Jaw Joint Disorder

Jaw joint disorder is a disorder that is mostly seen in young and middle ages. This disorder manifests itself with symptoms such as headaches, ear, jaw-face pain, tinnitus, noise coming from the jaw joint, limitation in opening the mouth, pain or shifting. Sometimes it continues for years without clinical symptoms, while sometimes it continues as a disorder that makes people fed up.

An ideal jaw joint does not attract the attention of the person in daily life. Some of the changes that will attract attention do not require any treatment, but inevitably cause the person to focus on that issue. In many people in society, the jaw joint has a different anatomy and function than normal, but it is not noticed in the daily rush. The difference in the jaw joint is usually noticed during periods when psychological pressure increases, such as exam periods, etc. and when the person starts to listen to himself.

Causes

• Partial or complete tooth loss in the mouth
• Trauma; A traffic accident, a collision, a severe blow to the area, a difficult tooth extraction, tooth extraction or other dental interventions that take a long time
• Incompletely adapted dentures
• Sudden and dramatic change in the closing balance, which we call occlusion in the mouth (all teeth covered with porcelain, etc.)
• Gum chewing habit
• An anatomical weakness that exists or may develop due to a familial predisposition in the structures that form the joint
• Osteoporosis. Changes in the bone structure of women at older ages may cause a problem when combined with some other factors
• Rheumatoid arthritis. This condition, which causes discomfort in all joints, can also affect the jaw joint
• Infection
• Tumors

Your jaw joint, which is affected by your maxillofacial muscles, the closing of your teeth and your jaw bones, has a complex structure. Each of these three structures is very important for the harmony of your joint. Your muscles should be flexible and balanced. Your teeth should be balanced in complete physiological and biological harmony and should have a regular closing. Opening and closing movements of the mouth should be within physiological limits.

Symptoms

Teeth clenching or grinding (bruxism) is a common symptom of TMJ disease. Clenching or grinding of teeth puts excessive stress on tired muscles, which can cause pain in the head, neck, nape and shoulders.

Headaches are one of the most common complaints of TMJ patients. These pains can be confused with migraine pains. TMJ-related headaches are especially in the temple area, behind the eyes, at the back of the head, neck and shoulders. Migraine headaches are unilateral. The pain occurs visually with discomfort or light. The treatment of such pains is different. If you suspect migraine pain, you should consult a neurologist. If you have a TMJ problem, you should see a dentist who specializes in this area.

One of the most common symptoms of TMJ problems is clicking, clicking, grinding sounds coming from the jaw joint. When the patient opens their mouth, the jaw joint moves forward and slides over the dislocated disc, and at this moment, a clicking sound is heard. The grinding sound called crepitus indicates that bone rubs against bone and the dislocated disc is completely deformed. The purpose of the disc is to cushion and protect between the lower jaw (condyle) and the glenoid fossa in the upper jaw.

When this protective disc is deformed and dislocated, the two bones rub against each other, and sounds called crepitus occur. Another symptom occurs during opening and closing. Doctors try to treat at the stage where the clicking sound occurs and do not want to wait until the stage where pain occurs in cases such as creaking, opening and closing.

If patients hear sounds such as ringing in the ears, buzzing, or have a problem such as congestion without any ear infection, it may be an indication that TMJ has a skeletal problem. Other symptoms include hearing loss, buzzing, and loss of balance. If the joint is positioned too far back and the disc is positioned too far forward, it can cause spasm in the chewing muscles. If your otolaryngologist cannot find a reason for your hearing problem and other symptoms, you should see a dentist who specializes in this field.

Patients with condyle problems also have sleep problems. The brain prevents reaching the deep sleep stages and does not have a comfortable sleep. Patients cannot rest enough and experience insomnia and lack of energy throughout the day. Another reason for sleep problems is the pain caused by muscle spasms and tensions that occur with the disc being positioned incorrectly as a result of squeezing and grinding.

Another symptom of TMJ dysfunction is depression. These patients complain of chronic pain that is constantly increasing and has no solution. Depression is a problem for both the dentist and the medical doctor. If the pain is caused by an infection, tumor, malnutrition, systemic diseases, allergy or trauma, another specialist should be consulted.

Also

• Limited opening or locking of your jaw
• Pain or stiffness in the neck
• Dizziness, fainting
• Pain while chewing
• Facial pain
• Pain when closing your teeth on top of each other
• Facial fatigue while chewing
• Numbness in the hands
• Difficulty yawning

Control Methods

• Put your fingers in your ears, open and close your jaw a few times. Do you feel any clicking or popping sounds?
• Stand in front of a mirror and slowly open and close your jaw. Does it shift to the other side or cause pain when opening?
• Shift your jaw from side to side and note any pain.
• Place your fingers on the area where your joints are, slightly in front of your ears, and apply pressure to your cheek area.
• If you experience any discomfort or pain in your jaw joint, consult a dentist who specializes in TMJ.

Types of Joint Problems

Internal irregularities

• Jaw joint fractures
• Fusion of the jaw joint to the base of the skull (Ankylosis)
• Pathological growths, tumors in the jaw joint
• Dislocations in the jaw joint
• Osteoarthritis

Internal Joint Irregularities

They are changes due to irregularities in the structures that make up the jaw joint. They are characterized by noise, pain, narrowing of the mouth opening and difficulty in movements in the jaw joint. The factors that cause the problem are listed above, and all factors except tumor and infection play a role in the occurrence of this disorder.

