Hi all of my wonderful TMJoiners!
I’m Priya Mistry the TMJ doc and today’s video is about the anatomical components of
the Temporomandibular Joint - the jaw joints - and how those components relate to the specific
signs and symptoms that come along with TMJD.
These signs and symptoms include but are not limited to: clicking and popping noises in
the jaw joints, episodes of the jaw locking or catching, crackling noises in the joints,
snapping noises in the joints, headaches, jaw pain, ear pain, neck pain and more!
Watch this video until the end to really understand
how the anatomy relates to these specific
signs and symptoms and to just learn more about TMJ Disorder.
It is a condition which can be truly debilitating and difficult to both diagnose and treat.
Before getting into it, be sure to check out my other social media accounts.
Follow me on there.
There's tons of tips, information, and self massage techniques that can bring you relief
today!
The links for all of those are below.
For those of you who don’t know me, I’m a general dentist with a practice in Vancouver,
Washington where we are dedicated to taking care of patients with TMJ disorders
So let’s get right into it.
First, let’s start with basic terminology.
Many people will refer to “TMJ” as an actual condition, and it's not.
All it really means is “Temporomandibular Joint” - or jaw joint.
Saying “I have TMJ” is actually then incorrect because all you're really saying is "I have
jaw joint" - which is not only grammatically incorrect but it really just doesn't make
any sense.
It’s actually correct to say “I have TMD” or “I have TMJD”.
TMD is Temporomandibular Disorder and TMJD is Temporomandibular Joint Disorder.
Why does that even matter?
Well, to me it doesn’t because I know what you mean when you say “I have TMJ” but
not every provider will know what you mean.
Additionally, not every provider will know how to differentiate or distinguish between
a muscular problem vs. a joint problem vs. a combination of a muscular problem and a
joint problem that's causing the TMJ Disorder in the first place.
In addition to being grammatically incorrect, I think it’s just not specific enough if
you say “I have TMJ”.
Another term I want to go over is “reduction”.
In medical terminology, “reduction” refers to body part getting back into alignment.
It does not refer to a lessening or diminishing.
Understanding the term reduction is important when I discuss clicking and popping noises
in the jaw joints which I'll be going over in this video.
SO now let’s get more into the anatomy.
The jaw joints are made up of two bony components - the temporal bone (a skull bone)and the
condyle - which is the little bony knob our jaw bone ends on.
The temporal bone has a fossa - a concavity - that the condyle actually sits in.
It also has a bony projection called the articular eminence that the condyle actually slides
down when we go to open our mouths.
When we go to open, the condyle rotates in the fossa and then it slides down the articular
eminence.
On full opening, that condyle should not go beyond the articular eminence.
It should sort of stop where the articular eminence stops.
So these are things to keep in mind as we move through this video.
Between the temporal bone and the condyle sits a cartilaginous pad of tissue called
the “articular disc”.
The articular disc sits on top of the condyle, kind of like a hoodie, and has medial and
lateral discal ligaments that hold it in place.
So the proper position for that disc is on top of the condyle, kind of like a hoodie.
It shouldn't slide forward or backward.
In front of the articular disc is a muscle called the “lateral pterygoid” muscle.
I call this "the Troublemaker", I've heard it called "the Terrible" which sounds more
like "pterygoid" I suppose - and the reason for this is that muscle can cause a lot of
pain, so I'll be circling back to that soon.
Behind the articular disc sits some very highly innervated tissue called the retrodiscal tissue.
The entire joint is then held together by a fibrous capsule.
The various muscles of the head, neck, and jaw work together to help the jaw function.
All of these muscles are considered a part of the temporomandibular complex and can be
involved when there is pain or dysfunction that is present.
These muscles include but are not limited to: the masseter muscle, the temporalis, the
lateral pterygoid, the medial pterygoid , the
sternocleidomastoid, the trapezius, the suboccipital
group of muscles, and more!
Now let’s discuss some of the most common
signs and symptoms that come along with TMJD and how these relate
back to this basic anatomy that we've just gone over.
I’m a firm believer that knowledge is power and it’s always good to have at least a
basic understanding of what’s happening when you’re experiencing a medical condition
- in this case TMJD
Let’s start with jaw joint noises - clicks and pops, snaps, and crackles.
Right off the bat, click and pop refer to the same thing in terms of what’s happening
anatomically inside the jaw joint.
When this click or pop happens, what that's telling
us is that the little articular disc inside of our jaw joints is coming in and
out of alignment, which is often not painful but it’s also not ideal.
That click and pop can stay exactly as it
is over a long period of time - really, many years - OR it can actually progress to the jaw
locking closed which is NOT a fun thing to go through.
