TMJ is a “catch all name” that refers to your Temporal Mandibular Joints. You have one jaw with a joint at each end, right in front of your ears. If you place your fingers in front of your ears and open and close, you can feel how your joints work forward and back. When you have problems in either or both joints like clicking, popping or grinding, we use the term TMD or Temporal Mandibular Dysfunction!
Faulty or poor positioning of your TMJ’s results in a poor bite which can result in either/or sore, worn or broken (especially front) or loose teeth (gum disease). If you avoid biting by holding your jaw in other positions, you will have head &/or neck aches, often misdiagnosed as migraines. Your dental bite and TMJ issues must be evaluated by a well-trained dentist to eliminate these possibilities. One of the more difficult issues is this bad jaw joint relationship resulting in repeated chiropractic neck and back adjustments. If your adjustments do not “hold”, the mal-position of your bite keeping your neck and back from resolving. My experience is that once the bite is harmonized with the proper position of the jaw joint (Dr. Piper classifications), chiropractic adjusted hold for a much longer time.
Each joint must function properly to avoid future deterioration and pain. When a good examination is done by your dentist, one must evaluate the position of each condyle (the part attached to the jawbone) and how it is located in its fossa (base of your skull).
Figure 1 to the right is the correct position.
Figure 3: is a front to back (anterior/posterior) view of a joint assembly with the condyle against the skull bone. This location is called the “glenoid fossa”.
Figure 5: Front view of a healthy joint
Dr Mark Piper explains the breakdown of joints from healthy to fully diseased in its various stages. This info can be found at http://www.pipererc.com/tmj.asp He has coined the phrase “Joint Based Occlusion” on which I base my restorative dentistry.
The Doppler is used in our examination, allows us, including you, to hear and grade any clicking, popping or grinding in either jaw joint. These sounds along with physical exam can be correlated to 3D imaging for diagnosis and prognosis of your TMD issue.
Visual Aids: We have 3 animated computer programs that help show and explain to you the particular problems you may have with your bite and temporomandibular joints (see the view to the right). They are BiteFX and 2 of Dr. Piper’s TMD Program. When you have a New Patient Examination, with these exams we use the doppler with the Piper program to help you hear your joint sounds, if you have any.
If necessary, due to your health history, we may require a more Comprehensive TMD History and Examination to better understand the extent of your problem and how it may effect your treatment.
Figure 6: Damage is beginning, you feel clicking & popping in the ear as the condyle slips off the disk. As you open, your jaw swings to that side but then comes back to the center
Figure 7: When you reach the point that the disk is completely off the disk. It feels like your jaw "locks open" to that side, your bite is unstable and prognosis is guarded.
There is a right & left joint in the lower jaw,
so what happens to one affects the other!
Many thanks to Jim McKee for the illustrations!
Transcranial (across the skull) x rays are of limited value due to distortions and overlapping structures.
Tomograms or sliced radiological views are more helpful.
Galileos 3D Cone Beam (see our section “Imaging & more ...) is best in that it gives us 3 dimensional view of the joint from 3 directions in 0.3 mm increments. It does not show the soft tissues, only spacing burt is invaluable to determine is there is bony degeneration of the condylar heads on the medial or lateral poles of either joint.
MRI gives a view of the soft tissues too so you can see the position of the disc. Due to cost, this is rarely used and a referral is necessary.