TMJ Pain Dentist North Carolina NC Charlotte
Damage and dysfunction in the joint itself can cause pain in the joint. Some of the common causes for pain in the TMJs are listed here.
More general info:
The temporomandibular joint is the joint of the jaw and is frequently referred to as TMJ. There are two TMJs, one on either side, working in unison. The name is derived from the two bones which form the joint: the upper temporal bone which is part of the cranium (skull), and the lower jaw bone called the mandible. The unique feature of the TMJs is the articular disc. The disc is composed of fibrocartilagenous tissue (like the firm and flexible elastic cartilage of the ear) which is positioned between the two bones that form the joint. The TMJs are one of the only synovial joints in the human body with an articular disc, another being the sternoclavicular joint. The disc divides each joint into two. The lower joint compartment formed by the mandible and the articular disc is involved in rotational movement—this is the initial movement of the jaw when the mouth opens. The upper joint compartment formed by the articular disk and the temporal bone is involved in translational movement—this is the secondary gliding motion of the jaw as it is opened widely. The part of the mandible which mates to the under-surface of the disc is the condyle and the part of the temporal bone which mates to the upper surface of the disk is the glenoid (or mandibular) fossa.
Pain or dysfunction of the temporomandibular joint is commonly referred to as "TMJ", when in fact, TMJ is really the name of the joint, and Temporomandibular joint disorder (or dysfunction) is abbreviated TMD. This term is used to refer to a group of problems involving the TMJs and the muscles, tendons, ligaments, blood vessels, and other tissues associated with them. Some practitioners might include the neck, the back and even the whole body in describing problems with the TMJs.
The TMJ is a ginglymoarthrodial joint, referring to its dual compartment structure and function (ginglymo- and arthrodial).
The condyle articulates with the temporal bone in the mandibular fossa. The mandibular fossa is a concave depression in the squamous portion of the temporal bone.
These two bones are actually separated by an articular disc, which divides the TMJ into two distinct compartments. The inferior compartment allows for rotation of the condylar head around an instantaneous axis of rotation, corresponding to the first 20 mm or so of the opening of the mouth. After the mouth is open to this extent, the mouth can no longer open without the superior compartment of the TMJ becoming active.
At this point, if the mouth continues to open, not only is the condylar head rotating within the lower compartment of the TMJ, but the entire apparatus (condylar head and articular disc) translates. Although this had traditionally been explained as a forward and downward sliding motion, on the anterior concave surface of the glenoid fossa and the posterior convex surface of the articular eminence, this translation actually amounts to a rotation around another axis. This effectively produces an evolute which can be termed the resultant axis of mandibular rotation, which lies in the vicinity of the mandibular foramen, allowing for a low-tension environment for the vasculature and innervation of the mandible.
The necessity of translation to produce further opening past that which can be accomplished with sole rotation of the condyle can be demonstrated by placing a resistant fist against the chin and trying to open the mouth more than 20 or so mm.
There are six main components of the TMJ.
Mandibular condyles Articular surface of the temporal bone Capsule Articular disc Ligaments Lateral pterygoid
Capsule and articular disc
The capsule is a fibrous membrane that surrounds the joint and incorporates the articular eminence. It attaches to the articular eminence, the articular disc and the neck of the mandibular condyle.
The articular disc is a fibrous extension of the capsule in between the two bones of the joint. The disc functions as articular surfaces against both the temporal bone and the condyles and divides the joint into two sections, as described in more detail below. It is biconcave in structure and attaches to the condyle medially and laterally. The anterior portion of the disc splits in the vertical dimension, coincident with the insertion of the superior head of the lateral pterygoid. The posterior portion also splits in the vertical dimension, and the area between the split continues posteriorly and is referred to as the retrodiscal tissue. Unlike the disc itself, this piece of connective tissue is vascular and innervated, and in some cases of anterior disc displacement, the pain felt during movement of the mandible is due to the condyle compressing this area against the articular surface of the temporal bone.
There are three ligaments associated with the TMJ: one major and two minor ligaments.
The major ligament, the temporomandibular ligament, is actually the thickened lateral portion of the capsule, and it has two parts: an outer oblique portion (OOP) and an inner horizontal portion (IHP).
The two minor ligaments, the stylomandibular and sphenomandibular ligaments are accessory and are not directly attached to any part of the joint.
The stylomandibular ligament separates the infratemporal region (anterior) from the parotid region (posterior), and runs from the styloid process to the angle of the mandible.
The sphenomandibular ligament runs from the spine of the sphenoid bone to the lingula of mandible.
These ligaments are important in that they define the border movements, or in other words, the farthest extents of movements, of the mandible. Movements of the mandible made past the extents functionally allowed by the muscular attachments will result in painful stimuli, and thus, movements past these more limited borders are rarely achieved in normal function.
Other ligaments, called "oto-mandibular ligaments", connect middle ear (malleus) with temporomandibular joint:
discomallear (or disco-malleolar) ligament, malleomandibular (or malleolar-mandibular) ligament.
Innervation and vascularization
Sensory innervation of the temporomandibular joint is derived from the auriculotemporal and masseteric branches of V3 (otherwise known as the mandibular branch of the trigeminal nerve). These are only sensory innervation. Recall that motor is to the muscles.
Its arterial blood supply is provided by branches of the external carotid artery, predominately the superficial temporal branch. Other branches of the external carotid artery namely: the deep auricular artery, anterior tympanic artery, ascending pharyngeal artery, and maxillary artery- may also contribute to the arterial blood supply of the joint.
The specific mechanics of proprioception in the temporomandibular joint involve four receptors. Ruffini endings function as static mechanoreceptors which position the mandible. Pacinian corpuscles are dynamic mechanoreceptors which accelerate movement during reflexes. Golgi tendon organs function as static mechanoreceptors for protection of ligaments around the temporomandibular joint. Free nerve endings are the pain receptors for protection of the temporomandibular joint itself.
In order to work properly, there is neither innervation nor vascularization within the central portion of the articular disc. Had there been any nerve fibers or blood vessels, people would bleed whenever they moved their jaws, and movement itself would be too painful.