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Temporomandibular joint

Dr David Benguira orthodontiste montreal
You suffer from chronic pain in the jaw, face, head, neck or shoulders? This pain can be caused by TMJ

TMJ disorders (source ADC and ADF)
Temporomandibular joint dysfunction syndrome (TMJ) is a musculoskeletal condition, characterized by pain, restricted mandibular movement and noises during jaw movement at the temporomandibular joint..

What is TMJ?

The temporomandibular joint (TMJ) is the joint that connects the lower jaw to the temporal bone of the skull that allows the jaw to move up and down and from left to right, which allows us to speak and chew. The main muscles of mastication are: temporal, masseter, medial pterygoid, and lateral pterygoid. It is located directly in front of the ear of each side of the head where the upper jaw (maxilla) and the lower jaw (mandible) meet. The TMJ is one of the most complicated joint in the human body.

anatomy of the temporomandibular joint (source ADC)

The movable part of the temporomandibular joint, is called the condyle. Its place in the temporal bone is called the articular fossa. Between the condylar fossa and there is a meniscus or cartilage disc which acts as a cushion to absorb the stress and allows a smooth movement when the mouth opens and closes.
Most problems of TMJ are related to the dislocation or damage of this meniscus between the two jaws, while fewer cases are related to muscles providing movement of the temporomandibular joint (TMJ).

Symptoms of TMJ

The signs and symptoms of TMD include pain and tenderness in or around the ear, jaw joint, muscles of the jaw, face or temples. Other symptoms include difficulty opening or closing the mouth, and cracking or grinding noises while chewing, yawning or opening the mouth. The TMJ can cause neck pain and headaches. In the presence of any of these symptoms, it is important to consult your ENT or dentist.

After a thorough examination and appropriate x-rays, if necessary, Dr Benguira may suggest a treatment plan for your TMJ pain. This treatment plan may include relaxation techniques, the recommendation of a physiotherapist, chiropractor or a behavioral therapist to help you relieve muscle pain. Other treatment options include painkillers, anti-inflammatories and muscle relaxants. If you are unable to sleep well, there are ways to improve sleep.

Dr Benguira may also suggest wearing an occlusal splint overnight which is made of transparent acrylic. It attaches to the occlusal surface of the teeth of the upper or lower jaw. This device supports the relaxation of joints and muscles of the jaw.

Dr Benguira followed more than 100 hours of post graduate  continuing education in facial pain and treated patients in clinical subspecialty  setting of orofacial pain and dysfunction (DDBF) at the University of Montreal.

Informations orthodontie troubles douleurs atm machoire visage

An occlusal splint is made of plastic and covers the face
occlusal teeth of the upper or lower jaw.


Because many other disorders can cause symptoms similar to ATM,

Dr David Benguira must review the patient's history and perform a thorough physical examination to determine the cause of symptoms, wich includes:

  • Physical examination of the temporomandibular joints and their movements.
  • Examination of the teeth for signs of malocclusion.
  • Palpation of the muscles.

In some cases, the diagnosis of ATM may require additional tests:

  • Panoramic Dental to verify the structural problems of hard tissue.
  • 3Dimensional radiography (CBCT available at our clinic see section technologies)
  • The magnetic resonance imaging (MRI) to also check the soft tissues of the TMJ. the MRI provides information about the condition of the disc.

diagnosis and identification of causes is very important to determine the appropriate treatment for the symptoms of TMJ disorders.


The treatment plan may include  medicatiosn to relieve pain, relax the jaw, TMJ exercises, physiotherapy, treatment by orthosis (occlusal plates of different styles), orthodontic treatment or sometimes a TMJ surgery.


 1. Stress Reduction
 2. Modify bite posture . Stopping clenching ...
  Physical therapy can help relax the muscles and increase joint flexibility. It is often used in conjunction with other treatments  the TMJ.
 3.Articular Rest. Avoid tension (Eliminate causes muscle tension periarticular), changing eating habits, avoid abnormal movements .
 4. Anti-inflammatory drugs (NSAIDs), muscle relaxants: to "relax" the muscles of the jaw, analgesics for pain relief temporomandibular joint .
Relieving pain is usually the first thing to do before any other TMJ treatment, especially if the TMJ pain is so strong that even small movements of the jaw become difficult.
Medications such as analgesics, anti-inflammatory drugs and muscle relaxants are usually sufficient to relieve TMJ pain. Ice packs and heat can also help to reduce muscle tension and relieve pain.
5. orthodontic treatment or wearing occlusal splints.

Relaxation of the jaw muscles relieves tension and TMJ. To "relax" the jaw, the patient should stop his bad habits and eliminate aggravating factors by chewing gum.

Avoid chewing hard, crunchy foods or foods that require opening the mouth too widely.

Help the patient to stop bruxism with:

• Stress management is essential for bruxism (counseling, medication).
• The occlusal splints are the best treatments for teeth grinding and they are also the most widely used treatment for TMJ problems and jaw muscles. This is a thin piece of hard plastic which is placed over the upper teeth. They are made from impressions of your teeth to make it fit perfectly.

In summary, the occlusal TMJ treatment can be summarized:

• Correction of occlusion problems
When someones  chews with uneven teeth, it can affect the ability of the temporomandibular joint to close properly, causing a TMJ dysfunction. The TMJ treatment should aim to restore and maintain a normal relationship between the jaws (maxilla and mandible) and stabilize the articulations.

• Orthodontic treatment: mandibular repositioning devices move the jaw in a better position. If the occlusal surfaces of the teeth were damaged because of gnashing of teeth, dental caries or trauma, correct occlusion can be restored by changing the occlusal surfaces of the teeth.

• Monitoring: Always first try conservative treatments: behavior modification, orthodontic treatment, drug treatment, reducing stress and, in case of failure, suggest arthroscopic surgery of the TMJ (repositioning or removal of the disk is destroyed) by an ENT surgeon or Maxillofacial surgeon.