If you can't open your mouth well, you can suspect temporomandibular joint diseaseProfessor Park Kwan-so, Department of Dentistry, Sanggyebaek Hospital, Inje University

 

1. What is temporomandibular joint disease?

If your jaw hurts and you can't open your mouth, it's usually called temporomandibular joint disease. The temporomandibular joint is called the temporomandibular joint in anatomical terms. In English, it's called temporo-mandibular joint disorder (TMD). In the temporomandibular joint, the 'temporal' refers to the side of the head. The mandible is connected to the skull and moves together, and that part is the temporomandibular joint.

 

Many people who often eat tough and hard foods come to us with a sudden pain in their jaws. Temporomandibular joint disease can be a sudden pain, but it can also build up and develop into a disease.

 

Also, if you open your jaw wide, you may make a 'click' sound. This case is related to temporomandibular discs. In this case, it is not possible to say "dangerous" or "no" in one way, but the test will determine whether or not to treat it. Symptoms usually improve spontaneously.

 

2. Temporomandibular joint disease, the rate of people in their 20s is high

 

The picture above is taken from an anatomy textbook. It's all muscle, right? You can see the muscles on the sides of the head, the muscles on the chin, and even the muscles on the cheekbones. These muscles connect to each other to move the jaw, and there is also a muscle inside the jaw that is hard to see. These are called chewing muscles, masticatory muscles.

 

The masticatory muscle has four large masticatory muscles, which work together to help us close, open, and chew. Therefore, temporomandibular joint abnormalities are all that affect the temporomandibular joint itself or the muscles and anatomical structures associated with it, causing functional and pathological changes in the mouth, jaw, and face. Because of this, there are so many different symptoms.

 

 

The table above shows the treatment aspects of temporomandibular joint disease. In 2015, 350,000 people received temporomandibular joint treatment, and in 2019, 410,000 people received temporomandibular joint treatment. About 10 to 20% in 3~4 years. That's about a 15% increase. And if you look at the statistics by age, the number of people who have seen temporomandibular joint treatment is the highest among people in their 20s. And if you look at the 20s, there are 49,000 men and 64,000 women. Women are 1.5 times more likely to be treated for temporomandibular joint disease.

 

The higher proportion of women may be due to psychological factors. The temporomandibular joint is also related to the jaw muscles. However, when you're nervous or stressed, you put a little bit of pressure on your face, and these things can also have an effect. Women are more affected than men. Another is hormonal changes. So there are a lot of theories out there that it can cause symptoms, even though there aren't many hormonal changes that occur in the teens or twenties.

 

Also, there are temporomandibular joint patients in their 70s and 80s. Of course, in the 80s, the total number of patients is a little smaller. But when you reach your 80s, that population decreases, right? So compared to the number of people, it's not a small number. In this case, it can be said that it is because the jaw joint is used a lot.

 

3. Causes of temporomandibular joint disease

 

In fact, there are many causes of temporomandibular joint disease.

 

First, it is the cause of the bones themselves. There are bones that you can touch when you move your jaw. It's the cause of the bone itself. Next, there is a part of the lower jaw that meets the skull called the condyle. The part of the joint that allows the jawbone to fit into the part that is concave in the part of the skull is called the joint fosssa, and the part that is stuck between them is called the disc. And then there's the muscles and ligaments that stick around it. Problems in these areas are called articular factors. In addition, there is a part called a 'tendon' in the chewing muscle that is attached to the outside of the joint. Problems in these areas are called muscular factors. Finally, there's the psychogenic factor. Earlier, I mentioned that the high rate of temporomandibular joint disease treatment among women in their 20s may be due to something like stress. Such psychological factors can overlap and cause temporomandibular joint disease.

 

It can also be caused by trauma. Trauma isn't just about being hit hard. This includes eating solid foods such as cuttlefish, squid, and nuts that constantly irritate the jaw. Also, there are more people than you might think who have a habit of clenching their jaws or clenching their teeth. These can also cause temporomandibular joint symptoms.

