms diminished; physical therapy or TENS treatment may be recommended
• If this is a chronic problem or trauma has destroyed the integrity of the joint, a special work-up by the dentist and special guard needs to be placed; different from above since all the teeth need to contact this device; physical therapy is mandatory to eliminate other muscle spasms in the body; TENS treatment and physical therapy should be considered BEFORE night guard is fabricated.

***Night guards (also known as occlusal guards, NTI, MORA, occlusal splints) are each designed for the specific dysfunction presented by the patient. No one type will treat all the stages of this TMJ dysfunction!!  Over the counter mouth guards work to protect the teeth from grinding/clenching but will not protect the TMJ or stop the muscles from contraction and spasm, which causes the pain. Without positioning the joint in a proper position, symptoms will continue to worsen and joint sturcture will continue to break down. If this dysfunction is allowed to continue, sometimes surgery is the ONLY hope for alleviating pain/discomfort. Surgery is only the last resort since it is not a very successful procedure in this area (remember the beginning statement of the unique type of joint).

This is a very difficult problem to diagnose and treat - it is not just a simple fix, like putting a filling in a cavity.  This disease requires a "whole body" treatment - bite and diet analysis (limit caffeine and nicotine, sugars), physical therapy, life-style changes (phone held by neck while talking, etc.), daily exercise given by the physical therapist (one trained in head/neck dysfunction) and specific oral device depending on duration of the dysfunction and joint damage.