TMJ/TMD and Sleep

The temporomandibular joint (TMJ) is the most unique joint in the whole body as it is two joints in one. The two joints located one on each side of the head, are connected by the lower jawbone. One joint may influence the position of the other joint. Because they are fused in the midline, this means that you cannot move one joint without moving the other. The two joints may differ in size, shape and even function. It is possible to have a problem in one joint but have no symptoms expressed in the other joint. You could also have a pain that starts on one side of the head and migrates to the other side simply because of the relationship of these joints to each other.

The second factor making this joint unique is that another structure dictates its function. This other structure is the teeth. The teeth are passive members of the upper and lower jaws, but they have a specific way that they must fit together and interrelate. As far as the brain is concerned, joint position has priority over tooth position. This means that the TM joints are forced by muscle to move and yet the teeth may not fit together properly. This can potentially cause a mal-alignment within the joint capsule. If this happens, the muscles are put in a compromising situation causing them to spasm, and result in pain. Many of the problems you may be experiencing are a result of muscle spasm, but the cause is not the muscles. The muscles are simply caught between two positions: the tooth position and the jaw position.

The third factor making this joint unique is that it has an articular disc located between the ball (condyle) and the socket (glenoid fossa). This disc has a muscle attached to the front of it that pulls the disc forward as the condyle moves forward in the glenoid fossa (when you open your mouth). The disc is also attached at the back by connective tissue that is much like a rubber band and pulls the disc back as the condyle moves backward in the glenoid fossa (when you are closing your mouth) In other words, these attachments can stretch and recoil as the jaw opens and closes. Since the disc is a separate structure and may move independently from the condyle, it can be displaced which is a cause of many symptoms. We call this disorder an internal derangement of the TM joint. Internal derangement of the TM joint can be a distressing syndrome of pain, limited jaw movement, and clicking, popping and crepitus (a grating sound similar to the crumpling sound of parchment paper) sounds in the TM joint(s).

This derangement may be caused by genetic pathological changes in the joint or acquired pathological changes as a result of trauma. Often, internal derangement of the TM joint is preceded by myofascial pain dysfunction that can involve moderate to severe spasms of the head, neck, shoulder and/or back muscles. A wide range of symptoms may occur such as headaches, muscle pain, ear pain, dizziness, stuffiness, and ringing in the ears, blurred vision, etc. Treatment of these conditions needs to be highly individualized and may include a combination of medical and dental therapies. Treatment of your particular problem will be determined by your specific diagnosis.

(As stated by the American Academy of Craniofacial Pain)

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