This animation shows the disc in the blue.
Right off the bat, you can see that that disc is NOT where it's supposed to be. It is
not sitting on top of the condyle like a hoodie. Instead, it is too far forward and
in front of the condyle when the mouth is closed and the teeth are together.
When the mouth opens, there is a CLICK or a
POP and that is the disc actually getting back in alignment for a
moment until the mouth closes again. When the mouth closes, the disc actually goes
back out of alignment often with a soft click or pop.
This click or pop on closing is typically not as audible as the one on opening. So it's just not
as loud, so many people don't hear the click on closing as much as they hear that one on opening.
It’s important to note that in this situation when the teeth are together, that is
when the disc is out of alignment. So when the teeth are together there's a
problem in the joint if there's a click or a pop.
If there's a click or a pop on opening and closing, this
condition is called “Disc Displacement WITH
Reduction”. That is the fancy way of saying clicking or popping or that the
disc is kind of coming in and out of alignment.
Let's break that down - "Disc Displacement With Reduction".
This means the articular disc is displaced - in the wrong position - BUT it can reduce
- it can get back in alignment - for a short while when opening!
Let’s watch that animation again.
You can see when the mouth is closed, the disc is out of alignment - it is too far forward.
Then when the mouth goes to open - CLICK - the disc gets back in alignment for a short while.
When back is back in alignment - when it's sitting on top of the
condyle like a hoodie - it is REDUCED for that time, while it's in alignment.
When the mouth closes, the disc gets back
out of alignment sometimes with a reciprocal click or
pop.
To review: this condition is called Disc Displacement
WITH reduction because the disc is displaced but it's capable
of getting back in alignment for a short while, while
the mouth is open.
We've now covered Disc Displacement With Reduction. What about “Disc Displacement
WITHOUT Reduction”? Let's talk about that.
In this condition, the disc is out of alignment - too far forward - when the mouth is closed.
When the mouth goes to open, the disc CANNOT get back in alignment - it
cannot REDUCE.
Therefore, it is displaced without reduction. It cannot reduce. It cannot get back in alignment.
Instead, the disc is actually serving as a barrier to opening and it is during this
condition that people can barely open more than 2 or 3 finger widths and it's pretty painful.
The animation shows this perfectly.
This condition is also called "Jaw Locked Closed". So "Disc Displacement Without Reduction" and
"Jaw Locked Closed" refer to the same thing. This is a very painful condition during which
you can barely open more than 1 or 2 finger widths and it's accompanied with headaches,
jaw pain, ear pain, stuffy ears, neck pain, and MORE!
It's incredibly uncomfortable and it's often preceded with a history of clicking or popping
leading up to the incident of the jaw locking. The reason this hurts so much is that when
the disc is displaced without reduction, it's too far forward. And what it does when it moves and
gets dislocated too far forward, it pulls the tissue behind it into its position. So that's
that Retrodiscal Tissue we referenced at the beginning of the video. That is incredibly
nervy tissue that's now being sandwiched between two bones. So anytime you go to bite,
that tissue is really compressed and it sends off pain signals. So that's one
reason that this condition is really painful. Another reason it's painful
is that when the disc is dislocated, the muscles of the head, neck, and jaw go into
spasm and they enter a very dysfunctional state. And when the muscles are not in a
happy state, that's what can lead to the headaches, neck pain, ear pain, etcetera.
Since we've discussed the Jaw Locking Closed - or Disc Displacement Without
Reduction - now let's talk about the jaw locking OPEN. What happens with that?
Well, my friends, that’s actually totally different and it has nothing to do
with the articular disc.
When the jaw locks open, what happens is that the condyle rotates in the fossa of the temporal
bone and it slides down that articular eminence that we talked about. But instead of stopping
at the end of the articular eminence, it's able to kind of hyper extend and go beyond
that eminence. So that's what happens when the jaw is locked open. When this happens,
what that means is that on opening, the jaw can actually get outside
the boundary of the jaw joint! This typically occurs in people who have some hypermobility in
their joints in general and they're able to sort of extend past the normal boundary of the joint.
For those who have gone through this, it is
not fun. It is not a fun thing to go through and the jaw typically has to be sort of loosened up
and then manually manipulated back into the right position. Most
people that experience this usually only go through this one, two,
maybe three times and then they kind of learn just to never open that big again.
And typically these people are opening way bigger than the rest of us can,
which is why they can get beyond the boundary of the joint. So limiting your
mouth opening if you are locking open is a good way to prevent it from happening again.
Let’s move on to crackling noises in the joint.
This crackling noise is called crepitus and it's sort
of like a crackly, grainy sound.
