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Temporomandibular Joint Disorder - TMJ Disease - Medical Malpractice
TMJ disease is also called temporomandibular joint disease or disorder and it is abbreviated as TMD. It is a relatively common disease with as many as 75 percent of people having some signs and symptoms of TMD at some point in their lifetime. True TMD with all of the criteria to meet the disorder occurs in about 5 to 10 percent of people. It is more frequent in Caucasians and more frequent in women at a ratio of 4:1. Young adults are more likely to be affected, particularly those between the ages of 20 and 40 years.
The temporomandibular joint is located in the side of the face, just in front of the ear. We have two TMJs that connect the jaw or mandible to the rest of the face; these are important in the ability to open or close the jaw properly. The TMJ is a ball and socket joint with a ball that that glides across the underlying socket. There is a meniscus or fibro-cartilaginous structure that helps the joint glide and that fits between the two bones that make up the joint. Those with TMD can have damage or loss of the meniscus, which is very painful.
TMD is related to dental malocclusion. If your teeth don't fit together properly, you tend to clench your teeth and open your jaw in an unusual way that stresses the temporomandibular joint. You can also have bruxism or grinding of your teeth that can clench the jaw and harm the TMJ. There are two types of TMD. The first is called myogenous TMD and it is caused by the muscles of the face being too tense and pulling the TMJ out of proper positioning. The second is joint-related or arthrogenous TMD and this is due to injury to the actual bones of the joint itself. It is like having arthritis in the TMJ. Most patients have both types of TMD going on at the same time.
In myogenous TMD, the cause of the problem is usually spasm of the mastication muscles and muscular hyperactivity due to malocclusion. In arthrogenous TMD, the pain and difficulty noted with TMD is due to displacement of the disc within the joint. Patients often feel a pop or click when the joint is involved in the disease. Other causes of arthrogenous TMD include degeneration of the joint, rheumatoid arthritis, infections, cancers, ankylosis and dislocation of the joint.
The various causes of TMD include having a history of heavy use of the computer, having psychiatric issues, having a history of facial trauma, poor dental care or emotional distress. Patients who have eating disorders are at a higher risk of TMD. Related pain includes shoulder and neck pain and pain when clenching the jaw. One cause of TMD is bruxism or clenching and grinding of the teeth at night or in the daytime.
Symptoms of TMD include pain in front of the ears that is worsened with chewing that may turn into a sort of headache. It can be on one or both sides of the head. The pain can be aching with intermittent sharp pain. There can be a palpable pop, click or snap in the affected area of the TMJ. There can be limitations with the jaw opening and closing with locking of the jaw at times. Headaches are common.
The diagnosis of a temporomandibular joint disease depends on a thorough history and physical examination. Doctors ask about bruxism and the various symptoms you may have and will then feel the joint for clicking or popping when you open and shut your mouth. The range of motion is assessed and is often limited. There can be swelling of the joint itself.
Doctors diagnose TMJ also through lab work and x-rays. The lab work includes a rheumatoid factor, FANA (a test for lupus), a CBC (for infection) and uric acid levels (for gout). An arthrocentesis can be done to look for gout crystals in the joint space. X-rays of the joint can show degeneration of the bones and joint. An MRI of the TMJ can be done to show damage to the meniscus.
Treatment of TMD includes improving the bite, fixing malocclusion, hot and cold to the side of the face to relax and decrease inflammation of the muscles. Non steroidal anti-inflammatory medications can be used to decrease inflammation of the muscles. Physical therapy to the joint can help. In the worst cases, surgery is used to fix the meniscus or replace the joint altogether.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here