Why is Understanding the Anatomy of the TMJ Important?
The TMJ is one of the most important joints in your body. It gives you the ability to open your mouth to speak and eat. But we don’t always think about the jaw joint the same way we think about the knee or the hip.
Did you know that the TMJ is just like the knee, hip, or elbow?
Yes, there are some differences between them. But at the end of the day, the TMJ is a joint. The anatomy of the jaw joint is like the anatomy of the knee or the hip.
There are ligaments. There are tendons. There are muscle attachments.
The anatomy of the jaw joint should affect how we deal with TMJ disorders. We need to take care of it like we take care of our knees and hips. When we understand the anatomy of the jaw joint, we can take a more orthopedic approach to TMJ disorders. Knowing the structure of the TMJ allows us to offer a more accurate diagnosis. A more accurate diagnosis means more effective treatment options.
Let’s look at the Anatomy of the TMJ.
The TMJ is made up of two bones joined together which allows for the movement between those bones. Inside the joint, there are ligaments that hold it in place. Cartilage and tendons are also important parts of the jaw joint.
There is also a synovial disc. The synovial disc contains fluid that lubricates and provides nutrition to the joint. The synovial disc allows for better movement and keeps the joint healthy.
What Problems Can Occur Within the Joint?
Whenever your bite changes or you lose a tooth it can affect your jaw joint. In these situations, there is extra pressure on the TMJ. This pressure causes damage. It’s like putting extra pressure on the knee or the hip. If you spend a long period of time on your knees, for example, damage will occur. The TMJ is no different. If we put too much pressure on the jaw joint, we can cause damage, resulting in TMJ disorders.
The synovial disc often plays a role in TMJ disorders. A lack of synovial fluid can cause cartilage cells to thin. Thin cartilage cells can become damaged. Damaged cartilage is difficult to repair when there is no synovial fluid. The result is a breakdown of the jaw joint. The bones begin to wear down and become damaged, leading to TMJ disorders.
How Do We Take Care of the TMJ?
Understanding the anatomy of the jaw joint helps us take care of it better. We treat the TMJ like we treat the knee or hip. If you injure your knee, what will your doctor say?
Take some pain medication.
Maybe ice it.
Well, it’s the same thing for the TMJ. If you are experiencing pain in your jaw the first thing we need to do is rest it. Eat softer foods. Don’t chew gum for a while. Give it a chance to repair itself. We may prescribe anti-inflammatories and recommend icing the joint to help with the pain.
In some cases, when you injure your knee your doctor may prescribe a knee brace to help support it. We can support the jaw joint in a similar way. For some patients, a mouthguard or bite brace can help. Mouthguards are especially helpful for patients who grind or clench their teeth. Grinding and clenching can not only cause damage to the teeth. They can also put unnecessary pressure on the jaw joint. Mouthguards keep that damage from happening.
And like in the hip or knee, there are certain cases where conservative methods won’t work. There are times where surgery is the only permanent solution to TMJ disorders. Again, this is where anatomy can help us determine whether or not surgery is necessary. In the same way, a doctor would evaluate the knee or hip, we should be looking at the jaw joint carefully. We need to make sure we account for any damage that has taken place. We want to use conservative treatments as much as possible, but it’s also important to know when surgery is the best solution for our patients.
How the Anatomy of the Jaw Joint Helps US Determine Treatment Options
In order to determine what treatments are best for each individual patient, we need to be able to examine the joint well. This involves not only feeling it but also getting scans so we can see what’s going on more clearly. A doctor evaluating your knee will take several scans of the knee before recommending treatment. This is because they want to see everything that is going on inside the knee so they can address those issues. We want to do the same thing with the jaw joint.
We need to be able to see inside the joint. So, we’ll take X-Rays and even an MRI so we can see the whole picture. When we understand the anatomy of the jaw joint we can detect where damage has occurred. And we can figure out the cause of that damage. Once we understand what’s going on, we can offer treatment options that actually work for you.
