Lesson

TMJ injuries

Dislocation/subluxation

The most common Temporomandibular joint (TMJ) injuries in football are fractures of the condyle of the TMJ and subluxation of the joint. Subluxation generally occurs when there is a blow to the jaw when the mouth is open. The athlete may have difficulty opening or closing their mouth and malocclusion. When the joint is dislocated, the athlete is unable to close their mouth. When this joint is subluxed, it is imperative that the touchline doctor make a prompt effort to reposition this joint back into place before muscle spasm makes this impossible without hospitalisation and sedation. This is done by placing both thumbs on the lower teeth and applying a downwards and posteriorly directed force. An X-ray should be done to look for an associated fracture.

Post-injury management following reposition would include ice, the use of anti-inflammatory medication and minimising opening for five to seven days. A soft diet and appropriate physiotherapy is also suggested.

TMJ anatomy

The TMJ is an atypical synovial joint located between the condylar process of the mandible and the mandibular fossa and articular eminence of the temporal bone. The unique feature of the TMJ is the fibrocartilagenous articular disc.

Chronic pain

The TMJ is the only joint in the body capable of both translation and rotation. This is accomplished by means of the articular disc. When the ligaments supporting this disc have been traumatised, the athlete may have clicking, popping, or locking of the joint. TMJ “dysfunction” in most common in men in their early twenties.

The clinical examination of the painful joint may reveal limitation of opening, pain and/or malocclusion.

Treatment requires a proper diagnosis, radiographs or other imaging if indicated. An assessment from a dentist is suggested. Exercise therapy can be effective. Analgesics and dietary strategies should also be considered.

TMJ injuries can become chronic and debilitating injuries if not identified and managed properly. A team approach which includes dental assessment (and splinting if indicated), nutrition counselling and physiotherapy, provides the best solution for the injured athlete.

Dr Paul Piccininni

Sport, Cosmetic and Restorative Dentistry