TMJ: What is it?

TMJ, TMD, TMJD, confused?

Sometimes we have common names or phrases for objects that really do not accurately reflect the thing we are trying to describe. When you sneeze do you ask for a ‘facial tissue’ or do you ask for a ‘Kleenex’? If you want dinner ready when you get home do you look for your ‘slow cooker’ or your ‘Crock Pot’? If you get hit in the back of the head by an errant ‘flying disc’ do you bend down and pick up the ‘Frisbee’? Brand names become synonymous with the actual item.

The same naming confusion applies to the syndrome or condition we call TMJ. TMJ has become synonymous with the over-reaching and annoying condition of head, neck and jaw pain. Across the world everyone refers to an actual anatomical structure as a description for a variety of pains and problems. The term TMJ is really just an acronym for the two jaw joints called the ‘Temporo-Mandibular Joints’. There is one on each side of your head, where the lower jaw connects to the skull. We all start life with the potential to have 2 TMJ’s.

TMJ-joint

Many years ago, the term for pain in and around the jaw joint were called “Temporo-Mandibular Joint Disorders” which quickly got shortened to TMJD or just TMJ.

New understanding of true causes of pain and dysfunction of the head, neck and jaws has relegated the TMJ to be at most a casualty and far from a culprit. New research and new perspectives have shown medical and dental doctors that the imbalance of how teeth bite, the imbalance of growth in the physical structures of the head and neck, and the relating physiologic stress are the true root cause of ‘TMJ’ pain.

Temporo-Mandibular Joint Disorders are a consequence of multiple factors related to impaired nasal breathing, physical injuries, dental care intrusion, age, and genetics.

While ‘TMJ’ is still the most commonly used term for the dysfunction of the head, neck and teeth, the scope of problems it chronicles are truly multi-factorial in scope with many possible outcomes and symptoms.

Further understanding has led to the connections between where your teeth bite and how your teeth move or function and medical problems such as migraines, neck pain, tension headaches, tinnitus, vertigo, sinus pain, and sleep apnea. As an increasingly more global view of the body is embraced, the interconnectivity of the teeth, jaws, head, neck, spine, hips, legs and feet is more apparent.

Do all Health Care Providers understand this interconnection?

Medical professions are broken up into segments or specialties. Heart surgeons do not treat spine injuries. Ear, Nose and Throat physicians do not deliver babies in their offices. All medical professions start from general education then focus on specific aspects of care. If you bring all of the specialties together you would be looking at a giant medical Jigsaw Puzzle.

The problem is that your body is NOT a giant medical Jigsaw Puzzle. It is interconnected, interdependent and interactive. You cannot alter one part of your body without causing a consequence within other parts of your body. This is very important when diagnosing the consequences of a dentist’s area of concern (the teeth, jaws and joints) and the physical structures of the head, neck, spine, and hips; the muscles, tendons and ligaments that attach the head, neck, spine and hips; the nerve connections that allow the head, neck, spine, and hips move, and all of the other parts of the body important to keeping us humans alive and productive.

So what is TMJ? It is a less than perfect term, used by the world at large, to try and encompass an ever growing understanding of the stress and strain on our physical structures and physiology. It is the same stress and strain that keeps us from playing Frisbee and enjoying a cooked dinner when we get home.

Do all Health Care Providers understand this interconnection?

Medical professions are broken up into segments or specialties. Heart surgeons do not treat spine injuries. Ear, Nose and Throat physicians do not deliver babies in their offices. All medical professions start from general education then focus on specific aspects of care. If you bring all of the specialties together you would be looking at a giant medical Jigsaw Puzzle.

The problem is that your body is NOT a giant medical Jigsaw Puzzle. It is interconnected, interdependent and interactive. You cannot alter one part of your body without causing a consequence within other parts of your body. This is very important when diagnosing the consequences of a dentist’s area of concern (the teeth, jaws and joints) and the physical structures of the head, neck, spine, and hips; the muscles, tendons and ligaments that attach the head, neck, spine and hips; the nerve connections that allow the head, neck, spine, and hips move, and all of the other parts of the body important to keeping us humans alive and productive.

So what is TMJ? It is a less than perfect term, used by the world at large, to try and encompass an ever growing understanding of the stress and strain on our physical structures and physiology. It is the same stress and strain that keeps us from playing Frisbee and enjoying a cooked dinner when we get home.

