Misalignment of the joints connecting the jaw to the skull, known as the temporomandibular joints, can have a massive impact on the entire body. They are often described as one of the most important joints in the body. Problems with TMJs are generally treated by specialists, like osteopaths and physiotherapists. However, therapy to the temporomandibular joints often involves a dentist as well, because the joint position and the bite of the upper and lower teeth are inextricably linked.
SPECIAL FEATURES OF TMJS (TEMPOROMANDIBULAR JOINT)
The TMJ, which is unremarkable in a healthy state, is one of the most complicated joints in the body. It flexibly connects the lower jaw to the skull. The joint is a socket at the base of the skull and the joint head at the top of the bony lower jaw. The joint has some fibrous tissue involved as well.
The TMJ has some special features that are different from other joints in the body. For example, the right and left TMJs never work independently. The mandibular condyle connects with the temporal bone cavity. A malfunction is caused when the intermediate joint disc becomes unbalanced, which affects the movement and function of the jaw.
The temporomandibular joint is under constant strain, for instance during biting, eating, speaking, laughing, or swallowing, and hardly any other joint in the body is as strong, The structure of the temporomandibular joint varies from person to person and depends on the position of the teeth. Even the smallest changes to the chewing surfaces of the teeth can affect the temporomandibular joint.
THE RELEVANCE OF THE TMJs FOR THE HUMAN BODY
Due to the anatomical and physiological relationships that the temporomandibular joint has with the rest of the body, any dysfunction can affect the entire musculoskeletal system. This can vary from just a malfunction to more serious conditions, so it is important that a dentist who specializes in temporomandibular joints first carries out an extensive diagnosis as this will determine what treatment is needed.
Consequences of functional disorders of the craniomandibular system (CMD) on the musculoskeletal system can be complex. Muscular or functional complaints manifest primarily in the area of the neck, spine, pelvis and extremities, for example tension in the shoulder and neck, misalignment in the spine, or problems in the pelvic area. This is due to the anatomical connection between the TMJ and the four upper cervical segments and their common neurophysiological circuit.
The region of the temporomandibular joint share highly sensitive proprioceptive nerve endings with the adjacent soft tissues. In fact, the craniomandibular region has the greatest proprioceptive density found in the human body, to convey information about muscle tension, joint position and movement to the central nervous system. This explains why the system is so sensitive and reacts to changes so quickly. So new dentures, that cause even the smallest changes in the bite, can affect the TMJ. Good dentists are very aware of this fact and explicitly address it.
Functional diagnostics in the dental practice
In functional diagnostics, the condition of the chewing apparatus is examined closely. The position of the teeth and the person’s bite are closely connected with the temporomandibular joint. When a dentist asks you to grit your teeth, he wants to see how your teeth and body actually work together. Many people clench their teeth very tightly when they carry heavy things or when they are stressed.
The resulting force is passed through the body, because the nerves and tissues of the TMJ are connected to the skeletal structure. Therefore functional diagnostics of the TMJ often provide information about problems in other parts of the body.
The focus is particularly on examining the temporomandibular joints. Close attention is also paid to the bite position and whether the person shows a ‘harmonious’ chewing movement. The dentist wants to see a ‘clean’ bite between the upper and the lower teeth. A malfunction in the chewing apparatus or the TMJs can cause various symptoms, like craniomandibular dysfunction, in which case a CMD expert may have to assist with the treatment.
SYMPTOMS OF CMD (CRANIOMANDIBULAR DYSFUNCTION)
The body is a fine-tuned system, and sensory cells transmit information to the central nervous system. A bite disorder caused by, for instance, crooked teeth, can cause a problem somewhere else in the body. Patients are often not aware of the consequences of craniomandibular dysfunction, as the symptoms are often not immediately traced back to the area of the temporomandibular joints.
This can have far-reaching consequences and cause long-term functional disorders involving facial pain, tension in the neck muscles, numbness in the arms, tinnitus (noises in the ear), or pelvic misalignment. So CMD dysfunction can affect the back, hips and the legs. Help from a CMD specialist will be needed in these cases.
CLINICAL AND MANUAL FUNCTIONAL ANALYSIS OF THE TEMPOROMANDIBULAR JOINTS
If a functional disorder of the temporomandibular joints (CMD) is suspected in our dental practice, we ask patients about their medical history as we carry out our preliminary examinations.
We establish the state of their teeth, and how good is the tooth contact between the upper and lower jaw is. Is there any TMJ noise when the jaws move?
We also scan the chewing muscles. Our examination includes questions about their personal life as stress can trigger a CMD or TMJ disease.
INSTRUMENTAL FUNCTIONAL DIAGNOSTICS OF THE TEMPOROMANDIBULAR JOINTS
The next step is instrumental functional analysis. For this, models of the bite are made via a precisely defined path into a so-called articulator or bite simulator. This device shows us how the patients teeth make contact and helps us determine whether the position of the teeth and the patient’s bite are in fact triggering TMJ problems. Based on the results from the bite simulator, we will decide what therapy is needed.
This could be splint therapy, for example, or building up the bite height of the patient’s teeth. Especially if craniomandibular dysfunction is diagnosed, input from a CMD specialist, or other specialists like a physiotherapist or osteopath, might be indicated.