TMJ dysfunction affects more women – 12/06/2023 – Balance

Pain, clicking and difficulty opening and closing the mouth are signs that something is wrong with the temporomandibular joint, the TMJ.

This is one of the most complex connections in the human body and is activated even while we sleep, as we contract our facial muscles, grind our teeth and swallow our saliva.

“Overloading this joint structure can cause changes in movements, which combine rotation and translation, as well as a lot of pain”, says Rodrigo Teixeira, dental surgeon and president of SBDOF (Brazilian Society of Temporomandibular Dysfunction and Orofacial Pain).

The TMJ connects the mandible to the temporal bone at the base of the skull and moves in three directions: up and down, protrusion and retrusion, and laterality. It has a cavity with synovial fluid, which works as a lubricant, and an articular disc, with a fibrocartilaginous structure, which has the function of protecting and enabling the fit between bone surfaces.

The problems that arise in this region are called temporomandibular disorder (TMD), which can have a muscular origin —when it involves masticatory muscles— or articular —when it affects the bones and articular disc.

The causes of TMD are multifactorial and include trauma to the region, poorly adapted prosthesis, systemic diseases (such as rheumatoid arthritis and osteoarthritis), anatomical factors, sleep disorders and psychosocial factors (such as stress, anxiety and depression), which can lead to parafunctional habits — the best known of which is bruxism, which occurs when a person grinds their teeth involuntarily, especially while sleeping.

Symptoms include pain in the chewing muscles and in the TMJ, which can radiate to the head and neck region, noises such as clicking and clicking noises in the joint, difficulty opening or closing the mouth and the feeling that the jaw moves out of place when doing so. some movements.

Teixeira states that clinical and population epidemiological studies indicate that these signs can appear in up to 70% of the population. “Despite this, the reported prevalence of cases requiring treatment for pain or functional disability is 5 to 12%,” he notes.

Women are at least four times more likely to suffer from TMD, highlights the dentist.

“Anatomical factors, behavioral and psychosocial aspects and hormonal changes linked to the menstrual cycle were also studied in order to justify the higher prevalence of TMD in females”, says Teixeira.

Marcos Pitta, oral and maxillofacial surgeon, explains that women tend to have more elastic ligaments than men. “When the muscle exerts force, the ligament stretches and the articular disc moves out of its correct position,” he says.

An out-of-place articular disc is one of the most common anatomical changes in the TMJ, highlights Pitta. “One of the signs is when you open your mouth and hear a pop. This noise happens because the disc moves back and forth.”

Half of the population has an articular disc out of place without showing any symptoms, says Pitta. “It’s a common condition, it’s not considered a pathology. But when a person feels pain, has difficulty opening their mouth or feels their jaw is locked, they need to seek treatment.”

That’s what happened to publicist Elisabete Costa, 56. She says she had already been diagnosed with bruxism, but never gave much importance to the problem. Until, during lunch, she felt that her jaw was out of place.

“I put the fork in my mouth and stopped it. That scared me a lot, because I felt a hook movement. As if something had left its place, but then returned”, reports Elisabete.

This happened in 2020, at the beginning of the Covid-19 pandemic, when the publicist was taking care of her father, who was sick.

“I was going through a moment of great stress. I heard a little noise on the left side of my jaw, as if it were a bone being crushed, but I didn’t have time to take care of myself at that moment.”

The problem got worse, until the publicist began to have difficulty opening her mouth. “I went to a professional who gave me a bite plate to wear at night, but it didn’t help.”

On the recommendation of her dentist, Elisabete made an appointment with Pitta. She underwent treatment with an oral muscle relaxant and botulinum toxin applied to the TMJ region, in 2022.

“Today I can yawn, something I couldn’t before. I also no longer wake up with pain or hear any noise in the joint. And, most importantly, I can eat calmly, without fear of having my jaw locked”, he says.

Pitta says that conservative treatment, which helps the patient relax the muscles in the region, is the most recommended for most cases.

“Each case is evaluated individually and the diagnosis is clinical, made during the consultation. The professional will find out where the pain is coming from, whether it is muscular or intra-articular. When the patient has difficulty opening their mouth, we can request a magnetic resonance imaging to find out what is causing this limitation”, he concludes.

Even when the articular disc is out of place, surgery to reposition this structure is only necessary in a few cases. “The procedure is only indicated when the disc prevents jaw movement, when it locks in the front and prevents jaw movement”, explains Pitta.

The surgery is considered minimally invasive, but must be performed in a hospital, with general anesthesia. The surgeon repositions the articular disc in the correct place and fixes this structure with an anchor, which can be made of polyethylene or titanium, and reconstructs the ligament.

“However, the patient needs to know that today we have resources to treat the problem without needing surgical intervention”, says Pitta.

Among them, points out the oral and maxillofacial surgeon, are the use of medications such as muscle relaxants and antidepressants (when tension is caused by anxiety disorders, for example), bite plates, application of botulinum toxin, physiotherapy and acupuncture.

Even before going into surgery, it is possible to try arthrocentesis, which is a minimally invasive procedure in which the professional infiltrates the TMJ with saline solution. “But arthrocentesis is only used in those cases where the articular disc is the cause of the problem, and if the patient has not responded to conservative treatment.”

Rodrigo Teixeira, dental surgeon and president of SBDOF, highlights that treatment for FTD can involve more than one professional, as the condition is multifactorial.

“The dental surgeon specializing in temporomandibular dysfunction and orofacial pain (TMD-DOF) is the most suitable professional to make the diagnosis. Treatment will address biological issues, such as inflammatory conditions, to behavioral issues, such as anxiety and changes in sleep patterns “, explains Teixeira.

Therefore, after evaluation with a dentist, it is possible that this professional will refer the patient to a physiotherapist, a neurologist, a psychologist or a psychiatrist.

“For the most part, treatments are conservative and have excellent results, with proof of effectiveness in the literature. Invasive procedures, such as surgery, are less frequent. It is worth noting that cases of TMD require specialist knowledge that goes beyond dentistry. This avoids incorrect diagnoses and unnecessary interventions”, highlights Teixeira.

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