TEMPOROMANDIBULAR JOINT DISORDERS

Temporomandibular joint disorders are a collective set of problems involving the soft and hard tissues within the joint and/or the muscles of mastication. According to the classification made by the American Academy, there are 19 subgroups.

Contrary to what might be assumed, it may not originate solely from within the joint. For example, the problem of a person with restricted mouth opening might be a condition originating from the muscles rather than an intra-articular disorder. Or, it could be both.

It can affect the joint and/or muscle on one or both sides with varying severity. This condition can restrict functions such as speaking, eating, chewing, swallowing, and yawning.

​

CLINICAL SYMPTOMS OF TEMPOROMANDIBULAR JOINT DISORDERS

There are 4 main symptoms:

• Limitation in jaw movements

• Grating or clicking sounds during jaw movements

• Pain in the chewing muscles (muscles of mastication)

• Deviation (shifting) of the jaw to different directions while opening the mouth

​

OTHER COMMON SYMPTOMS:

• Ear pain, a feeling of pressure in the ear

• Headache

• Dizziness

• Vision problems

​

BRUXISM

Bruxism, simply put, refers to the grinding of teeth. Its prevalence in the population varies between 6% and 91%. It can occur in both children and adults.

While formerly classified as night and day bruxism, it is now classified as sleep bruxism and awake bruxism.

• Sleep Bruxism: In sleep bruxism, the muscles of mastication (chewing muscles) contract rhythmically. Sleep bruxism originates from the Central Nervous System, occurs in association with periods of lighter sleep, and can be a sign of a sleep disorder.

• Awake Bruxism: Bruxism seen in the awake state is considered a type of tic and is related to daily stress.

We can also categorize bruxism into two types: primary and secondary.

• Primary Bruxism: There is no underlying medical condition.

• Secondary Bruxism: A medical or psychiatric condition is present.

It is possible to determine whether a person suffers from bruxism by examining intraoral signs. The most significant finding is wear on the teeth.

​

BRUXISM TREATMENT

There is no known definitive cure for bruxism. However, treatment options are available aimed at preventing the damage it causes.

Regarding this, an EMG study has shown that soft appliances—which are very frequently produced in our country for this purpose—actually increase sleep bruxism by 50%.

Furthermore, it has been reported that such appliances lead to permanent changes in dental occlusion (bite) at a rate of 67%, causing intrusion (burying) of the molar teeth.

​

BOTOX (BOTULINUM TOXIN)

Botulinum toxin is a neurotoxin produced by a bacterium named Clostridium botulinum that affects the nervous system. It was first used therapeutically in humans by Scott in 1978 for the treatment of strabismus (crossed eyes).

Today, botulinum toxin is used in many fields for both aesthetic and therapeutic purposes. However, the FDA has approved the use of this toxin only for the treatment of the following conditions:

• Hemifacial spasm

• Blepharospasm

• Strabismus

• Cervical dystonia

• Hyperhidrosis (excessive sweating)

• Chronic migraine

• Glabellar lines (frown lines)

Use in Bruxism: There are only a few studies regarding the treatment of bruxism with Botox. These studies have reported that botulinum toxin alleviates severe bruxism by reducing voluntary muscle contraction. However, the use of botulinum for bruxism has not been approved by the FDA.

Furthermore, animal studies have shown that Botox exerts its effect not only on the injected muscles of mastication but also on the surrounding muscles. Additionally, it has been demonstrated that it causes osteoporotic changes in the jawbone due to the reduction in functional forces.

​

FREQUENTLY ASKED QUESTIONS (FAQ)

​

When should I see a doctor?
If you suspect you have a TMD (Temporomandibular Disorder), it is beneficial to see a doctor specializing in this field to clarify your condition.

​

Which specialist should I see?
There is no specific institution granting specialization in this subject globally or in our country. When choosing a doctor, you should consider criteria such as the doctor having received long-term training on this subject, possessing documentation of this training, and having conducted scientific research in this field.

​

What can I do until I see a specialist?

You can limit your jaw movements, and if your pain is severe, you may take a pain reliever that you normally use. You should opt for a soft food diet.

​

What is a TMD Examination like?

First, your doctor will review your detailed medical history (both written and verbal) to understand your condition. Then, they will perform a detailed physical examination of your jaw joint, teeth, and muscles. It is a painless procedure and takes a total of 30-60 minutes.

​

How is TMD treated?

TMD stems from multifactorial causes; therefore, its treatment must be multidisciplinary. 50% of patients benefit from pharmacological treatment, 40% use oral appliances (splints), and 6% benefit from conservative treatments such as physiotherapy. Only 1-2% of patients require surgical interventions such as arthrocentesis, arthroscopy, arthrotomy (open-joint surgery), or modified condylectomy.

​

My doctor gave me a soft night guard; can I use this for treatment?

First, your condition must be accurately diagnosed. If your physician deems it necessary, they may create a custom-made appliance for you using hard acrylic after taking the necessary measurements. Scientific research has shown that, contrary to expectations, soft appliances increase masticatory (chewing) muscle activity and are not recommended. It is emphasized that they can further aggravate clenching and grinding habits.

​

My doctor suggested surgery. Should I have it?

The rate of surgical treatment in Temporomandibular joint therapy is determined to be 5%. There are two types of indications for surgical treatments: absolute and relative. Tumors, growth anomalies, and ankylosis are among the absolute indications. For relative indications, parameters suggested by the association of oral and maxillofacial surgery should be considered. Surgical intervention is indicated only when non-surgical methods are ineffective and pain or dysfunction is moderate to severe. Surgical treatments are not indicated in asymptomatic cases or cases with very few symptoms. Furthermore, they should not be used as preventive treatment in cases where there is no pain and function is good.

​

My doctor said that the incorrect bite (occlusion) of my teeth caused the joint problem and needs to be corrected. Will this solve my problems?

The idea that the way teeth bite together causes TMD is a long-standing concept, but it has lost its validity as it is not supported by scientific data. In TMD treatment, irreversible treatment methods that permanently change your occlusion (such as veneers, tooth grinding/equilibration, orthodontic treatment, orthognathic surgery, etc.) should be avoided.

​

My jaw locked during orthodontic treatment. What should I do?

In this case, you must be examined by a TMD specialist to assess your condition, and if deemed necessary, the treatment should be paused. Your orthodontist will likely refer you to the necessary specialist in such a situation anyway. It is recommended that your TMJ status be documented prior to starting orthodontic treatment.

​

When will the existing sounds go away?

The goal of the treatment is not to eliminate existing sounds. What is important is that you perform your functions painlessly and effectively.

​

Will I use the appliance for a lifetime?

No. If your doctor deems it necessary for you to use an appliance, they will ask you to use it strictly during the treatment period. The duration of appliance use varies for each case. At the end of the treatment, your doctor will inform you about the situations in which you might need to use the appliance again.

​