TMJ disorders are disorders that involve the temporomandibular joint and its supporting structures. TMJ disorders are also known as TMD or temporomandibular disorders. All TMJ disorders can be broken down into those that originate in the joint itself and those that originate in the structures surrounding the joint. There is adequate research to show that between 80% and 90% of all TMJ disorders are caused by injury to the joint itself.

Most injuries to the TMJ cause an injury to the TMJ disk ligaments. The TMJ disk is a piece of fibrous connective tissue that separates the TMJ ball from the socket. If you have clicking from your TMJ, then the disk is usually slipping in and out of place. If you have an inability to open your mouth more than half of normal, then the disk may be out of place at all times. If you have grinding noises from your TMJ, then the disk may be out of place at all times and the ball is contacting the bare socket.

There is research to show that 30% of the population who think they have normal TMJs actually have a disk displaced in one of their TMJs and do not know it and have no symptoms from the condition.

The top twelve symptoms of 48 consecutive complex chronic TMJ patients were:

If you have the above symptoms, then you should be evaluated by a dentist who treats temporomandibular disorders and craniofacial pain.

Temporomandibular Joint disorders are usually caused by injury to the ligaments in the TMJ.  This injury to ligaments is usually from acute macrotrauma. Trauma can be a blow to the jaw or an abrupt opening of the mouth. An abrupt opening of the mouth may cause stretching of the TMJ ligaments and may occur during emergency intubation for general anesthesia or during a motor vehicle whiplash injury.

There is no research which shows that grinding teeth (bruxism) at night or in the daytime causes TMJ disorders. Therefore, we cannot say that grinding teeth causes TMJ disorders. Grinding your teeth may cause a TMJ disorder to be more painful due to loading of the TMJ apparatus.  Grinding your teeth may cause slight, moderate or severe damage to your teeth.

There is no research that shows that stress causes TMJ disorders. Therefore, we cannot say that stress causes TMJ disorders. Stress may cause a TMJ disorder to be more painful.

There is no credible research that shows that a bad bite or malocclusion causes TMJ disorders. Therefore, we cannot say that a bad bite or malocclusion causes TMJ disorders.  A bad bite or malocclusion can cause a TMJ disorder to be more painful.

There is research which shows that orthodontic treatment does not cause TMJ disorders. This research also shows that orthodontic treatment done with extraction of teeth does not cause TMJ disorders. Orthodontic treatment alone does not usually help a TMJ disorder either.

There is research which shows that routine extraction of teeth does not cause TMJ disorders.

There is research which shows that extraction of wisdom teeth (third molars) when all four are extracted at one appointment may cause TMJ disorders.

Not everyone who has a clicking or grinding sound from their TMJ needs treatment. There are several measures as to who needs treatment.  One of the easiest guides is to use my PDQ^® Evaluation.  If you do not have one of the three elements of the PDQ^®Evaluation, then you probably do not need TMJ treatment.

Pain upon opening your mouth, eating food, swallowing, talking, or yawning

Dysfunction – which means an inability to open your mouth fully to normal opening without problems and cannot move your jaw in all directions without hindrance

Quality of life – which means that your TMJs are causing you a negative change in your quality of life (your friends make fun of your jaw popping, etc.)

This method actually makes sense. If you have no pain, how can a health care provider relieve your pain? If you have no problem in moving your jaw, how can a health care provider make you move better? If you have no negative change in your quality of life from your TMJs, how can a health care provider improve this?

If you do have some or all of the above PDQ^® Evaluation components, then you may need to seek care with a dentist who diagnoses and treats temporomandibular disorders and craniofacial pain. The level of care you will need is generally based upon your severity and complexity of symptoms.

All treatment of TMJ disorders can be broken down into two types:

Definitive treatment

Definitive treatment is treatment with a goal of correcting the disorder. TMJ disorder treatments that fall under this category are:

A: Nonsurgical Definitive treatment:

• Anterior Repositioning Appliance therapy 24 hours a day with permanent alteration of the bite with orthodontics, crowns, bridges, or partial dentures

B: Surgical Definitive treatment:

• Modified Condylotomy Surgery

Supportive treatment

Supportive treatment is treatment with a goal of helping an individual adapt to their disorder. TMJ disorder treatments that fall under this category are:

A: Nonsurgical Supportive treatment:

• Anterior Repositioning Appliance therapy less than 24 hours a day and no bite alteration
• Flat plane splint therapy
• Pharmacotherapeutics (drug treatments)
• Physical therapy
• Night guards or occlusal guards
• Biofeedback
• Soft diet
• Alteration of bad oral habits

B: Surgical Supportive treatment:

• Arthrocentesis (flushing out the joint)
• Arthroscopy (looking into the joint)
• Menisectomy surgery (disk removal surgery)

When the patient’s condition allows, Dr. Devine uses definitive treatment methods. Dr. Devine believes that correcting a disorder is superior treatment to helping a patient to adapt to their disorder.