Taking an Orthopedic Approach to TMJ Disorders
PRECiDENT believes that understanding the anatomy of the jaw joint is crucial for treating TMJ disorders. When we understand how the jaw joint works, we can take a more effective orthopedic approach to issues within the jaw joint. This allows us to see exactly what is going on within the TMJ, so we can give our patients the treatment options they really need. Some patients will be just fine with rest, pain medication, and ice. Others will need a mouthguard. And there will be some situations where the only real solution is TMJ surgery. But the only way we can know which treatment option is best for our patients is to understand the anatomy of the jaw joint.
If you are experiencing jaw pain, earaches, and frequent headaches, you may be one of the millions of Americans who suffer from TMJ disorders. TMJ disorders happen when your jaw joint, otherwise known as the temporomandibular joint, is damaged or misaligned. TMJ disorders can happen for a number of reasons including injury, arthritis, stress, and even poor posture. The symptoms that come with TMJ disorders can be frustrating and make it hard to enjoy life. If you’ve already spoken to your doctor, they possibly have prescribed pain killers and a bite brace. They may have told you to try to avoid any sources of stress. And even though you’ve followed their instructions exactly, you’re still in pain. In fact, your symptoms are getting worse. But, you keep on trying to manage the pain in the hope that you’ll find relief.
Unfortunately, many TMJ patients are stuck simply managing their pain with pain killers and bite braces due to an inability to reach a complete diagnosis. Diagnosing TMJ disorders can be challenging. The jaw joint is a very complex system. Taking a comprehensive, orthopedic approach to diagnosing TMJ disorders gives us the opportunity to get a full understanding of what is going on in the joint. When we know what’s going on in the joint, we can offer effective treatment options that actually help you find relief.
An Orthopedic Approach to Diagnosing TMJ Disorders
An orthopedic approach involves fully evaluating every aspect of the jaw joint area in order to get the most accurate diagnosis possible. This is the same way problems with other joints are managed. If you were experiencing knee pain, for example, your doctor would not only feel your knee, they would also take several scans so they would be able to see exactly what is going on. Only then would they offer treatments based on their diagnosis.
We need to approach TMJ disorders the same way. Even though the jaw joint may have some differences from other joints in the body, it is still a joint. It’s susceptible to the same diseases and damage as other joints in the body.
The Anatomy of the TMJ Effects How We Diagnose TMJ Disorders
An important part of an orthopedic approach is understanding the anatomy of the joint. Having a thorough understanding of the anatomy of the TMJ allows us to find the cause of pain more easily. When we know how the joint is built and how it works we can deliver a more accurate diagnosis.
The TMJ is a synovial joint, joining your lower jaw to your skull. The joint is covered by cartilage and joined together by a fibrous tissue capsule that encloses the joint cavity. Within the joint, between the jaw and skull, is a cushion called a disc. The disc contains synovial fluid which lubricates and supplies nutrients to the joint, allowing for a greater degree of movement and health of the bone.
The jaw joint is also made up of ligaments, tendons, and muscles, just like other joints in the body, which help provide necessary stability to the movable joint. TMJ disorders may be a result of damage to the disc, the ligaments, and tendons, or even the bone of the jaw, where it attaches to the skull (condyle). Your TMJ specialist at PRECiDENT will be able to see, through a thorough examination, just which part of your TMJ is causing your issues.
How We Diagnose TMJ Disorders
Patients that come to see us for TMJ disorders will go through a full, comprehensive evaluation. We examine every aspect of the jaw joint area. When we’re evaluating you for TMJ disorders we’re not just looking at the joint itself. We want to look at the whole system. We’re asking questions like:
- What do the ligaments look like?
- What do the muscles look like?
- How is your joint moving?
- Is your bite being affected?
- How does the airway work?
- How is all of this affecting the neck?
When you come to PRECiDENT to treat TMJ disorders, you’ll spend 3-4 hours just getting the diagnostic work done. Our goal is to uncover every issue that is going on inside your jaw joint. We don’t just want to examine one aspect of your jaw and treat symptoms immediately with pain medication or a mouthguard. We need to examine everything in order for you to find true relief from your TMJ disorder, so we don’t miss an underlying cause of your pain, allowing it to linger unnecessarily.