Getting Educated: Where is My TMJ?

Find your ears.

Usually there is one on each side of our head. Now about a finger width in front of the ear canal a bump can be felt that moves when you open and close your lower jaw or mandible.

Note: some TMJ’s do not work properly and will not move, as they should when you open your mouth. These are dislocated TMJ’s and usually a sign severe TMJ dysfunction. Call it a cry for help by the jaw joint.

The Temporo-Mandibular Joint is comprised of the ‘Temporo’ part. This is the bone in the skull called the Temporal Bone. It is where we get the word ‘Temple’ as being an area on the side of the head. The temporal bone has a concavity called the ‘Mandibular Fossa’. It is the ‘socket’ part of the TMJ.

The ‘Mandibular’ part of the TMJ is the mandible. It is your lower jaw. There is a bilateral joint (one on each side of the head) and the ‘Condyle’ of the mandible fits within the temporal bone in the mandibular fossa.

The ‘Joint’ part of the TMJ refers the function of the mandible with the skull and all of the ligaments and spaces required to make the mandible move smoothly.

My TMJ is really strong, right?

No.

The TMJ is NOT A LOAD BEARING JOINT. I have that capitalized to emphasize that unlike what some antiquated dental school texts state, the TMJ is actually just a guiding joint. Load bearing joints include the hips and knees and ankles. They support the body and are thick and sturdy. The TMJ does not resemble these robust bones. The bone composition in the condyle or ‘HEAD’ of the joint is very delicate and thin. On an x-ray called the Cone Beam Cat Scans (CBCT) the condyle often has the thickness of an egg shell (or less), with large open spaces beneath its outer covering. The TMJ is merely there to help guide the mandible movements created by jaw and neck muscle contraction and relaxation.

This “not a load bearing joint” reality is very important in placing its importance or the TMJ with respect to the function of the mandible. The hardest parts of the mandible are the teeth. The teeth provide a ‘stop’ for your mandible and attending muscles and nerves determine how the mandible and hence the TMJ are going to move. The teeth make the TMJ the only joint with a terminal endpoint of movement (where you bite) and support the condyle from being fractured by assaults from the real world. The TMJ’s are the only joints in the body that have TEETH as their protector and limiter.

If the teeth are not sitting in the most optimal position, if the upper and lower jaws do not position teeth correctly with respect to the rest of the head, the TMJ will suffer.

My TMJ is really strong, right?

No.

The TMJ is NOT A LOAD BEARING JOINT. I have that capitalized to emphasize that unlike what some antiquated dental school texts state, the TMJ is actually just a guiding joint. Load bearing joints include the hips and knees and ankles. They support the body and are thick and sturdy. The TMJ does not resemble these robust bones. The bone composition in the condyle or ‘HEAD’ of the joint is very delicate and thin. On an x-ray called the Cone Beam Cat Scans (CBCT) the condyle often has the thickness of an egg shell (or less), with large open spaces beneath its outer covering. The TMJ is merely there to help guide the mandible movements created by jaw and neck muscle contraction and relaxation.

This “not a load bearing joint” reality is very important in placing its importance or the TMJ with respect to the function of the mandible. The hardest parts of the mandible are the teeth. The teeth provide a ‘stop’ for your mandible and attending muscles and nerves determine how the mandible and hence the TMJ are going to move. The teeth make the TMJ the only joint with a terminal endpoint of movement (where you bite) and support the condyle from being fractured by assaults from the real world. The TMJ’s are the only joints in the body that have TEETH as their protector and limiter.

If the teeth are not sitting in the most optimal position, if the upper and lower jaws do not position teeth correctly with respect to the rest of the head, the TMJ will suffer.

What is the ideal TMJ position?

For the TMJ to function without having or causing stress to itself and surrounding structures, it will nestle without strain within the mandibular fossa of the temporal bone while supported by surrounding joint tissue. When the alignment of the teeth force the TMJ to sit in a strained position, all manners of symptoms can occur including pain, tinnitus, vertigo, ear congestion, limited opening, and limited function. When the alignment of teeth creates TMJ stain, the TMJ can either have malformed development or degeneration and destruction. You simply cannot stress any structural part of the body for a long time without a deleterious consequence.