 

4. Classification of temporomandibular joint disease

 

Diagnostic Criteria (DC) There are diagnostic criteria called TMD. Temporomandibular joint diseases are classified as follows.

 

- Temporomandibular joint abnormalities

- Abnormalities in the chewing muscles

-headache

- Abnormalities in the structure around the jaw

 

Temporomandibular joint abnormalities can be caused by pain in the joint, abnormalities in the discs, limitations in jaw movement even though there is no disc abnormality, or the jaw moves too well. And 'joint disease, fractures, and congenital dysplasia' are all temporomandibular joint abnormalities.

 

And, there's the headache. You may think it's strange that headaches are included in the classification of temporomandibular joint disease. The easiest thing to think about is that I mentioned earlier that I have a jaw muscle attached to the side of my head. The muscles that move the jaw and mouth are attached to the head, which can cause pain in the sides of the head. That's why every time you chew, you may experience a headache due to an abnormality of the jaw muscles.

 

5. Examination for temporomandibular joint disease

 

There are several tests used to diagnose temporomandibular joint disease. Seeing the patient, touching the patient, and seeing the movement of the jaw is called a "clinical examination method."

 

And then there's the 'aperture', which is simply the amount of mouth opening. The degree of mouth opening is usually that if three fingers go in relative to your own fingers, your mouth will open easily. If you can't get even two, it's best to go to the hospital as soon as possible.

 

And then there's the use of video. Basic X-rays, CT scans, bone scans, MRI scans, things like that. The reason for this test is to look at the movement of the discs and the movement of the joints. You can't actually look at the disc. You can't see in perspective. That said, you can estimate the condition of the disc by looking at its movements. Also, X-rays should be taken to determine if there is a change in bone shape or not.

 

The combination of these things gives some idea of whether it's a disk failure or something else that's preventing it from moving.

 

6. Treatment of temporomandibular joint disease

 

The simplest known method is device therapy. It is a very basic treatment that uses a device to stabilize the jaw so that it is always in a stable position. It's also known as a 'splint'. There are different types of splints. The anterior position splint is when you put the splint on and close your mouth so that your chin is where you want it to be. It's a method that I don't use much these days. There are side effects, so I have to keep checking with the hospital. A stable splint, on the other hand, is a slight guide to keep the jaw in a stable position, like a compensator. However, this splint is not covered by health insurance yet, so there is some cost.

 

And there is a way to inject it into the temporomandibular joint. It's an injection into the joint to make the jaw move a little less. I don't do Botox directly on the jaw joint, I do a lot of Botox on the jaw muscles. This prevents the jaw muscles from moving harder, reducing the force of chewing and making the jaw slightly slimmer.

 

There is also a temporomandibular joint irrigation procedure. It is called the temporomandibular joint cavity and is injected into the area to clean it.

 

 

All the inflammatory stuff that's been sick for a long time is piled up here. So, if you remove the inflammatory substances and sprinkle a lot of water on them, it will have a little bit of a lubricant-like effect. And when I try to open my mouth, it gets stuck in a certain area and doesn't open. This has the effect of blowing water this area to remove the material that is attached to it. This will move your jaw and the pain will gradually improve. This method is not applicable to all patients, but it is a treatment method that can be used for those who have difficulty moving their jaw due to temporomandibular joint disc disease and suspect slight adhesions. You need local anesthesia to be treated.

 

Some things you can do at home include stretching and warm compresses. When I stretch, it hurts, but I don't force myself to open it, and it hurts a little, but I can open it up slightly. Applying warm compresses also helps a lot. If the left side hurts, don't just apply a compress on the left side, if you warm both sides together, it will basically improve blood circulation, and if you have an inflammatory reaction, it will help you recover from the inflammatory response. But don't hold it on for too long.