Dr. Howard A. Israel
Diplomate, American Board of Oral & Maxillofacial Surgery


What causes the most common TMJ disorders?



Since TMJ simply refers to a part of the anatomy, as a diagnosis it isn't very meaningful. Imagine having severe pain in your knee for months and you decide to see the orthopaedic surgeon who is the knee expert.  The doctor spends over an hour reviewing your history and examining your knee.  He takes x-rays of your knww and then orders an MRI.  After this comprehensive evaluation you are escorted into the doctor’s consultation room by the nurse and you anxiously await the verdict.  The doctor walks in, sits down behind the desk, studies your chart, x-rays and MRIs and explains in great detail all of the anatomic structures and abnormalities present on these diagnostic tests.  You hold your breath awaiting the verdict that is your diagnosis.  Finally the doctor says “I have diagnosed your condition……,you have “knee.”  Of course, this is not a diagnosis and reflects a failure of your physician to provide you with a meaningful basis for treatment.  If your doctor tells you that you have “TMJ,”  you should realize that this term is the abbreviation for an anatomic structure, and has no diagnostic value.

Following a thorough evaluation by your doctor, a precise diagnosis is necessary because all treatment should be based on that diagnosis. If you're told that you have TMJ and your doctor leaves it at that, you should ask for a more specific diagnosis. Listed below are some of the more common ones associated with inflammatory disorders of the temporomandibular joint and surrounding muscles and structures. Many patients have some combination of the conditions listed below:

Inflammation (Synovitis)



Localized pain and swelling of the TMJ is often due to an inflammation of membranes inside the joint.  The synovial membrane produces the fluid that lubricates the joint surfaces and lines the interior surfaces with the exception of the cartilage.  The condition in which the synovial membrane is swollen and inflamed is called synovitis.   Pain in the temporomandibular joint is commonly caused by synovitis, and is associated with tenderness to touch of the TMJ, either from the area in front of the ear or from inside the ear. Jaw motion, such as opening and side-to-side movements, cause more pain in someone with this condition. There are a variety of causes of synovitis however, this condition is most commonly due to excessive trauma to the joint. So if you clench or grind your teeth, you are more susceptible to synovitis.

Muscle disorders



Disorders of the muscles that open and close the jaw are extremely common. A continuous dull aching sensation in the area between the cheekbones and lower jaw (in front of the TMJs) or in the temple region, is commonly associated with such disorders. For some reason, many people are susceptible to tightness and spasm of these jaw muscles — a problem exacerbated by stress. Those who clench or grind their teeth during the day or at night will often develop muscle tension and spasm, too. Common names for these muscle conditions include myofascial pain dysfunction, myospasm, and myalgia. Chronic and severe muscle spasm can increase pressure on the TMJ, contributing to synovitis or osteoarthritis.

Arthritis



Arthritis can occur in any joint in the body, and the temporomandibular joint is no exception. Osteoarthritis of the TMJ occurs when the cartilage in the joint breaks down, usually due to an excessive "load" caused by clenching or grinding of the teeth. The cartilage that is worn away results in a roughened surface, and symptoms include crackling noises in the joint, joint stiffness, and pain. Recent studies show that osteoarthritis of the TMJ is fairly common.

Disc Displacement


The TMJ has a cushion of cartilage called a disc that is located between the cartilage lining the bones of the joint.  Some people have discs that slip forward, resulting in a clicking or popping noise when they open their mouth widely. The clicking noise is made when the disc slips into and out of place in the open and closed mouth jaw position.  Some people with more advanced temporomandibular joint conditionsdevelop limited jaw opening, in which the disc remains in a forward position. In the past, doctors tried numerous treatments to get the disc to go back into position — bite plates and surgery among them — usually without success. But new research shows that 30 to 40 percent of people without any TMJ symptomshave disc displacement.  Recent studies indicate that disc displacement is not the cause of a TMJ problem, but the end result of a process in which there is poor lubrication in the joint (from synovitis) or impaired joint sliding from irregular cartilage surfaces (from osteoarthritis). The important point to remember is that a clicking jaw joint by itself does not require treatment.

Scar tissue



Scar tissue of the TMJ can be formed by acute trauma (e.g. a car accident) or chronic trauma (e.g. clenching or grinding), synovitis, or lack of mobility. Such tissue in a joint usually results in a limitation of jaw opening. Treatment requires "passive motion" physical therapy and sometimes surgery.

Other conditions

Other types of arthritis of the TMJ include those due to illnesses such as rheumatoid arthritis, Lyme disease, and gouty arthritis. In these conditions, swelling and pain of multiple joints usually occur. Blood tests and a referral to a rheumatologist are necessary for appropriate diagnosis and treatment. Although relatively uncommon, TMJ/TMD can be caused by more serious conditions such as tumors, jaw fractures, or neurological conditions.

Synovial Chondromatosis - a rare condition in the TMJ



TMJ Disorders - What Every Patient Must Know

Learn about the most common TMJ Disorders and what you an do about them in Dr. Israel's informative article . TMJ Update



Contact Info:

Dr Howard Israel
NY Presbyterian Hospital
Weill-Cornell Medice

525 East 68th Street
Suite F2132
New York, NY 10065

P: (212) 746-5175

F: (212) 746-8400

drhowardisrael
@yahoo.com

hoi2001
@med.cornell.edu