The
temporomandibular joint (TMJ) is the complex joint of the
lower jaw which occasionally presents
some diseases and dysfunction. In spite of extensive basic and clinical
research, confusion continues regarding the differential diagnosis of
temporomandibular joint disorders. This confusion arises to a large degree
because we are dealing primarily with complaints of pain. The principal
diagnostic challenge is to distinguish those patients whose signs and
symptoms are caused by internal derangement from those whose disturbances
are caused by myofacial pain 
and dysfunction; in other words, joint
problems versus muscular disorders. The typical patient with joint derangement
will have pain and mandibular dysfunction or both localized to the TMJ.
The pain will be less in the morning and become worse during the day and
with mandibular function. The affected joint(s) will be tender to palpation
and painful when loaded. There will be minimal muscle tenderness. In contrast,
the typical patient with a muscle disorder will have pain that is diffuse
and poorly localized. The pain frequently will be worse in the morning.
The patient generally sleeps poorly and is aware of clenching or grinding
the teeth. Examination reveals diffuse masticatory muscle tenderness.
The intra-articular problems usual emanate from a 
deformity, injury,
or displacement of the "meniscus", which is a supporting capsular disc
that is suspended around the condylar head of the lower jaw (the ball
part of the socket joint) and has a fluid media around it which lubricates
and creates a " shock absorbing" affect. If this suspension ligament is
damaged through injury it may need repair. There are now arthroscopic
procedures available to allow the surgeon to take a look into the joint
interior just like any other joint such as the knee, which is common practice.
Nevertheless, due to the small size and complexity of the joint, it is
difficult to operate directly. It takes special training and skill to
accomplish this. The
oral surgeon would be a good place to start to develop a diagnosis and
treatment plan. It may be suggested that you have an MRI (magnetic resonance
imaging) radiographic study done. This less invasive than other diagnostic
tests and provides a guide to whether there is capsular damage or displacement.
Splint therapy may be recommended. This is an appliance that is fabricated
in a laboratory and adapts to your teeth, used therapeutically to "rest"
the joints for aid in repositioning a strained capsular disc. Since many
TMJ patients appear to have stress problems as well, psychological counseling
may be recommended.