Diseases of the temporomandibular joint are not uncommon. Within Germany, disorders of the normal temporomandibular joint function, in addition to the occurrence of carious defects, are even among the most common abnormalities in the area of the oral cavity. Extensive studies suggest that more than 10 million people suffer from TMJ osteoarthritis. The number of patients suffering from less conspicuous diseases of the temporomandibular joint exceeds this figure by far.
Deficits in the temporomandibular joint function in most patients are expressed very early on by the occurrence of TMJ, tensions and pain in the muscles of the jaw, headache and earache, or restrictions on mouth opening. In general, it is believed that such temporomandibular joint problems are in most cases caused by improper loading and mechanical wear of articular cartilage surfaces.
However, there are also patients who develop such symptoms due to inflammatory or infectious causes. With increasing age, there is also a demonstrable increase in the risk of developing a disease of the jaw with clearly perceptible (and in part audible) jaw joint cracking. In addition, a possible genetic bias or heavy physical labor also seems to play a crucial role in the development of temporomandibular joint disorders.
The temporomandibular joint (lat. Articulation temporo mandibularis ) is a movable connection between the bony upper jaw (lat. Maxilla ) and the lower jawbone (lat. Mandibula ), in which the so-called lower jawbone (Latin Fossa mandibularis ) a direct contact with the upper jaw ( Caput mandibulae ).
While the maxillary bone forms the rigid portion of the temporomandibular joint, the lower jaw, which is essential for opening the mouth, is freely movable in the joint. This bone connection is supported by numerous muscles (masticatory muscles) and ligaments. To prevent the two bony structures of the temporomandibular joint from rubbing against each other, the maxilla and mandibular fossa are separated by a mobile cartilage portion ( discus articularis ). The cartilage slice divides the temporomandibular joint into two functionally independent parts, the upper and the lower joint space.
Sliding movements are mainly carried out in the area of the upper joint part (upper joint gap). In contrast, rotational movements essentially occur in the lower joint space. For chewing or speaking, however, it is not enough to carry out one of these two movements separately. In these operations, both ranges of motion must be skilfully combined. It can be deduced from this fact that combination movements (so-called rotary-sliding movements) can also be performed in the temporomandibular joint.
Since jaw joint cracking is merely a symptom of various diseases of the joint, its causes can be manifold. Thus, the long-term treatment of this symptom can only be achieved by appropriate therapy of the underlying problem. For this reason, it is extremely important to be aware of when the jaw fracture occurs and under what conditions it worsens or how it can be alleviated if necessary.
In addition, the affected patient should pay attention to whether other abnormalities occur besides the jaw joint cracking. Accompanying symptoms of temporomandibular joint are, for example, tensions or pain in the area of the jaw muscles, headache or earache. In particular, the concomitant symptoms that occur in the course of the underlying disease can provide a first indication of the underlying problem and provide essential help in the choice of appropriate treatment measures.
In some patients, wisdom teeth breakthrough seems to be responsible for the occurrence of TMJ. This phenomenon can be explained by the fact that the size of the human jaw has greatly decreased in the course of evolution and therefore this no longer has enough space for the reception of 32 teeth. After breaking the wisdom teeth, the remaining teeth can be displaced from their original place in the jaw and moved. As a result, there is often incorrect loading of the temporomandibular joint, which can lead to wear and tear and ultimately to the TMJ cracking.
In addition, some affected patients report that in mentally or physically induced stressful situations, they often tend to grit their teeth at night or press the rows of teeth against each other with enormous pressure. These patients usually notice a jaw joint cracking and severe pain in the area of the temporomandibular joint, the head and the ears after getting up.
However, all the causes just described are comparatively rare reasons for the occurrence of temporomandibular joint cracking. By far the most common cause of this symptom is the presence of a disorder of the temporomandibular joint called CMD syndrome (craniomandibular dysfunction). Craniomandibular dysfunction is a malfunction of one or more parts of the temporomandibular joint itself.
Malocclusions that have not been treated or have received insufficient orthodontic treatment are the most common cause of craniomandibular dysfunction, which can lead to the perception of TMJ and sometimes severe pain in the patient. Typically, the pain that develops as a result of this malfunction occurs in the ears, head and back. In most patients, especially the neck is affected. In addition, visual disturbances and tensions in the masticatory muscles are typical accompanying symptoms of craniomandibular dysfunction.
In addition to the mechanical causes already described, bacterial or viral infections, which lead to inflammatory processes in the area of the temporomandibular joint, can also promote or even trigger the occurrence of temporomandibular joint cracking. Back pain, headache and neck pain, as well as general symptoms such as fever and fatigue are among the most common concomitants of infectious TMJ disease. In addition, a one-sided stress during chewing is considered to be the cause of severe wear and tear of the joint, which may be associated with TMJ cracking.
Also a temporomandibular joint inflammation can produce crackling noises.