Our Diagnostic Process
We’ll start by getting your full medical history. Medical conditions such as arthritis or past injuries can help us understand more about what is going on with your jaw. Any information on orthodontic or previous dental work will be helpful as well. If your bite has been adjusted by orthodontic work your jaw joint can be impacted, for example. Upon scheduling with us, we will provide you a full, health history packet, so we can get all of your health information. Sometimes, things that may seem unrelated can help us tailor your treatment plan for the best outcome.
After reviewing your medical history, we will start the physical exam. We will feel your jaw as you open and close it. We will also listen for any clicking and popping sounds. The goal of the physical exam is to feel for any kind of misalignment in the jaw joint. While we’re feeling your jaw, we’re also keeping the anatomy of your jaw joint in mind.
Finally, we will need to get a better look at what is going on in your jaw joint with CT scans, MRIs, or X-Rays. These images will help us see exactly what is going on with your joint. We will take scans from multiple angles in order to determine the extent and nature of the damage to your joint. In most cases, we’ll help you schedule an MRI prior to your consultation with us. This allows us to see all of your soft tissues surrounding your joint and make a more complete diagnosis at your very first visit.
From Pain Management to a Pain-Free Life
So many patients continue to deal with symptoms of TMJ simply because they haven’t had a thorough diagnosis. The TMJ is a complex system, and our specialists belong to a very elite group of professionals who have dedicated themselves to both the repair and management of this intricate joint. With over 30 years of experience and training specific to TMJ, you are in the best possible hands with our clinicians and surgeons.
At PRECiDENT, our goal is to move you past simply managing your pain. For some of you with mild symptoms of TMJ, bite braces and pain medications may be all you need. But for others of you, a more focused treatment plan may be necessary. That’s why taking a comprehensive, orthopedic approach to diagnose TMJ disorders is so important. It helps us design treatment options that actually work for you, so you can finally live a pain-free life. If you are tired of managing your TMJ symptoms and want to experience treatments that truly solve your TMJ problems, schedule a consultation with our TMJ specialists today.
TMJ stands for temporomandibular joint. The TMJ is the joint that connects your jawbone to your skull. You have one on both sides of your face. Your jaw joint acts as a hinge that allows you to open and close your mouth and move your jaw side to side. The TMJ is just like every other joint in your body. It has ligaments, muscles, and tendons. The TMJ also has a disc that contains synovial fluid, which is crucial for the proper function of the jaw joint.
You may not always think about your jaw joint, but when it’s not working properly it can cause a lot of pain. When your jaw joint is damaged or misaligned, it is known as a TMJ disorder. Pain in your TMJ can happen for a number of different reasons, including arthritis, injuries, and even stress. Poor jaw alignment and teeth grinding can also cause issues with your jaw joint.
Symptoms of TMJ Disorders
TMJ disorders can often go undiagnosed or misdiagnosed for years because many of the symptoms associated with the TMJ are seen in other conditions. It’s important to have a thorough diagnosis to make sure you get the proper treatment. If you have one or more of the following symptoms, you may want to talk to your doctor about TMJ disorders:
- Jaw pain
- Clicking and popping in the jaw
- Difficulty chewing and opening your mouth
- Frequent headaches
Ear pain is another common symptom of TMJ disorders. A lot of our TMJ patients are referred to us from the ENT after they thought they had an ear infection. The nerves that surround the TMJ are many of the same sensory nerves that supply the ear with sensation as well. So, when there is an injury or damage to the TMJ it can feel like an ear infection. Many physicians assume that the ear is hurting because of pressure in the ear when really it’s because of issues in the jaw. Of course, if you have ear pain an infection is a possibility. But if you have been treated for ear infections without any relief, it may be time to consider taking a look at your jaw joint.
How We Diagnose TMJ Disorders
Your jaw joint is a very complex system. This complexity can make it difficult to diagnose properly. When you come to PRECiDENT with jaw pain we will thoroughly evaluate your jaw. We want to look at every part of your jaw. When we’re evaluating you for TMJ disorders we’re not just looking at the joint itself. We want to look at the whole system. We’re asking questions like:
- What do the ligaments look like?
- What do the muscles look like?
- How is your joint moving?