With crepitus, what's happening is that there's too much compression in the joint - there’s
not enough space between the bony components
of the joint. This will put a lot of pressure on the articular disc, which sits between those bony
components causing it to tear or perforate. This will then lead to bone on bone contact.
This bone on bone contact can then lead to roughening and breakdown of the bony components
of the joints - which will then lead to those crackly noises
on opening and closing.
Crepitus - these crackly noises - are usually associated with chronic
clenchers - people who have been clenching
for a long, long, long time. That clenching activity will compress the joints even more
and put pressure on that disc even more. I'm a firm believer that most of us clench or grind
our teeth. And any given night it can vary - the force with which we clench, the frequency,
and the duration for which we clench. All of those can vary and they usually ramp up in times of
stress. Crepitus is usually indicative of advanced osteoarthritic degenerative changes inside of the
jaw joints, which sounds scary but is common and it's
treatable. Keep in mind that these are the most used joints in the body - just from talking,
chewing, then you throw in clenching and grinding and these joints get a lot of use! Additionally,
many of us clench our teeth or grind them without even realizing it.
So I would really challenge you to sort of watch yourself during the day when you're stressed,
focused, stuck in traffic - see where your teeth are. Many of you will find
that you're actually going like this [clenching teeth] more than you realize.
The way that this is treatable is with TMJ orthotics. A well made orthotic by a skilled
and experienced TMJ dentist will decompress the jaw joints when you wear it. Space is created in
those joints while you're wearing the orthotic. This will slow down the rate of future wear and
tear which could be very beneficial because it could prevent locking or pain in the future.
The last joint noise we will discuss is a loud "snap", "crack" or "pop" that typically
happens once and is painful when it happens.
When this happens, what's usually going on is that a ligament within the joint - typically the
lateral collateral ligament that attaches to the articular disc - gets stretched or
strained.
Because this ligament is stretched or strained, the articular disc can then more easily displace.
And this one loud incident of pop, snap, crack can then lead to Disc Displacement With Reduction -
click, pop - or even Disc Displacement Without Reduction where the jaw is actually locked closed.
So that really covers all of the jaw joint noises.
If you have any questions, sound off below!
Let’s move on to the muscles!
When there’s a problem in the joint OR when
the muscles of the head, neck, and jaw enter a dysfunctional state, it can lead to a LOT OF PAIN!
The way that these muscles become dysfunctional is usually due to chronic
clenching, chronic bruxing, an imbalanced
bite, or injury to the head, neck, or jaw.
This injury can be a direct impact or a
whiplash type incident.
When the muscles enter this dysfunctional
state, they get trapped it a chronic pain and spasm
cycle which can lead to a variety of symptoms.
These include but are not limited to: headaches - any and all types- neck pain, jaw pain,
eye pain, eye strain, ear pain, tooth pain, numbness or tingling in
the face or the fingertips, facial pain, tinnitus, vertigo AND MORE!
These symptoms can be debilitating. I have seen it time and again. I see it every single day multiple
times in my practice. And it can very difficult to figure out exactly what's going on because
there's no testing or scanning or imaging that identifies those dysfunctional muscles.
For this reason, so many of my patients go on such a LONG journey visiting various healthcare
providers ranging from Oral Surgeons and Root Canal specialists to Otalaryngologists
and Neurologists looking for answers as to why they’re experiencing so much pain.
The upside of seeing different specialists and getting all these scans, imaging, testing done
is that it can rule out other conditions - like a dental infection, ear infections, and even brain
tumors. There can actually be a lot of overlap between all of those - dental infections,
ear infections, brain tumors, and TMJ/TMD. So lots of overlap between the symptoms that
present with all of those. So getting those things ruled out is always great.
The discouraging part of all of that testing and seeing so many different
doctors for many of my patients is that oftentimes they don't get a
clear answer and instead they're just put on strong pain medications with even
stronger side effects.
Having no clear reason for pain that can be debilitating can be incredibly discouraging
and incredibly depressing for the person
experiencing that pain.
That is WHY I’ve created this YouTube channel - is to get this information
out there and to help people who are going through this find the cause of their pain,
get that treated, and live their best lives!
So that’s really it my friends!
Again, I’m Dr. Mistry and I hope you found this video helpful.
If so, please feel free to like, Subscribe, and share with your family and friends!
For TMJD pain relief from the comfort of your own home, please download my free PDF Guide called
“3 Steps to TMJD Pain Relief”.
You can find that on my office website.
Questions and comments are always welcome so please sound off below. I'll
try to get back to you. I've gotten a little slower at it lately so be patient with me!
And remember, my friends, you can never have TMI about TMJ!