-IBIS-1.5.0-
tx
musculoskeletal system
TMJ syndrome
diagnoses

definition and etiology

definition: Malocclusion, or fixation of the TMJ on one or both sides of the jaw.

etiology: Several factors may be involved in the development of TMJ.
• Thumb-sucking in children: in susceptible children, thumb-sucking can cause an overbite, putting stress on the TMJ.
• Grinding the teeth (especially at night while sleeping): this causes extreme tension in the TMJ.
• Blows to the jaws/head: any trauma to the jaw (or temporal bones) can injure the tendons and joint area of the TMJ resulting in the syndrome.
• Cervical vertebra fixations: especially the occiput-C1 and C1-C2 levels.
• Malocclusion of the jaw (over-bite and/or underbite); crowded teeth.
• Head and neck tension can cause muscular strain in the TMJ area.
• Dental procedures: removing wisdom teeth, for example.
• History of spinal traction: can cause internal rotation of the temporal bones.
• Constrained emotions, particularly frustration and suppressed anger, as in the Stagnant Liver Qi syndrome of Traditional Chinese Medicine.

TMJ is more common in women, although it is not rare in men. Any age range may be affected.

signs and symptoms

signs and symptoms:
• Cracking of TMJ when opening/closing mouth.
• Pain at TMJ with chewing, talking.
• Malocclusion.
• History of trauma, grinding teeth, thumb-sucking.
• Fixations of cervical vertebrae; neck pain, headaches.
• Ear pain/fullness/excess wax build-up.

tests:
• Place index fingers in ear canal meatus or directly inferior to tragus. Have patient open and close mouth and check for symmetry and clicking of the TMJs.
• Face the patient and have him/her open and close mouth. Check for lateral displacement of jaw during opening and closing.
• Check for spasm in muscles: masseters, internal pterygoids (located by putting pressure against musculature between the last upper and lower molars), and buccinators.

course and prognosis

TMJ is a reversible disorder that can cause surprising morbidity before it is diagnosed and treated. Untreated, TMJ can initiate an array of chronic ailments that can be very puzzling and disconcerting for the patient and physician. Treatment consists of a jaw brace (in severe cases); trigger point therapy to the spasmed muscles; manipulation of TMJ and related fixated joints; exercises designed to retrain the jaw into opening and closing properly; physiotherapy to reduce inflammation and break up muscle spasm. If left untreated TMJ can develop into an arthritic joint.

differential diagnosis

Cervical strain/sprain.
• Dental disease.
• Otitis externa/media.


footnotes