We take a comprehensive, orthopedic approach to diagnosing TMJ disorders. The TMJ is similar to other joints in the body like the knee or the hip, and it’s important to keep that in mind when evaluating patients with jaw pain. A thorough diagnosis is crucial for offering the best treatment possible. It’s not enough to simply provide pain management for TMJ pain. We want to find solutions for you that last long term.
The Diagnostic Process
We’ll start by getting some information about your medical history. Medical conditions such as arthritis or past injuries can help us understand more about what is going on with your jaw. We also want to know about things like mouth breathing while you sleep or a bad bite so we can address those issues while we’re evaluating your TMJ. Any information on orthodontic or previous dental work will be helpful as well. Sometimes adjustments to your bite or other dental procedures can have an effect on your jaw joint. The more information you can provide about your symptoms and medical history, the easier it will be for us to understand the underlying problem.
The next step in the diagnosis process is the physical exam. We’ll look for any sign of misalignment by feeling your jaw while you open and close it. We’ll also listen for any popping or clicking sounds.
After reviewing your medical history and examining your jaw joint, we may need to get a better look at what’s going on in the jaw joint. So, we may need to get an X-Ray, CT scan, or MRI. These scans will give us a better picture of what is actually happening with your jaw joint.
Treatment Options for TMJ Disorders
The treatment for a TMJ disorder depends on what is causing it. That’s why we take so much time evaluating your jaw joint before offering treatment options. When the diagnostic process is rushed, physicians end up prescribing treatments that don’t help the patient. They manage the pain and symptoms instead of treating the underlying cause.
For mild cases of TMJ disorders, symptom management may be a viable, non-surgical treatment option. In those cases, we recommend various combinations of the following:
Keep in mind, your jaw joint is similar to the other joints in the body. When you hurt your knee or your hip your doctor will usually tell you to stay off of it for a while to let it heal. Your TMJ is no different. If your TMJ is damaged in any way it’s important to rest it. We usually recommend going on a soft diet for a while to see if that helps your pain at all.
Ever wear a knee wrap or brace? Depending on the case, your surgeon may prescribe a bite splint that acts in a similar way, by supporting your jaw in its correct position relative to the joint. This can reduce pain and further damage. Some patients respond well to this mouthpiece, relieved from pain and symptoms for months or years, before needing to take additional measures.
Anti-inflammatory medications, such as ibuprofen, can also be very helpful in the management of pain in the joint. Heat and/or ice are another option to help reduce inflammation and stress on the jaw.
Treatment for More Severe TMJ Disorders
In more severe cases, the only lasting treatment for a TMJ disorder is surgery. Of course, all surgery has risks, so your surgeon at PRECiDENT will carefully consider all other options, first. If surgery is necessary for optimal health, then your surgeon will review all of your health history and risk factors to minimize any risks for your best outcome. Again, at PRECiDENT, we take an orthopedic approach to these surgeries, since the TMJ is a ball-and-socket joint, like a knee, hip, or shoulder. Depending on your particular case, your surgeon may recommend one or a combination of the following:
If your disc is malpositioned or “slipped” from the top of your jaw, inside the joint, it will not provide the proper cushioning and lubrication to the joint and bone. In that instance, your surgeon may perform an “arthroplasty.” This is a technique in which the surgeon makes a small incision just behind your jaw joint and repositions your disc.
If your surgeon finds that you have ligament damage, this can be repaired as well. At PRECiDENT, our surgeons’ approach is to use MITEK anchors, which will give stability back to the joint while allowing for optimal flexibility for eating, chewing, and talking (without that pain you may be experiencing now!) after healing.
In some of the most severe cases where the disc and ligaments have been damaged beyond repair and the bone in the joint has started to degenerate (such as with arthritis, for example), or has been broken or crushed (such as after a trauma to the facial bones), it may be necessary to have your joint replaced. Advancements in this type of surgery have allowed for a customized joint replacement that has superior and lasting results.
Our TMJ Specialists Are Here for You
Our goal at PRECiDENT is always to make sure we find solutions that really work for our patients. We know that living with the pain of TMJ disorders can be frustrating and painful and can get in the way of your life. That’s why we take so much time working with you to understand what is going on with your jaw joint. If you are tired of dealing with the pain of a damaged jaw joint, our TMJ specialists are here to help you find relief. Schedule a consultation today and we will help you get started on the path to a pain-free life.
