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The temporomandibular joint (TMJ) is the most unique joint in
the whole body as it is two joints in one. The two joints, one on each
side of the head, are connected by the jawbone. One joint may influence
the function of the other joint. Because they are fused in the midline,
this means that you cannot move one joint without moving the other. The
two temporomandibular joints can differ in size, shape, and even in function.
It is possible to have a problem in one joint but have the symptoms expressed
in the other joint. You could also have a pain that starts on one side
of the head and migrates to the other side simply because of the relationship
of these joints one to the other.
The second factor making this joint unique is that another
structure dictates its function. This other structure is the teeth. The teeth
are passive members of the upper and lower jaw, but they have a specific
way they must fit together and interrelate. As far as the brain is concerned,
tooth position has priority over joint position. This means that the
TM joint is forced by the muscles to move so that the teeth will fit
together properly. This can potentially cause a mal-alignment within
the joint capsule. If this happens, the muscles are put in a compromising
situation causing them to spasm and resulting in pain. Many of the problems
you may be experiencing are the result of muscle spasm, but the cause
is not a muscle problem. The muscles are simply caught between two positions:
the tooth position and the jaw position.
The third factor making this joint unique is that it has an
articular disc located between the ball (condyle) and the socket (glenoid
fossa). This disc has a muscle attached to the front of it that pulls the disc
forward as the condyle moves forward in the glenoid fossa. The disc
is also attached in the back by elastic connective tissue that is much
like a rubber band and pulls the disc back as the condyle moves backward
in the glenoid fossa. In other words, this attachment can stretch and
recoil as the jaw opens and closes. Since the disc is a separate structure
and may move independently from the condyle, it can be displaced causing
many problems. We call this disorder an internal derangement of the
TM joint. Internal derangement of the TM joint can be a distressing
syndrome of pain, limited jaw movement, clicking, popping and crepitus
(a grating sound similar to the crumpling sound of parchment paper)
in the joint.
This derangement may be caused by genetic pathological changes
in the joint or acquired pathological changes as the result of trauma. Often, internal derangement of the temporomandibular joint is preceded
by myofascial pain dysfunction that can involve moderate to severe spasms
of the head, neck, shoulder and/or back muscles. A wide range of symptoms
may occur, such as headaches, muscle pain, ear pain, dizziness, stuffiness
and ringing in the ears, blurred vision, etc. Treatment of these conditions
needs to be individualized and may include a combination of medical
and dental therapies. Treatment of your particular problem will be determined
by your specific diagnosis.
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