The temporomandibular joint is complex - a task for specialists
The human temporomandibular joint is complex and powerful – a small miracle of nature. Normally, it simply works and you don’t even notice its existence. The latter quickly changes when the function of the temporomandibular joint is disturbed. This leads to movement disorders, temporomandibular joint noises and the temporomandibular joints can become painful. At the same time, the finely tuned interaction of the temporomandibular joints with the masticatory muscles and the occlusal surfaces of the teeth becomes unbalanced.
In order to successfully treat such imbalances, it is therefore necessary to examine and understand the functional state of the muscles, jaw joints and teeth. There is a whole range of special dental examination techniques for this purpose.
Tasks of the temporomandibular joints
The temporomandibular joints form the hinge between the upper and lower jaw. In addition to opening and closing the jaw, they also enable the complex human chewing movement to grind food in the mouth.
In the course of evolution, the structure of the human temporomandibular joint has changed to allow a wider jaw opening for biting off large food objects. The former hinge joint had to become a rotating-sliding joint. This in turn also makes it possible to grind food between the teeth – with a small jaw opening.
To prevent the muscle forces from overloading the temporomandibular joint, the posterior teeth adjust the jaw position during occlusion so that the temporomandibular joints are correctly positioned and function properly. And so that the temporomandibular joints and posterior teeth are not overloaded during jaw movements with tooth contact, the canines guide the posterior teeth apart during jaw movements (“anterior-canine-protected occlusion”).
Structure and function of the temporomandibular joints
A prerequisite for the functional diversity of the temporomandibular joints is their structure consisting of a joint socket (fossa) and an end of the lower jaw bone embedded in it, the condyle. Between the fossa and the condyle there is – normally – an articular cartilage (articular disc). This trick of nature moves largely freely between the two bone surfaces, divides the joint space into an upper and a lower joint space and is very important for joint function.
Basically, the presence of the discus prevents the bones from rubbing directly against each other; this avoids joint inflammation (arthritis) and premature degeneration (arthrosis). The discus has a dual function for jaw movement:
- Initially, the temporomandibular joint opens like a hinge; the disc allows the condyle to rotate freely in the lower joint space.
- In the second movement section, there is an additional advancing movement of the complex of the joint head and cartilage (discus).
Both are illustrated below in an animated video sequence that we have created for you:
Disorders of the temporomandibular joint function
The undisturbed movement sequence is linked to the physiological position of all three joint parts in relation to each other. A significant deviation in the arrangement of the various joint parts therefore leads to a functional disorder, resulting in craniomandibular dysfunction (CMD) with joint disease (arthropathy).
Various faults can occur:
- The misalignment of one or both condyles (condyle displacement) can lead to overloading of the soft tissue in the temporomandibular joint and joint inflammation, resulting in joint pain.
- As a further consequence of the incorrect position of one or both articular heads, the articular cartilage (disci) is or are pushed out of position, resulting in movement disorders of the temporomandibular joints and the lower jaw as a whole, up to blockage of the jaw opening.
- If the joint cartilage (discus) is subjected to an unphysiological load, it can stick to the top of the joint cavity (discus adhesion). This can also impair joint function and thus jaw movement.
- Excessive forces acting on the discus can lead to its perforation or tearing; as a result, the cartilage loses its function, the bone surfaces rub against each other and there is a risk of inflammation and impaired movement.
Video animation: impaired temporomandibular joint function, with backward displacement of the condyle and initially reversible and later irreversible forward displacement of the articular cartilage (discus articularis), as well as pain in the temporomandibular joint resulting from overloading (Video: PD Dr. Ahlers/ © Alila Medical Media)
Why do we need TMJ specialists?
Patients are usually aware of temporomandibular joint dysfunction themselves. Deciphering the cause , however, is difficult due to the mutual influences of the temporomandibular joints, the masticatory muscles, the position of the teeth and the shape of the occlusal surfaces; clarifying the correlations is therefore more complicated than other issues in dentistry.
This is why there are specialists with the relevant knowledge in the diagnosis and treatment of CMD. In its new diagnostic scheme, the German Society for Functional Diagnostics and Therapy (DGFDT), as the responsible specialist society, therefore expressly distinguishes between the level of simple diagnostics (Level I) and diagnostics by specialists (Level II).
To implement this knowledge, in-depth training in the procedures of dental functional diagnostics is just as necessary as the procurement and maintenance of the required technical instruments and software systems as well as a high level of training for the entire treatment team.
Where can you find TMJ specialists?
The CMD Center Hamburg-Eppendorf is one of the leading institutions in the diagnosis and treatment of CMD, especially diseases of the temporomandibular joints and the cofactors of teeth grinding and tooth wear. It was founded as the first specialized practice in Germany by PD Dr. M. Oliver Ahlers after years of leading his working group at the University Medical Center Hamburg-Eppendorf. More about PD Dr. Ahlers
In addition to PD Dr. Ahlers, the team of specialists also includes colleagues Tim Petersen, Dr. Lukasz Katzer and Jakob Röhl – all of whom have successively transferred from the UKE to the CMD Center and are specialists in the temporomandibular joint. As such, they examine and treat significantly more CMD patients than the consultation hours at large university clinics in Germany and abroad.
PD Dr. M. Oliver Ahlers
Tim Petersen
Dr. Lukasz Katzer
Stephan Herrmann
The practice equipment at the CMD Center is also specifically designed for this purpose, supplemented by state-of-the-art instruments and special software. The team is continuously developing the instruments and software as part of its own research projects.
The location opposite the University Medical Center Hamburg-Eppendorf enables close cooperation with colleagues there in orthodontics, oral surgery, neurology and imaging diagnostics.
Arrange an appointment for an examination
If you suffer from jaw joint problems or pain in the facial area, or if you have the feeling that your teeth do not fit together properly: make an appointment for a detailed examination!
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