The answer is simple, it is NOT. Yes, the anatomy of the TMJ is unique, but the underlying structures in the joint are similar to the hip, knee, shoulder, and elbow. In other words, the TMJ is a synovial joint just like the other movable joints of your body. Inside the TMJ joint, there are ligaments that help hold the joint in place, tendons (muscle attachments) to the bones, cartilage, synovial fluid, and an associated capsule. The anatomy of the TMJ is not that much different than the other joints in your body.
Why it important to understand the anatomy of the TMJ? It is important to realize that the TMJ is like other joints in your body, and you must take care of your TMJ just as you do your other joints. The TMJ is the articulating joint that allows your lower jaw to move at the base of your skull. It is the joint you use to eat, talk, drink, sing, smile, and laugh. This joint could be considered the most important joint in your body, but yet we tend to not think about it much. Unfortunately, when it does become painful or symptomatic most patients do not address it early and are often given advice that it will simply get better with time or on its own. Since the TMJ is so close to our ear, many patients think they have an earache or ear infection and the problem is misdiagnosed or treated incorrectly. Many patients are ignored when they describe their problem or are just given pain medications without any understanding of the problem. Your physician will most likely send you to the dentist or physical therapist. The physical therapist will try a series of adjustments and or exercises, while your dentist may try a variety of dental appliances or suggest adjustments to your teeth or bite. Unfortunately, many times all the recommendations and treatments you may receive will all be recommended without a true diagnosis or understanding of what the problem may be.
When you have a knee injury, what is one of the first things that your physician or orthopedic surgeon will do? In addition to a thorough exam, the physician will most likely obtain some imaging. This is usually covered on your medical insurance. Usually, the initial imaging is a radiographic or X-ray with a series of images that allow them to look at the bones of the knee and make sure that there is no underlying bone disease or damage. Secondarily, they will most likely also recommend an MRI. An MRI, otherwise known as Magnetic Resonance Image, allows the physician to see the soft tissues of your knee to evaluate the tendons, ligaments, synovial fluid, and integrity of the joint itself. This is also usually covered by your medical insurance.
Did you know that the evaluation of your TMJ requires the same approach as your knee? If you have an injury or painful TMJ, it should be approached just as a physician or orthopedic surgeon would approach your knee. The same diseases that occur in the knee such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis, ligament tears and disruption, fractures, and tumors can all occur in the TMJ just as they can in the knee. Radiographic images and an MRI are essential to understand the potential internal diseases of the TMJ and should be considered before any recommended treatment. These tests when ordered appropriately are usually also covered by your medical insurance.
The TMJ is an orthopedic joint and is a very important joint for your body. Take care of your TMJ, and seek help when symptoms occur. You do not have to live with your TMJ pain. Seek out a team that has a well organized and comprehensive orthopedic approach to managing your symptoms.
Dr. Scotty Bolding DDS, MS
Oral and Maxillofacial Surgeon
For Your TMJ Health
As a child, I had chronic ear infections that caused me significant pain. Many of us experienced gnawing earaches when we were kids. Our parents would take us to the doctor, who would give us antibiotics or pain medication. This seemed to be the only way to relieve our pain. Why do I bring this up as a TMJ surgeon?
Ear Pain and TMJ Disorders: An Interesting Relationship
A very interesting experience happened to me as a child when I was playing whirly-ball with a friend. As kids, we would hit the ball tied to a rope around the pole. My friend would hit it one way and I the other. The goal was to get the ball past your opponent and wrap it the rope around the pole. On one occasion my friend hit the ball in the opposite direction and I missed it; the ball hit me in the left jaw. Instantly, I began to have severe right ear pain. This was always very odd to me. I didn’t know at the time there was a correlation between ear pain and issues in the jaw.
In dental school, I learned about the relationship between TMJ disorders and ear pain. I learned about the anatomy of the jaw. What I realized was that a lot of the time ear pain has nothing to do with the ear. It’s pain in the temporomandibular joint (TMJ). The pain I felt when the ball hit me was actually due to pain in my jaw.
Interesting isn’t it?
The Connection Between the Jaw and Ear Pain
Why does the TMJ mimic ear pain?
