Jaw joint (TMJ) disorders

Jaw joint disorder is also known as temporomandibular joint disorder – TMJ disorder for short. Mr Luke Cascarini is one of the UK’s leading experts in conditions of the TMJ.

The jaw joint is one of the smallest in the body. It is a hinge joint that allows the lower jaw to move up and down against the fixed upper jaw and also to rotate to some extent. This makes it possible for us to chew, sing, shout, speak and yawn.

Like other joints, the jaw joint has a protective cartilage that cushions the bones as the jaw joint moves. The jaw has a small disc of cartilage that moves with the jaw; it slides backwards and forwards as the lower jaw moves. This disc can become displaced or folded and when it snaps back into place, the jaw ‘clicks’.

Many people feel the clicking sensation when they exercise the lower jaw but are not aware of it generally during eating or speaking. If the cartilage disc becomes deformed and does not spring back, this can then lead to inflammation and a loss of movement.

TMJ disorders are difficult to classify but they may arise because of a problem in the joint itself, with the cartilage or in the muscles that move the joint.

• Osteoarthritis can affect the jaw joint as it can any other joint in the body. This leads to a TMJ disorder usually seen in older rather than younger people. The cartilage that cushions the joint can become worn or damaged, causing inflammation and pain.
• Inflammatory arthritis – such as rheumatoid arthritis – can also affect the jaw joint.
• Traumatic injury can damage the bones of the joint, the cartilage disc or can affect the alignment of the upper and lower jaw.
• Overusing the muscles around the jaw can lead to jaw joint problems. A painful jaw joint, noticeable jaw clicking and not being able to open the mouth properly is more common in people who clench or grind their teeth in their sleep. This condition is known as bruxism.

• Clicking of the jaw when it is moved.
• Feeling as if the jaw has got stuck.
• Restricted jaw movement – not being able to open the mouth to yawn.
• Pain that feels like it’s coming from the jaw joint, or that radiates around into the cheek, temple, and ear or down to the lower jaw or neck.
• Problems in the ear such as tinnitus (ringing in the ears), pain or feeling dizzy.

Luke diagnoses and treats all types of TMJ disorder. He recommends that if you are worried about your jaw joint or you are developing troublesome symptoms that you have your jaw joint checked by someone with his expertise. TMJ disorders can often be treated easily without medical or surgical intervention but this becomes less likely if you ignore the problem and just hope it will go away.

Luke is an expert in surgery for jaw joint disorders including TMJ arthroscopy, open surgery and jaw joint replacement.

When you first come and see Luke, he will take a full history of your symptoms and then listen to how your jaw joint problems have affected you.

He will then conduct a full examination, looking at how much function you still have in both your jaw joints. In some cases, he will then need you to have a scan to look at what is going on inside the joint.

Being thorough at this first stage allows Luke to develop an understanding of your TMJ disorder, form a diagnosis and make a treatment plan.

A broad range of treatments options are available. It is important to start with the least invasive and it is not uncommon for people to need several types of treatment to resolve the problem fully.

The overall idea is to start with the easiest, least invasive treatment to see if they work first. If they don’t bring about sufficient improvement in your symptoms, he will then move onto the next procedure until your jaw joint problem is solved.

Luke diagnoses and treats all types of TMJ disorder. He recommends that if you are worried about your jaw joint or you are developing troublesome symptoms that you have your jaw joint checked by someone with his expertise. TMJ disorders can often be treated easily without medical or surgical intervention but this becomes less likely if you ignore the problem and just hope it will go away.

You might also benefit from a course of anti-inflammatory medicines. This is especially true if you have an acute problem (it has come on quite quickly and you are in quite a lot of pain) and definitely after TMJ surgery.

In certain cases, you may need jaw joint arthroscopy, TMJ open surgery, or in severe cases, jaw joint replacement.