TMJ
TMJ or TMD is a multifactoral disorder of the temporomandibular jaw joint and associated structures.
Terence Lau, D.D.S., F.I.C.O.I., F.A.A.C.P. is available for examination, diagnosis and treatment of TMJ/TMD related cases. Dr. Lau is available for Expert Witness Services. C.V. available upon request.
TMJ or TMD is a disorder of the jaw joint and related structures where the ball (condyle), socket (fossa), cushioning disk (meniscus) and/or muscles of the joint are damaged, misaligned and/or inflamed. This could occur as a result of trauma, disease, wear due to aging and/or habits. Over time, the meniscus becomes increasingly compressed and torn, allowing the bony structures of the ball and socket to deteriorate at an accelerating rate due to the grinding wear on the joint and the loss of cushioning effect of the meniscus.
This grinding (crepitus) or popping / clicking (reduction) and concurrent pressure on the capsular ligament surrounding the joint can cause head pain, and may create difficulty in opening or closing of the mouth. The body attempts to realign the joint using the musculature in the face, jaw and neck. As these muscles become fatigued, additional muscles in the shoulders and back attempt to help this condition, then become stressed themselves. This can cause symptoms of generalized muscle pain and weakness that are diagnosed as Myofascial Pain Dysfunction Syndrome (Fibromyalgia) and/or Chronic Fatigue Syndrome.
The misalignment of the joint can also affect the nearby ear structures, due to pressure on the petrotympanic fissure and tympanic bone. The tympanic bone separates the jaw joint from the ear canal. The mandibular malleolar ligament (disco-malleolar ligament) connects the malleous as this ligament traverses through the fissure to attach to the meniscus and the capsular ligament of the TMJ. The capsular ligament is the sac surrounding the joint. The anterior tympanic artery, which is responsible for supplying oxygenated blood to the tissue around the tympanic membrane (ear drum) travels through this fissure. The chorda tympani nerve traverses through this fissure. This nerve gives pain sensation to the tongue. Pressure on these structures can cause dysfunction and symptoms such as ear pain, tinnitus (ringing in the ears), vertigo (dizziness), subjective hearing loss, hyperacusis (increased sensitivity to sound), Chronic Fatigue Syndrome, tongue pain, muscle pain, and other symptoms.
Do you experience any of the following:
- Does your jaw joint make a popping, clicking or snapping sound when you move it?
- Do you hear and/or feel a grating sound in your jaw joint on movement?
- Is the joint tender to external pressure? This can be assessed by manually pressing the area in the front of the ear.
- Do you clinch and/or grind your teeth at night or during the day?
- Do you sometimes have difficulty opening or closing your mouth?
- If you have tinnitus (ringing in your ears), does the ringing sound change in any way as you open and close your mouth while applying external pressure to the joint?
- Do you have frequent episodes of vertigo and/or nausea?
- Do you have ear sensitivity and/or pain associated with sound?
- Do you have recurring ear aches for which the doctor can find no apparent cause?
- Do you have recurring migraine-like headaches that do not respond to migraine medicine and for which the doctor can find no cause?
- Are your neck and shoulder muscles constantly tense and/or painful?
- Do you have a recurrent knot in the muscles on the edge of your shoulder blades closest to the spine?
- Do you feel chronically fatigued and/or depressed?
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