TMJ Dysfunction Treatment in Ukraine

The temporomandibular joint connects the lower jaw to the base of the skull and works every time you speak, chew or yawn. It is more complex than the other joints of the body: between the head of the jaw and the temporal bone lies a cartilage disc that moves together with the head of the jaw and absorbs load. The right and left joints are rigidly linked by a single bone, so they cannot move independently, and they are controlled by a group of chewing muscles.

When this system goes wrong, there are three typical complaints: the jaw clicks or crunches, there is pain in front of the ear or in the chewing muscles, and the mouth does not open fully. Normal opening is 40–55 mm between the incisors, roughly three fingers held together; opening of less than 35 mm is considered restricted. Symptoms may affect one side or both, appear in the morning, build up towards evening or come in episodes.

Dysfunction is divided into two broad types, and the whole approach depends on which it is. The muscular type is overload and spasm of the chewing muscles: the pain is dull and diffuse, gets worse after chewing hard food or a long conversation, and the mouth opens with effort but usually wider than in the joint type. The joint type is associated with displacement of the disc or with changes in the bones themselves: here there is clicking at a particular point in the movement, deviation of the jaw to the side on opening, and sometimes sudden locking.

Not everyone needs treatment. Clicking without pain and without restricted movement is a common finding and is not a disease in itself: it needs treatment when pain appears, the jaw starts to lock or the sound changes quickly. On the other hand, you should not put off a visit if the pain lasts more than two weeks, if you suddenly cannot open your mouth wider than two fingers, or if the way the teeth meet has noticeably changed in a short time.

It is also worth knowing what dysfunction is not. Swelling and redness over the joint with a raised temperature, a sudden change in the bite after an injury, numbness of half the face, pain in the temple in an older patient together with deteriorating vision: these call for a different route, to a maxillofacial surgeon, a rheumatologist or a neurologist. MediUkraine helps patients find and arrange treatment; it is not a clinic. We select the clinic and a doctor with the right specialisation, agree dates and support you throughout, while the doctor decides on diagnosis and treatment after an in-person examination.

Diagnosis begins not with equipment but with a structured examination. The international DC/TMD diagnostic criteria describe the sequence: questions about the nature and duration of the pain; palpation of the temporal, masseter and pterygoid muscles and of the joints themselves; measurement of mouth opening with a ruler in three variants (unassisted, maximum and assisted by the doctor); assessment of side-to-side movements and forward movement of the jaw; and recording of sounds with each movement. At this stage the doctor can usually already tell the muscular type from the joint type, and the figures in the record become the baseline for comparison a few months later.

Imaging answers two different questions, which is why there are two methods. Cone beam CT shows the bones: the shape of the head of the lower jaw, narrowing of the joint space, erosions and bony outgrowths in osteoarthritis, the consequences of a fracture. MRI is the only method that shows the disc itself: its position with the mouth closed and open, its shape, and the presence of fluid and signs of inflammation. That is why MRI is prescribed for clicking and locking, and CT when the bone needs to be assessed. Not every patient needs both scans.

The most common joint variant is disc displacement with reduction. At rest the disc slips forward off the head of the jaw, and on opening the head catches up with it and returns it to its place: that is the moment you hear the click. A second, quieter click often occurs on closing, when the disc slips off again. The range of movement is usually preserved. If there is no pain, it needs no active treatment, only sensible limits on jaw load and monitoring.

A worse scenario is disc displacement without reduction, also called closed lock. The disc no longer returns to its place and mechanically blocks the movement of the head of the jaw: the mouth suddenly opens only 20–25 mm, the jaw shifts towards the affected joint when you try to open it, and the clicking that was heard for years disappears, which is not a sign of recovery. In the first weeks the doctor may try to gently reduce the disc and prescribe a splint; later the emphasis shifts increasingly to stretching the tissues and exercises. Notably, even if the disc never returns to its place, the range of movement gradually recovers in most patients: the joint adapts, although the image remains abnormal.

The muscular type is more common than the joint type and is almost always linked to overload: night-time teeth grinding, daytime clenching, long conversations, anxiety, poor sleep. The pain is dull and diffuse, covers the cheek and temple, is often on both sides, and in the morning the muscles feel bruised. Patients are often surprised that their ear and head hurt when the problem is in the jaw. The explanation is simple: the joint lies directly in front of the external ear canal, and sensation in the joint capsule and part of the ear is supplied by one and the same branch of the trigeminal nerve, the auriculotemporal nerve. So the brain often reads overload or inflammation of the joint as pain in the ear, sometimes with a feeling of blockage or ringing, even though the ENT specialist finds no changes. Headache is mostly caused by an overloaded temporalis muscle: it is broad, fans out over the temple, and its spasm is felt as a squeezing pain in the temples and behind the eye.