This group is the most well-known and most common joint disorder among the public. Characterized by the loosening of joints and ligaments whose anatomy is disrupted for one or more reasons and the joint disc sliding forward or sideways, this picture exhibits a clinical appearance such as pain in chewing, limitation in mouth opening and even inability to open at all in the later stages.

Treatment

It depends on the severity of the disease. In the early stages, it is important to eliminate the cause. If there is a missing tooth, it should be completed, incompatible prostheses should be corrected or renewed, and disorders in the closing balance, which we call occlusion, should be eliminated. It should not be forgotten that even a high-set dental filling can cause this discomfort in some patients. A bite plate should be used to help the disc rest. In addition, long-term, controlled and appropriate drug treatment will be very useful. In more advanced cases, additionally, arthrocentesis, which is the simplest form of surgical intervention, is the washing of the joint spaces (one or more times) and intra-articular drug application can be performed.

Jaw Joint Fractures

Jaw fractures are different from other bones in the body in terms of treatment principles. Joint region fractures, on the other hand, are quite different from other region fractures of the jaw.

The history of its treatment dates back to very old times. Today, instead of treatment methods that will alienate the patient from society as in Figure 10, it is treated by tying the teeth inside the mouth or surgically as presented in Figures 11 and 12. In the technique of tying with wires inside the mouth, the patient's mouth remains closed for about 3-4 weeks, whereas in the surgical fixation method, the mouth is opened within 1-3 days and the patient's normal chewing ability is immediately returned.

Joint Fractures in Children

Although maxillofacial region fractures are less common in children compared to adults, the joint region is most frequently affected by these fractures. One of the most important problems in our society is that the child is dropped from the lap or from a high place and a jaw joint fracture that has occurred is not noticed. Unnoticed joint fractures are one of the most serious problems of jaw surgery in the future; It causes jaw ankylosis, which leads to problems such as inability to eat and facial deformity in the future.

Joint Fusing to the Skull Base - Ankylosis

As partially mentioned above, ankylosis treatment is a difficult and serious problem, and its cause is completely the result of late or incorrect treatment of the jaw joint fracture. Since this problem occurs in childhood, it will negatively affect growth and development, and will cause facial deformities.

The treatment is definitely surgical and requires long years of follow-up. According to international principles, this disorder requires 5-8 years of follow-up, even if the surgery is very successful. It is possible for the patient to see the doctor again after 5 years with a recurrence. An inappropriate surgery, the patient not being followed up for long periods, and the ankylosis becoming very severe as a result of seeing the doctor years later may negatively affect the results of the surgery. As with almost every disorder, starting treatment early has a positive effect on both the doctor and the patient.

Pathological Growths in the Joint

In the jaw joint area, developmental problems and tumoral structures can be encountered, although rarely, as in other joint areas of the body. The treatment for these is surgical.

Some patients complain that their jaws dislocate when they yawn or open their mouths too wide. Although most of these types of complaints are confused with other complaints of the joint, the experiences of some of our patients confirm true joint dislocation. In true joint dislocation, the patient's jaw moves forward and down, taking on a very painful shape.

There is no possibility for the patient to close their jaw on their own and it can only be done by a physician. Since there is no specialist in this field in every region of our country, even though the jaw has been placed with emergency intervention, a jaw surgeon should be consulted in the following days to investigate the real cause of the event and to start preventive treatment to prevent recurrence. Most of our patients who have experienced this type of disease come to us with a recurrence of the disease.

If a specialist is consulted after the first dislocation, it is treated with preventive treatment and follow-up to prevent recurrence. Since a recurrence of the disease once will bring about further recurrences, it can only be treated with surgery at this stage.

This disease causes deformities in the joint surfaces as in other joint areas. Treatment is with medication and, if necessary, surgery in the later stages.

Treatment Methods

Your dental examination, which helps to understand the causes of the jaw joint disorder, constitutes the first stage of your treatment. Your detailed examination by the dentist is not only about the jaw joint disorder but also about your overall health. Questions are asked about whether you are under stress, whether you clench your teeth, whether you grind your teeth, and whether there are any complaints about the jaw joint in your family. The answers and examination results obtained from you are used to try to understand the causes of your disorder.

Again, during the examination, it is tried to understand whether there is a nervous system or orthopedic disorder that will affect your muscles, whether your jaw-face and neck muscles work in harmony. Your doctor completes your examination by palpating your jaw joints with your fingertips to see if there is pain, opening and closing your mouth to see if there is pain in your jaw joints, whether there is a sound coming from your jaw joints, whether your lower jaw shifts when opening and closing, and by measuring your maximum mouth opening.

Although there is no single definitive treatment method for jaw joint disorder, there are many different treatment methods that will significantly reduce the symptoms. Your dentist may recommend one or more of the following:

• Relieve muscle spasms and pain by applying mild heat or taking muscle relaxants, aspirin or similar painkillers or painkillers,
• Wear a protective plate (occlusal splint), also known as a bite plate, which is custom-made and placed over the teeth and prevents them from catching on the teeth in the opposite jaw, thus reducing the harmful effects of clenching and grinding,
• Learn relaxation techniques to control muscle pressure in the jaw,
• Your dentist may recommend that you receive training or counseling to reduce stress,
• If your jaw joints are affected and other treatment methods have failed, then jaw joint surgery may be recommended.