The temporomandibular joint is a small joint located in front of the ear, near the skull, where the temporal bone and the mandible (lower jaw) meet. The temporomandibular joint is the most commonly used joint of the body, which makes gliding movements. The rounded end, in other words, the movable part of the chin on the upper back is called the condyle. The other side of the condyle is called the articular socket (socket). There is a disc of cartilage between the condyle and the socket. The disc acts as a cushion that absorbs the stresses and allows the condyle to move freely during jaw closure. Lower jaw attaches to the temporal bone with the help of the muscle and ligaments; and move and function thanks to these muscles. Depending on various factors, this function may be impaired and temporomandibular joint disorders (TMD) occur.
Temporomandibular joint disorders (TMD) develop due to many factors (multifactorial). There are many etiological (preparatory) factors and risk factors such as traumas to TMJ and surrounding tissues, malocclusions and parafunctional activities, genetic and developmental predisposition, and psychological tensions.
If we list them;
- Trauma: Acute damage to the joint may occur as a result of a blow to the face during a traffic accident, fight/fall.
- Occlusal factors: Chronic damage to the joint may occur as a result of excessive load due to malocclusion (inter-relationship of the jaws/teeth, tooth crowding).
- Parafunctional (movements other than chewing, speaking and swallowing) activities: Bruxism (involuntary teeth clenching/grinding habit) as well as cheek/lip/tongue biting, nail biting, holding pens or similar items in the mouth are among other common oral parafunctional habits. The intensity and frequency of parafunctional activities may increase with stress, anxiety disorder, sleep disorders and neuroleptic drug use.
- Gender: It is seen 4-6 times more in women.
- Age: The incidence increases with age
- Emotional stress and personality: Factors such as disappointment in the social environment, loneliness, losses, lack of value and job loss cause emotional stress. Emotional stress can lead to increased tension (tonus) in the masticatory muscles and various parafunctional habits.
Temporomandibular joint disorders are generally characterized by pain, joint sound (clicking) and limitation of lower jaw movements. In addition to these signs (symptoms), headache, dizziness, tinnitus and hearing loss may accompany the picture. Although approximately 75% of the Turkish population has TMJ disorders, 3-11% of the population has serious symptoms that will require treatment.
Displacement or dislocation of the disc located between the lower jawbone and the socket is the leading cause of TMJ disorders. A displaced disc may make a clicking sound. It also restricts jaw movements and causes pain during mouth opening and closing. One of the temporomandibular joint disorders is joint inflammation (arthritis). Arthritis develops as a result of injury or clenching at night.
The role of the oral and maxillofacial surgeon
When temporomandibular joint disorders occur, an oral and maxillofacial surgeon should be consulted. Oral and maxillofacial surgeons are able to diagnose problems correctly due to their command of the mouth, teeth and jaws. They may request various imaging tests.
Appropriate treatment for temporomandibular joint disorders is provided after correct diagnosis. Since TMJ disorders are multifactorial, there are conservative approaches in which different methods are used in combination in the treatment. Surgical treatments are preferred when conservative treatments are insufficient. The goal in the treatment of TMJ diseases is to determine the causative agent and to apply the appropriate treatment for the etiology. The success of the treatment depends on the motivation of the patient, cooperation with the physician and attention to the warnings.
Treatment is aimed at correcting the predisposing factors, eliminating the symptoms of the disease, and restoring joint movements. In most patients, the signs and symptoms of TMD improve over time with or without treatment. However, 85% recover within 3 years. Therefore, conservative/protective treatments should be applied before interventional treatments.
Initial treatment of TMD includes patient education, soft diet, reduction of parafunctional factors, physical therapy, medical therapy, improvement of sleep quality and application of therapeutic approaches such as occlusal therapy.
If conservative treatment is unsuccessful or damage has occurred in the joint, surgery is required. Surgery may involve repairing damaged tissue with arthroscopy or direct surgery.
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