For International Patients

What is Temporomandibular Joint Disorder?

Temporomandibular joint (TMJ) consists of the mandibular condyle, temporal bone, articular disc, joint capsule and ligaments. It moves constantly during talking and eating every day. Trauma, bad habits such as, bruxism, clenching, biting finger nails, malocclusion, stress can cause pain or tenderness in front of the ear or temporal area or cheek area. Sometimes, people complain about their jaw locking during movement or they complain about TMJ sounds or deviation of the mouth during opening. All of these complaints are signs of TMJ disorder.


Why do people have TMJ problems?

There is no one or exact cause of TMJ disorders. TMJ disorders are multifactorial problems. Direct trauma to the jaws, falling or car accidents, bruxism habit, clenching, bad habits such as biting finger nails, stress, depression, missing teeth and malocclusion, some growth problems of TMJ can cause TMJ disorders. Sometimes, the trauma during a tooth extraction or long lasting dental treatments can be initial factors for TMJ disorders.


I hear some sounds from my jaws? What does this mean? Is there a treatment for this?

There is an articular disc between mandibular condyle and the temporal bone which helps the mandibular condyle to move smoothly during opening and closing the jaw. In healthy TMJ’s, this articular disc stays always in between the articular surfaces during movement, but sometimes, in some TMJ’s this disc is anteriorly, medially or posteriorly displaced. These patients complain about a click sound while opening their jaws. This ‘click’ means that the anteriorly displaced disc gets into its neutral position during opening. This is called ‘disc displacement with reduction’. This click sound is quite a soft sound which does not bother anyone else other than the patient. Sometimes, this sound can be quite a loud sound which can be heard by a person sitting next to you. This louder sound is called ‘popping’. Another type of TMJ sound is the ‘crepitation’ which occurs when there is degenerative changes on the articular surfaces of the TMJ. It feels like, you grind something in your joint area.

There is no spesific treatment for TMJ sounds. We don’t treat TMJ sounds unless you have TMJ pain or you have inabilitiy to move your jaw properly accompanying your TMJ sounds. Sometimes ‘popping’ can really be an irritating problem for the patient. The only treatment for eliminating the popping sound is TMJ surgery.   


I feel that my jaw moves slightly sideways while I open my jaw and I feel that I cannot open as much as I used to in the past? What may be the reason for this?

The deviation can ocur as a result of a fracture in the TMJ area or more offen it occurs because of the displacement of the articular disc. You can watch your jaw movements in front of a mirror. If it moves slightly sideways during opening and comes to its normal place during maximum opening (deviation), it means that your articular disc is anteriorly displaced, but it comes to its normal position during maximum opening. This is called as ‘disc displacement with reduction’. If your jaw moves slightly to one side (deflection) and you feel that you cannot open your jaw as much as you used to, it means that your disc is anteriorly displaced and cannot come to its neutral position during opening. This is called ‘disc displacement without reduction’.


I feel that I have some of the symptoms listed above, what should I do for this?

Temporomandibular disorders are multifactorial and complex disorders. Sooner the disorder is diagnosed, easier and shorter the treatment will be. So it is recommended for everyone having the symptoms listed above to refer to a specialist. Temporomandibular disorders usually cause ear pain and tinnitus, so the patients generally refer to an ENT doctor first, but the specialists studying temporomandibular disorders are dentists. Temporomandibular disorders are treated by dentists specilized in TMJ area.


What kind of treatments do you have for Temporomandibular Disorders?

Temporomandibular disorders are multifactorial and complex disorders. It is not possible to treat them with a single drug or with a single procedure. The most important part of the treatment is the rutine follow-up. The first step of the treatment is  informing the patient about the problem. The treatment starts from least invasive and goes to surgery if necessary. Behavioral therapy, pharmacotherapy, physical therapy, occlusal splint therapy, intraarticular drug injections and arthrocentesis are the treatment modalities used before surgery. If none of these therapies are good for the patient, the patient is referred for surgery.