There are two temporomandibular joints (TMJs) that connect the lower jaw (mandible) to the skull bone. They are located on either side of the face, just in front of the ears.

The causes of ATM problems are multiple or multifactorial. Here are some examples of possible causes:

• Some predispositions: these disorders are more common in women aged 20 to 50 years;
• Some traumas: an accident or a blow to the jaw or face can break the jaw or damage the joint disc and affect the MTAs;
• Repeated tightening of muscles or teeth can cause muscle spasms causing pain;
• Teeth grinding, often done unconsciously during sleep, can produce greater than normal forces and contribute to pain;
• The habit of tightening the jaws (contraction of the chewing muscles), bruxism;
• Stress and psychological tensions that produce tensions in the jaws;
• Heredity, congenital or developmental anomalies;
• Certain pathologies or diseases: arthritis problems, degenerative joint diseases, etc..;
• Dental problems: dental movements following the loss of a tooth, fillings too high can cause a bad relationship between the teeth and affect the joints;
• Major malocclusions: tooth misalignment, functional interference causing jaw deflection. It should be noted, however, that although it is recognized that malocclusion may contribute to temporomandibular joint dysfunction disorders, it is not believed to be the main cause. The use of orthodontic treatment to correct a malocclusion for the sole purpose of eliminating problems with ATMs is not indicated.

Other factors that may indirectly contribute to ATM disorders:

• Poor diet ;
• Arthritis;
• Lack of sleep or sleep disorder (sleep apnea, snoring);
• Dislocations, fractures and structural problems ;
• Posture disorders or problems;
• Hormones;
• Occlusal trauma (interference between the teeth of both jaws, loss of teeth, addition of a new dental prosthesis, etc.);
• Depression (depressive syndrome, anxiety);
• Post-traumatic stress disorder;
• Various psychological disorders.

Many people have ATM disorders, but only a minority are affected by serious problems.

ATM disorders that may require treatment are those that:

• are accompanied by severe pain or discomfort;
• generate internal displacement;
• have signs of arthritis or lesions;
• cause reduced mobility (limited jaw opening) or excessive joint mobility;
• are affected by congenital or developmental anomalies.

However, most of the problems affecting ATMs are temporary: 80% of the affected people recover within six months, without intervention.

Promote the rest of the jaws

The therapeutic approach is primarily conservative and “reversible”, i.e. it avoids causing permanent changes in the structure or position of the jaws and teeth. The first step is simply to allow the jaw to rest. This may include:

• the use of compresses;
• physiotherapy, osteopathy or acupuncture;
• biofeedback and relaxation techniques;
• teeth balancing to eliminate slight interference between the teeth (occlusion adjustment or balancing).

Rest of the jaw can help ATMs heal. It is therefore preferable to avoid:

• hard foods;
• gum, caramels and hard candy;
• large jaw openings (yawning, etc.)

When a conservative approach is insufficient, the use of a joint plate or occlusal plate can be an essential asset.

Malocclusion and ATM disorders

In the presence of a malocclusion, orthodontic treatment may improve symptoms. However, since the cause of ATM disorders is multifactorial and we do not control all the variables involved, it is impossible to guarantee an improvement or elimination of symptoms, regardless of the therapy used.

Dislocation of the temporomandibular joint often occurs acutely during episodes of significant oral opening: yawning, dental care…

It manifests itself by blocking the mandible (lower jaw) in the open position. Impossible to close your mouth then. The phenomenon is not painful when it is installed, but can gradually become so over time (a few hours).

This extremely uncomfortable situation (difficult speech, impossible feeding, drooling patient) is a reason for emergency consultation.

Most often, symptoms improve or disappear a few weeks after their appearance because the joints are less stressed in a person who has difficulty chewing.

The risks lie mainly in discomfort and even the impossibility of eating.

The surgical indication is then immediately applied.

Prevention measures to minimize symptoms and problems at ATMs are a matter of common sense: it is a matter of avoiding anything that could force or “stress” the joints:

• Avoid excessive opening of the mouth;
• Avoid chewing gum, biting your nails or biting hard objects (pencils, etc.);
• Avoid foods that are very hard or require strong chewing; eat softer foods during painful episodes;
• In case of yawning, support the jaw with your hand;
• Monitor your posture (working position on the phone or computer for a long time);
• Avoid sleeping in a position that puts a lot of pressure on the mandibles;
• In case of teeth grinding, jaw clenching at night or in times of stress, tell your dentist or consult an orthodontist.