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Temporomandibular joint (TMJ) as the jaw joint is known in medical language, exists one on each side of the face in front of the ear. This joint comes into function each time the jaw moves ie. During speech, swallowing, yawning, eating etc. Considering the fact that an individual swallows some 600 times while awake you can imagine the amount of wear & tear this joint goes through.

The TMJ comprises a fibrous disc in between two bony surfaces moving against each other. The disc protects the bony parts from wear & tear, & thus often takes the brunt of it all.

These problems can be broadly divided into two categories :
1. Localized conditions involving the Disc, Ligament or Bony parts
2. Underlying systemic causes reflecting in TMJ malfunction

The former make up the majority of cases seen by an Oral Surgeon.

The most common complaints experienced by a patient of Temporomandibular Dysfunction (TMD) would be :
Pain on mouth opening
Clicking sounds on opening the mouth / on chewing
Pain in / around the ears
Pain along the side of neck
Pain in the upper jaw radiating to the forehead and eyebrows
Inability to open the mouth or a transient lock-jaw after wide opening

MYOFASCIAL PAIN

What exactly does this term mean?
It is a kind of myogenous pain characterized by local areas of hypersensitive bands of muscle tissue known as Trigger Points.

These Trigger Points cause central excitatory effects manifested as referred pain. For the treatment to be effective it should be directed towards the source of pain not the site.

Central excitation may also produce autonomous effects such as drying or tearing of the eye and nasal discharge .Treatment is aimed at eliminating the cause of local muscle soreness and also reducing the local and systemic factors.
Eliminating the Trigger Ponts may be done by painless stretching of the muscle.
For treatment to be effective and long lasting there has to be full cooperation from the patient's side.

ROLE OF SPLINTS IN TMD
There are splints and then there are more splints, but the goal which a practitioner has to achieve is to provide a patient with a splint that alleviates his symptoms.

Splints are helpful in ruling out certain causative factors. When malocclusion is considered to be a contributing factor to TMD, splint therapy may quickly introduce a more desirable relationship. If it does not affect the symptoms then malocclusion is probably not the cause and the need for irreversible occlusal therapy should be considered.

Many appliances have been suggested for treating TMD but the two most commonly used are the :
Muscle Relaxation Appliance
Anterior Repositioning Appliance

The muscle relaxation appliance is used to reduce muscle activity while the anterior repositioning appliance is used to change the position of the mandible.

Initially an increase in salivation may occur which should resolve in a few hours. If wearing the appliance causes an increase in pain the patient must discontinue wearing it and report to the therapist for further evaluation.