What is TMJ / TMD?

TMJ or the Temporandibular Joint is the joint that connects the lower jaw (mandible) to the temporal bone of the skull, which is immediately in front of each ear.  The TMJ's function differently than all other joints in the body because the lower jaw leaves the "socket" and slides forward when you open.  Muscles attached to the TMJ control the position and movement of the jaw.  A disk shaped cushion sits between the lower jaw

and skull to allow for movement.   

TMD or Temporomandibular Disorder is the name given to the conditions that affect the jaw joint.  Many patients use the terms TMJ and TMD interchangeably. TMD can include problems with muscle, bone, ligaments and other tissues that surround the TMJ.

How do I know if I have TMD?

Pain associated with the face, jaw joint area, ears, temples, teeth, shoulders or neck is the most common symptom and the reason people seek treatment. Other signs and symptoms include an inability to open your mouth very wide, a jaw that gets locked in the open or closed position while yawning or even clenching your teeth and clicking, popping or grinding sounds in the jaw joint when opening or closing the mouth.  

What causes TMD?

The TMJ (Temporomandibular Joint) orTMD (Temporomandibular Disorder) is so unique and different from other joints in the body that a disturbance in its complex function can often cause problems. The top portion of the jaw is called the condyle and it looks like a ball. This ball fits into a socket that is positioned in the skull. When your mouth is closed, the ball is completely seated in this socket. As you begin to open your mouth, the ball rotates in the socket. As you continue to open your mouth wider, the ball leaves the socket and begins to slide down a ramp that is directly in front of the socket. You can feel this happen if you touch the area directly in front of your ear and open slowly.

Sore jaws after chewing, difficulty chewing hard food or ringing in the ears (tinnitus) are also symptoms associated with TMD.

Clenching or grinding your teeth can cause symptoms.  One of the most common causes of morning headaches is clenching or grinding your teeth at night.  Patients do not always know they are doing this because they are asleep.  

There are many muscles involved with the opening and closing of your jaw.  When this complex system is not functioning properly, it can cause pain.  Muscle dysfunction is the number one cause of TMJ related pain.  

TMJ problems and symptoms can have so many different origins that it is often difficult to diagnose. Millions suffer from this complex and difficult disease. 


Diagnosis and Testing

Dr. Friedman has many ways that he can determine the cause of TMJ dysfunction.  

Below are just some of these.

  1. History - Much of the diagnosing will come from the history that you provide.  Some of the questions may include when the issue started, whether there has been any change and what type of treatment, if any, have you received for this issue. 

  2. Listen to and feel your jaw when you open and close your mouth.

  3. Observe the range of motion in your jaw.

  4. Press on areas around your jaw to identify sites of pain or discomfort.

  5. X-rays may be helpful if a problem with your teeth is suspected.  A CT scan         can provide detailed images of the bones involved in the joint and MRI's can       reveal problems with the TMJ disk.


The complexity of the TMJ lends itself to many different types of treatment.  A clear and concise diagnosis of exactly the cause of the dysfunction will see that the proper treatment is prescribed.


Orthopaedic Bite Guard / Night Guard

The term occlusal refers to the biting surfaces of the teeth.  The "guard" is made of clear acrylic.  It is hard and does not soften with warm water.  The "guard" is very comfortable to wear because Dr. Friedman addresses the system made of the TMJ's, teeth and the jaw chewing muscles as the ORTHOPAEDIC system it is.  This treatment is widely used because it is almost always helpful and because it is reversible (no permanent changes to the system have occurred).

Occlusal Equilibration

If it is determined that your bite is causing your TMJ symptoms, an occlusal adjustment may be necessary.  The biting surfaces of the teeth are recontoured to fit and function without stressing the TMJ's.  Occasionally, impressions of your teeth may be helpful in determining if occlusal equilibration is right for you.


If the position and fit of your teeth are causing TMJ symptoms, you may need to reposition your teeth by orthodontics.  This therapy is often prescribed when Dr. Friedman recognizes that the teeth are not fitting together properly, but where an occlusal adjustment cannot be performed.


Surgery is used to treat only the very worst cases of TMJ disorders.  In cases that have a bone or disk derangement that has degraded the joint to a point that the patient cannot function, surgery may be the only option.  The types of surgery vary from scoping to complete joint replacement.

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© 2016 by Dr Brian Friedman.