Mr Stefano Stea | London | Jaw Joint Problems
Jaw joint problems are common and may affect as many as 40% of the population at some time.
They are more common in females. They often begin in adolescence with pain and clicking in the joints which usually recovers, never to recur. A small group have further problems, some continuing into early adult life before symptoms subside. A very small percentage of these develop increasing symptoms and may end with chronic facial pain. Those who do not recover after the first episodes may develop continuous discomfort which can cause profound distress.
Temporomandibular joint dysfunction is ill-understood, but in general there are two groups of patients: those with normal anatomy, but abnormal function, and those with abnormal anatomy whose function may or may not be abnormal.
Regarding the first group (those with normal joint anatomy), there are several theories as to why they develop symptoms. On theory is that abnormalities in the way teeth fit together can cause abnormal movement of the joints with symptoms caused by muscle spasm. Another is that psychological causes and stress can increase temporomandibular joint symptoms and studies show that TMJ dysfunction patients have higher catecholamine levels than controls and indeed treatment with anti-depressants or sedation improves many of these patients. A further theory is that symptoms relate to habits (such as playing wind instruments or grinding teeth) and altering or eliminating these habits can reduce symptoms.
Whichever the theory followed, treatment usually involves conservative measures first and about 40-50% of patients will be improved by these alone. These include exercises, advice about diet, altering the dental bite with splints and medication to reduce anxiety and muscle spasm.
Regarding the second group (those with abnormal joint anatomy), problems can be with the bone itself (such as arthritis or ankylosis) or with the soft tissue of the joint (such as the cartilage).
With soft tissue problems the most common is meniscus displacement, where the cartilage within the joint does not function properly, and can get stuck in the wrong position, causing symptoms such as the jaw sticking open or closed (locking) or clicking loudly as the disc slips into or out of position. MRI scans may be used to demonstrate the position of the meniscus in function.
Problems with the bone itself may result in arthritis (inflammation of the joint) or even ankylosis (fusion of the joint). Ankylosis in the young can limit mandibular growth and cause distortion of the lower and the upper jaw, resulting in facial asymmetry.
Surgical treatment of patients with abnormal anatomy is complex and only undertaken after very careful evaluation and usually a thorough trial of conservative treatment. Operations can range from procedures to restore the meniscus to its correct position, through alterations to the joint anatomy, to joint replacement surgery.
Patients with temporomandibular joint disease place demands on time and clinical facilities and some are regrettably sufferers from chronic facial pain which is never really relieved to their satisfaction. These patients are best managed by oral & maxillofacial surgeons with a special interest in these conditions.