The third group is degenerative changes, that is, osteoarthritis of the joint. Its characteristic sign is not clicking but crepitus: a dry crunching, like grinding sand, heard throughout the movement. The CT scan shows a flattened head of the jaw, bony outgrowths and sometimes reduced height of the jaw's ramus. Osteoarthritis does not resolve, but nor does it mean an operation is inevitable: the aim of treatment here is to relieve pain, preserve the range of movement and offload the joint, not to make it look as it did at twenty.

The main treatment for dysfunction is reversible, and it always comes first. This means explaining the problem, changing habits, a soft diet for a few weeks, jaw and neck exercises under the supervision of a physical therapist, heat treatments, short courses of painkillers prescribed by the doctor, and work on sleep and anxiety. This set of measures brings relief to a significant proportion of patients, and it should not be skipped in favour of treatment that looks more serious.

Splint therapy uses a hard, removable full-arch splint of clear acrylic, made by a dental technician from models of the jaws. The most common is the stabilisation splint, worn mainly at night: it distributes the bite evenly, offloads the joint and reduces the destructive effect of night-time grinding. A repositioning splint, which brings the jaw slightly forward, has narrower indications: a recent disc displacement, and only for a limited period. The evidence base for splint therapy is moderate: studies show a reduction in pain, but the superiority of a hard splint over other reversible methods has not been confirmed in all of them, so the splint is regarded as part of the plan rather than a treatment in itself. Soft silicone mouthguards are less suitable for this purpose: in some patients they actually provoke clenching.

When reversible methods are not enough, procedures on the joint itself are discussed. Arthrocentesis, flushing of the upper joint space through two needles, is used for persistent restriction of opening; sometimes hyaluronic acid or a corticosteroid is injected into the joint. Arthroscopy allows the joint to be examined from the inside and adhesions to be cut, while open surgery on the disc is rarely needed, only with marked structural changes. Botulinum toxin injections into the chewing muscles are sometimes used for pronounced muscle hypertonicity, but the evidence on their effectiveness is conflicting and excessive doses weaken chewing, so this is not a first-choice method.

Sequencing is the key question for patients who also need braces or crowns. First the pain is relieved and the joint stabilised, and only after the jaw has worked for several months without flare-ups are orthodontics or prosthetic work discussed, in the position already tested with the splint. Irreversible procedures as first-line therapy, such as extensive grinding of the teeth or braces and crowns to correct the joint, are not supported by evidence: research in recent decades has not confirmed the idea that dysfunction arises primarily from the way the teeth meet, and the cause is considered multifactorial. If you are offered treatment that starts with grinding down your teeth, that is a reason to get a second opinion.

The first days with a splint almost always feel strange. Saliva production increases, speech changes, and in the morning there may be a feeling that the teeth do not meet the way they used to; this passes within 20–30 minutes of taking the splint out. Getting used to it usually takes 3–7 days. But if the splint presses on a tooth or the gums, do not wait: it is a fitting issue that takes a few minutes to fix at an extra visit.

The first check-up is scheduled after 1–2 weeks, and then roughly every 4–6 weeks. As the chewing muscles relax, the lower jaw takes up a different position, and a splint that fitted perfectly a month ago begins to make uneven contact. That is why adjustments are not an extra service but part of the method.

Muscle pain usually eases first, within 2–6 weeks. Joint pain and restricted movement take longer, typically 2–3 months of regular exercise. Clicking may remain for good, and this does not mean failure: the aim of treatment is the absence of pain and a normal range of movement, not silence in the joint.

If the initial restriction was marked and the mouth opened 20–25 mm, recovery is measured in millimetres per month. Here much depends on doing the exercises every day: without them the tissues around the joint remain shortened, and the splint on its own will not restore the range of movement.

After three months the doctor reassesses the situation using the same measures as at the first visit: millimetres of opening, pain intensity on a scale, tender points on palpation. If there is no progress, the right course of action is to reconsider the diagnosis, not to continue with the same splint for another six months. Sometimes at this stage an MRI that was not done at the start is prescribed, or the patient is referred to a neurologist or a rheumatologist.

To be honest about the long-term outlook: in some patients the symptoms come back, most often with stress, lack of sleep or a return to old habits. Only a doctor can predict the outcome for a particular patient, after an examination. That is why many people continue to wear the night splint after the active stage is over, as a way of protecting the teeth and the joint rather than as open-ended treatment.