Firstly I appologise for the length of this post. I have just sat down at my desk at the start of my day and I seems impossible to relay 15 years of study in this area to a single logical post. I may at times contradict my self but that is the nature of the jaw joint. To say the TMj is my area of specialty is a stretch because no one in their right mind would specialise in this (well not if you want to make money). However it is my pet interest and I use the basis of Temporal Mandibular Dysfunction (TMD) in most of my complex restorative cases. If anyone is referred to our practice with jaw issues they are generally sent to me.
To begin with I'll try and explain the clicking. A normal jaw when it opens has a smooth cartilage disc which slides forward with the jaw and cushions and protects the head of the condyl. If for some reason (trauma, maybe you were born with it, maybe it's maybelline) the disc catches or is jammed it will suddenly be pulled forward by it's ligament and pop or click into position. The same reason can cause the jaw to lock. If you have no pain from it then you are lucky. Plenty of people suffer from some joint sounds and although annoyinng, generally does no harm. The reason most cases are not treatable is the fact that surgery to this space will often result in scarring or adhesions that can by default case the disc to catch and jam. Surgery is generally reserved for extreme cases where the jaw is closed shut or dislocates instantly (and the patient needs a muscle relaxant plus manipulation to relocate it).
You can get pain for a number of reasons. Sometimes the head of the condyl sits on the disc's ligament rather than the cartilage and causes pain as it jumps on and off. You can get muscular pain in the head and neck due to the the jaw muscles having to work harder or for longer to try and open and close the jaw. Often these cases you see the jaw zig zag on opening rather than a smooth symetrical movement. You will often have tense pressure points in the muscles or generalise aches through the neck or across the forehead. Some people get ringing in the ears or numbness in their hands.... I have a checklist of approx 125 areas I usually examine.
The problem is TMD is such a broad term that incompasses any concern with the jaw including clenching and grinding. You have to treat every patient as an individual. What will work for one can often give no relief to the next patient with identical symptoms. The first step is often pain relief, massage and exercises to "train" the jaw to move correctly. I will often recommend a topical pain relief cream such as
Voltaren Emulgel for temporary relief but I don't like patients living on painkillers.
Chiro may have some roll if I suspect the neck or spine is causing the muscles to displace the jaw. It really is a case of chicken or the egg and I don't recommend you get any one manipulating the jaw joint itself (recipe for scarring and/or adhesions in my experience).
An occlusal splint or nightguard is a simple device to position the jaw in an optimum position. If you have a broken arm you place it in a sling... the same idea is used when designing a splint. I try and design them so the disc is in contact with the condyle head throughout opening and closing. Don't be fooled into thinking they are just a glorified mouthguard, there is a reason I can charge up to $5000 for them.
I might stop there, I could go into all sorts of other areas I have dabbled in including
Neuromuscular Dentistry. I'm sure if I get bored I'll come back and add some more.
It completely hangs to the left.... it's not extremely noticable (my face only becomes symmetrical if I smile hard enough for my muscles to pull my jaw up and into place, but even then not completely.![:\](https://bluelight.org/xf/BL_Images/Orig_Emoji/wrygrin.gif "wry grin :\")