The TMJ is the joint that connects the lower jaw to the base of the skull. This joint and its movements are very active throughout our lives. The TMJ is important for jaw movement and function, as well as lower jaw growth. The nerves that surround the TMJ are many of the same sensory nerves that supply the ear with sensation as well. So, when there is an injury or damage to the TMJ it can create symptoms that appear to be ear pain.
TMJ is Often Mistaken for Ear Pain
This is often missed by many dentists and physicians. As a TMJ surgeon, most of my referrals today do not come from dentists but from physicians. Many good physicians understand this correlation, but many do not. They assume the ear is hurting because there is pressure behind the eardrum. Antibiotics are often prescribed, even though the ear appears normal. We see this all too often. Patients are treated for multiple “ear infections.” Unfortunately, the problem might be the TMJ. Don’t get me wrong, you can have an ear infection or other issues associated with your ear. But you need to always rule out a TMJ injury or disorder.
If you are suffering from chronic pain in or around your ear it could be your TMJ. My recommendation would be to check with your dentist, physician or to see a good ENT doctor. They will be able to determine if the source of your pain is in the ear or the temporomandibular joint.
When it comes to TMJ diagnosis it is important to take a comprehensive approach. As surgeons and specialists, we need to make sure we are fully evaluating our patients before we give them any treatment options. And in order to provide this comprehensive diagnosis, we need to have a thorough understanding of joint anatomy and physiology. In short, we need to understand what we are treating before we treat it. We can’t offer the best treatment possible to our patients without know what the real issue is. Otherwise, we are just managing symptoms and not actually addressing the problem. Sometimes simple therapy and conservative treatments will do just fine. But, many times conservative treatments simply aren’t what the patient needs.
As an oral and maxillofacial surgeon, I do not always think surgery is the best answer and have been humbled many times throughout my career. However, I can assure you that sometimes surgery is a good choice for some patients, and in some cases, it is the best option for the patient. All surgery is not bad but in many of the cases that I treat, I wish they had been offered that option much earlier in their life, for it may have prevented a further breakdown. Thus being conservative may not always be that conservative, especially if there are anatomical limitations.
Understanding Joint Physiology and TMJ
For example, if the TMJ ligaments are chronically torn, stretched, or damaged for whatever reason, then the lateral pterygoid will almost always migrate the articular disc anteriorly and medially. When this happens, generally the majority of synovial fluid of this synovial joint is located anterior to the head of the condyle and glenoid fossa. The lateral ligament of the joint often becomes entrapped between the head of the condyle and the fossa and can lead to a variety of issues. Fibrocartilage lines the glenoid fossa and head of the condyle.
Fibrocartilage, as well as hyaline cartilage of other joint surfaces in the body, require synovial fluid to provide the nutrients for the cartilage cells needed for normal function and repair if damaged or overloaded. If these cells are traumatized and do not have adequate synovial fluid function, then these cells thin, breakdown, and lead to underlying bone damage as well thus ”osteoarthritis”.
As a profession, we have almost ignored these principles of joint physiology and focused on teeth and other therapies without having a clear understanding of the joint anatomy itself. Understanding these things is critical in the diagnosis and treatment of TMJ disorders. Without this understanding, we end up only looking at the surface issues of TMJ and we rarely look at how we can prevent further damage from occurring. For many patients, surgery is truly the best option. Surgery can help prevent further damage from occurring. But, we won’t know that unless we are thorough in our evaluation.
A Comprehensive Diagnosis is Essential for TMJ Disorders
As I have stated before, we need to understand what we are treating before we treat. A comprehensive diagnosis is essential. As surgeons, our goal is always to help our patients. We want to give the best treatment possible. We want to help relieve their pain. In order to give our patients the best treatment possible, we need to be thorough in our evaluation. When a patient presents us with TMJ Pain or Facial Pain and symptoms, we need to be astute diagnosticians first. Then we look at the various options that might help the patient with their symptoms. And yes, sometimes surgery needs to be considered. No, surgery is not always the best answer. But we can’t dismiss surgery altogether, especially if surgery can prevent further breakdown in the joint. By understanding how joints work, we put ourselves in a better position to diagnose and treat TMJ disorders.