The cracking of the temporomandibular joint may cause an unpleasant noise, but does not always have to be associated with pain. Pain often occurs when the jaw joint completely pops out of the socket (dislocation) and the muscle is overstretched. But this jumping out does not have to be complete. It can come to so-called subluxations, in which the condyle does not completely knock out, but only partially. This subluxation can even occur almost unnoticed without the patient noticing anything.
If the symptoms appear as a result of crunching and pressing, the patient has increased tensions in the head and neck in the morning after getting up and in stressful phases of life, which can lead to heightened pain.
Basically, any resident dentist should be able to effectively and long-term treat joint disorders that lead to TMJ. However, there are also specialists who are primarily concerned with the treatment of TMJ diseases and their effects and should therefore be preferred in pronounced cases. For the affected patient, the choice of the most suitable dentist is a crucial basis for the therapeutic success of the temporomandibular joint and its underlying disease.
In most cases, the dentist will be able to determine after a comprehensive doctor-patient interview and a few, simple investigations of what causes the jaw joint cracking. If, after the first diagnostic measures, it can be concluded that the jaw joint cracking is due to a malposition in the area of the jaw, then generally more extensive examinations must be carried out. Both the palpation of bony parts of the joints and the masticatory muscles, as well as a detailed functional analysis, are among the usual measures of examination in patients suffering from TMJ. In addition, it is advisable to make an X-ray, which completely images the teeth, the jawbone and the temporomandibular joints and clearly shows signs of wear and tear.
An unpleasant cracking when chewing can occur when the joint apparatus is overloaded. By crunching and pressing the muscles are stiffened and the articular surfaces overstretched. This can expand so much that the jaw joint can no longer adapt when eating, since it can not optimally use the muscles. This can lead to dislocation of the jaw joint head, which has an unpleasant cracking effect. During dislocation, the head pops out of the articular fossa because, for muscular or other reasons, the healthy, normal articular path can not be maintained. This dislocation can also cause discomfort and even occur while speaking.
Many sufferers only have complaints on one side, but not on both sides. Generally, this means that only one jaw joint tends to pop out and the other remains in the normal articular pathway. It is quite possible to feel these symptoms bilaterally. The causes can be manifold.
A disturbed bite can wear one side or both to the point that the jaw joint can not hold the normal joint guidance. In this case one speaks of Kiefergelenkarthrose. Even crunching and pressing can cause untreated arthritis over a longer period of time. Furthermore, a blow or impact in the event of a trauma can result in a fracture, which, if left untreated, can cause it to pop out.
Since the development of TMJ can have various causes, the therapy must be adapted as far as possible to the treatment of the causative disorder. Only in this way can the symptom of temporomandibular joint cracking be remedied in the long term and the patient be kept symptom-free. The correct treatment is therefore dependent on which diagnosis is made by the dentist.
Patients who suffer from joint misalignments due to worn or mismatched dental prostheses, which can lead to jaw joint cracking, will need to be replaced or grinded as soon as possible.
If temporomandibular joint pain is caused by inflammation of the temporomandibular joint, which is caused by inflammation of the muscles or the joints themselves, pain relieving (analgesics) and anti-inflammatory (anti-inflammatory) medications are usually used. As inflammation often causes severe tension, targeted massages and relaxation exercises are also performed.
Orthodontic treatment is often the only method for achieving freedom from symptoms in patients who suffer from temporomandibular cracking, which is caused by asymmetry with respect to tooth position or crowding in the teeth. In addition, the preparation and the regular wearing of a bite splint in patients who tend to grit with teeth in stressful life situations (bruxism) or bite the jaw halves hard on each other in most cases can already remedy. By wearing the bite splint, further tooth abrasion is avoided and the remaining tooth substance is protected. Furthermore, while using the bite splint, a more relaxed posture of the jawbone in the joint occurs. The result is a rapid reduction of TMJ.
Exercises, which can remedy the problem, is the massaging of overstrained muscles. The hardened muscle strands can be loosened by circular movements and slight pressure, so that the stiffeners dissolve. Even knots can be massaged this way. Furthermore, the TMJ can be trained through targeted maximum mouth opening so that the TMJ head no longer pops out. At the same time, the mouth should only be opened so far without the patient feeling pain.
Loosening exercises by moving sesame seeds or cherry kernels in the mouth with the tongue and tissues is also advisable. If all these exercises do not alleviate the symptoms, the attending dentist should be consulted, who may refer you to the Oral and Maxillofacial Surgeons if no conservative therapy with special physiotherapy is available.
The development of temporomandibular joint can be prevented in the majority of cases by simple means. On the one hand, regular visits to the dentist, in which the condition of the teeth and, if necessary, the dentures are examined in detail, are essential. On the other hand it can be helpful as a patient to pay attention in which situations one tends to strong tensions. Heavily worn dental fillings, crowns or bridges should be repaired or completely replaced within a reasonable period of time. In addition, simple relaxation exercises help to relieve the masticatory muscles and thus also the temporomandibular joint.