It all sounds confusing.

We could not agree more. There have been many theories, philosophies, theorems, and guesses on how the structures and tissues of the TMJ, the teeth, the head, the neck, and the body all work. For decades, the ‘separate puzzle piece’ theorem was in favor. This has changed with the reality that we cannot treat any part of the body as if it floated alone in space. Actions create reactions. And the way the body solves the problems of living means these reactions can alter our lives. We have to consider our actions carefully.

Physiology … How your body solves problems

The body does anything to survive. Physiology is really how our body solves problems it encounters. The first problem is breathing. Your body will do anything to get its next breath. If your nose is plugged you mouth breath. If the back of your throat area is constricted or narrow, you will stretch your neck out to help open your airway. This can cause structural strain, imbalance, muscle cramping, and pain in your head, your neck, your back, your hips and even your feet. All from switching from nasal breathing to mouth breathing.

Can my lower back pain mean I am a mouth breather?

Any postural change of the head and neck will create consequences for muscles, nerves and structures of the body. Forward Head Posture is a very real problem in posture. Carrying your head forward to facilitate getting an easier breath will cause stress and strain to all of the body. Often pain in the lower back begins with compensation of hip and back muscles related to a forward head posture that is related to having a short and narrow upper jaw causing the tongue to sit back in the mouth, blocking the airway from the nose. This gets complicated.

Can my lower back pain mean I am a mouth breather?

Any postural change of the head and neck will create consequences for muscles, nerves and structures of the body. Forward Head Posture is a very real problem in posture. Carrying your head forward to facilitate getting an easier breath will cause stress and strain to all of the body. Often pain in the lower back begins with compensation of hip and back muscles related to a forward head posture that is related to having a short and narrow upper jaw causing the tongue to sit back in the mouth, blocking the airway from the nose. This gets complicated.

I thought that ‘TMJ’ was only pain in the jaw joint.

There are so many complications related to the way we breathe, bite and balance that when you do the math (and it is possible to do the math) there are more ways a person can express their physiologic compromise that there are stars in the sky.

All the stars in the heavens

The number of signs and symptoms related to a malocclusion or bad bite can easily run up to 46 expressions of problem. Add variations in timing of symptoms (chronicity) and varying pain from symptoms (severity) you end up with options found by multiplying 46 x 45 x 44 x 43 … etc.

This gives you a number that is very big. This is roughly 8.16 X1047. There are an estimated 4.0 X 1011 stars in the Milky Way (our home galaxy). Isn’t math fun?

So there are many ways that a simple reaction to nasal breathing or an injury to your body, or even a new filling on a tooth that touches too soon, can be expressed.

So how does anyone figure all of this out? It seems hopeless.

Actually, the therapy for treating TMJ or TMD is usually fairly simple. Either you need your bite to be rebalanced or realigned or both. The key is measuring before treatment. Using new technologies can assist the dentist in determining the stress within the bite and the stress within the jaw muscles and bony structures.

Adjusting the bite using sensitive measuring equipment has been shown to be superior to the traditional methods.

I encourage you to find out more and search for a TMJ practitioner in your area.

So how does anyone figure all of this out? It seems hopeless.

Actually, the therapy for treating TMJ or TMD is usually fairly simple. Either you need your bite to be rebalanced or realigned or both. The key is measuring before treatment. Using new technologies can assist the dentist in determining the stress within the bite and the stress within the jaw muscles and bony structures.

Adjusting the bite using sensitive measuring equipment has been shown to be superior to the traditional methods.

I encourage you to find out more and search for a TMJ practitioner in your area.

Quality TMJ Education Programs

In every field of healthcare, new courses and programs are developed constantly to help both physicians and patients expand their knowledge. This helps the two groups collaborate together to diagnose issues quicker and implement successful corrective action. From TMJ 101 to advanced concepts, getting the right education is important. It can be easy to browse the internet and get information from any source, but this can sometimes result in more confusion. TMJ – What is it? It’s a condition that can be treated easily by applying the right methods under appropriate conditions with trained professionals. Getting educated in a proper manner with correct materials is the first step to tackling this issue.

TMJ.Today provides one, two, and three week courses to help patients and dental practitioners alike understand TMJ-related conditions. Click here to find out more about enrolling in these courses today!

Find a TMJ practitioner in your area.

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