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Temporomandibular Joint (TMJ) The temporomandibular joint (TMJ) is the hinge joint that connects the lower jaw

(mandible) to the temporal bone of the skull, which is immediately in front of the ear on each side of your head. The joints are flexible, allowing the jaw to mo e smoothly up and down and side to side and enabling you to talk, chew, and yawn. Muscles attached to and surrounding the jaw joint control the position and mo ement of the jaw. Temporomandibular Disorders (TMD) Temporomandibular disorders (TM!) occur as a result of problems with the jaw, jaw joint and surrounding facial muscles that control chewing and mo ing the jaw. These disorders are often incorrectly called TMJ, which stands for

temporomandibular joint. The Causes TMD The cause of TM! is not clear, but dentists belie e that symptoms arise from problems with the muscles of the jaw or with the parts of the joint itself."njury to the jaw, temporomandibular joint, or muscles of the head and neck # such as from a hea y blow or whiplash # can cause TM!. $ther possible causes include%&rinding or clenching the teeth, which puts a lot of pressure on the TMJ!islocation of the soft cushion or disc between the ball and socket'resence of osteoarthritis or rheumatoid arthritis in the TMJ(tress, which can cause a person to tighten facial and jaw muscles or clench the teeth The Symptoms TMJ TMJ pain disorders usually occur because of unbalanced acti ity, spasm, or o eruse of the jaw muscles. (ymptoms tend to be chronic, and treatment is aimed at eliminating the precipitating factors. Many symptoms may not appear related to the TMJ itself. The following are common symptoms. a. )eadache% *pproximately +,- of patients with a TMJ disorder complain of headache, and .,- report facial pain. 'ain is often made worse while opening and closing the jaw. /xposure to cold weather or air0conditioned air may increase muscle contraction and facial pain.

b. /ar pain% *bout 1,- of patients with a TMJ disorder notice ear pain and do not ha e signs of ear infection. The ear pain is usually described as being in front of or below the ear. $ften, patients are treated multiple times for a presumed ear infection, which can often be distinguished from TMJ disorder by an associated hearing loss or ear drainage (which would be expected if there really was an ear infection). 2ecause ear pain occurs so commonly, ear specialists are fre3uently called on to make the diagnosis of a TMJ disorder. c. (ounds% &rinding, crunching, clicking, or popping sounds, medically termed crepitus, are common for patients with a TMJ disorder. These sounds may or may not be accompanied by increased pain. d. !i44iness% $f patients with a TMJ disorder, .,- report a ague sense of di44iness or imbalance (usually not a spinning type ertigo). The cause of this type of di44iness is not well understood. e. 5ullness of the ear% *bout 66- of patients with a TMJ disorder describe muffled, clogged, or full ears. They may notice ear fullness and pain during airplane takeoffs and landings. These symptoms are usually caused by eustachian0tube dysfunction, the structure responsible for the regulation of pressure in the middle ear. "t is thought that patients with TMJ disorders ha e hyperacti ity (spasms) of the muscles responsible for regulating the opening and closing of the eustachian tube. f. 7inging in the ear (tinnitus)% 5or unknown reasons, 66- of patients with a TMJ disorder experience noise or ringing in the ears (tinnitus). $f those patients, half will ha e resolution of their tinnitus after successful treatment of their TMJ disorder. DIAGNOSIS OF TMJ D SF!NCTION The most common indicator of TMJ dysfunction is pain. 'ain can be assessed through &/8T9/ palpation of both the right and left joints in all species. *dditionally, the health of the acupuncture point (T 1 (located in the center of the masseter muscle) can be assessed through palpation. Motion in the joint can be

determined by obser ing mastication or by taking the joint manually through a range of motion. "n cases where arthritis is suspected, radiographs and:or joint fluid analysis may be performed.The diagnosis of TMJ dysfunction indicates the need for a full oral examination. "n the e3uine, because of continually eruption of teeth, malocclusion can be common due to lack of proper dental care. (edation of the horse with examination after placement of a full mouth speculum is essential. Many problems in the rear molars of the horse may be missed without the use of a full mouth speculum. "AT#O$OG OF T#% TMJ The TMJ is greatly affected by malocclusion. This can certainly result from congenital mandible or maxillary malformations, trauma, ertebral subluxation, dental malocclusion, or bite misalignment secondary to poor bitting in the e3uine or abnormal stress in the canine (eg, carrying a ball on one side of the mouth). ;hanges in dental occlusion lead to stimulation of the periodontal ligaments, which sense premature tooth strike and stimulate afferent input through the trigeminal ner e. ;hanges in muscle tone in the head and cer ical region increase dural tension all the way to the sacrum. 7eciprocal effects can be seen in the TMJ area secondary to sacral and pel ic areas ia transmitted dural tension.The normal cranial respiratory function of the cranial bones can be inhibited secondary to muscle spasm and dural tension from TMJ dysfunction. ;ranial bones are normally mobile and flex and extend with the hydraulic action of the pulsation of cerebrospinal fluid throughout the craniosacral system. *ltered cerebrospinal fluid rhythm not only affects dural tension, but can alter endocrine function as well. !ue to changes in the cranial shape from altered cranial suture function, ision can be altered as well.'ain in the TMJ also reduced

mastication from joint pain as well as from local muscle spasm. 8ormal hinge motion of the jaw is needed for balance and coordinated mo ement. Muscle tension around the hyoid apparatus also alters the body<s sense of orientation in space. Sour&e '>?,@1Apage>. treatment0of0tmj0disorders