Temporomandibular Joint Treatment at Prodent Gdańsk

Clicking, popping, or crepitus in the temporomandibular joint is a symptom of articular disc displacement – a structure that acts as a shock absorber between the mandibular condyle and the articular fossa of the temporal bone. In a properly functioning joint, the disc moves synchronously with the mandibular condyle during opening and closing the mouth, without any sounds. When the disc is dislocated (displaced) – most often forward – the mandibular condyle must "jump" over the posterior part of the disc to seat on it when opening the mouth, which is heard as a click. A second click occurs during closing when the disc pops out again. This condition is called disc displacement with reduction – the disc returns to its correct position during movement, but not where it should be, hence the sound. If the disc is completely displaced and never returns to its correct position (displacement without reduction), there may be no clicking, but restricted mouth opening and pain appear. Are clicks dangerous? Do not ignore them. Clicks are an early warning sign that something is wrong with the joint mechanics. At this stage, the problem is often reversible – appropriate therapy (splints, physiotherapy, bite correction) can restore the disc to its correct position and eliminate clicks. If you ignore the clicks, the disc may undergo further degeneration, perforation (tearing), or complete displacement without reduction, leading to joint locking, chronic pain, and degenerative changes in the bony structures of the joint. The earlier you start treatment, the greater the chance of full recovery without permanent damage.

Morning headaches (temples, back of the head) and jaw pain and stiffness upon waking are characteristic symptoms of nocturnal bruxism – unconscious teeth grinding during sleep. Bruxism is the most common cause of TMJ and masticatory muscle overload. During sleep, especially in the REM phase, involuntary activation of masticatory muscles occurs, generating forces of 400-800 N – many times more than during normal chewing (50-100 N). The muscles work under tension all night, become overloaded, and create trigger points that radiate pain. Enormous forces strain the joints, compress the discs, and can damage them. In the morning, you wake up tired, with a headache and stiff muscles. Characteristic signs: increased tooth wear, enamel chipping, sensitivity, tooth indentations on the cheeks and tongue. Most people are unaware they grind their teeth – they are woken by a partner or doctor. At Prodent, we offer comprehensive treatment: a splint protects teeth and relieves joint pressure, physiotherapy relaxes muscles, bite correction eliminates premature contacts, and stress management techniques reduce the cause. In persistent cases, we use Botox in the masticatory muscles.

Yes, TMJ dysfunction is a common cause of tinnitus, a feeling of ear fullness, and ear pain without an apparent ENT cause. If an ENT specialist has ruled out ear problems, it is worth examining the joints. Why does TMJ cause tinnitus? Firstly, anatomical proximity – the joint lies directly in front of the middle ear, separated by a thin bony wall. Inflammation or pathological movements in the joint can compress ear structures. Secondly, the malleus ligament connects the middle ear to the joint capsule and disc – abnormal tension translates into pressure on the eardrum and auditory ossicles. Thirdly, the tensor tympani muscle is innervated by the same nerve as the masticatory muscles – excessive tension can reflexively induce spasms of this muscle. Characteristic: tinnitus intensifies with jaw movements, chewing, yawning – if you can induce or worsen tinnitus with jaw movements, it almost certainly has a joint origin. Treating TMJ dysfunction (splint, physiotherapy, bite correction) often completely eliminates or significantly reduces tinnitus.

An occlusal splint is a custom-made overlay of hard, transparent acrylic material worn on the teeth (most often upper), 1.5-3 mm thick, covering all teeth of the arch. It has precisely modeled indentations and convexities ensuring ideal contacts during closing and jaw movements. It eliminates all premature contacts and bite asymmetries. As a result, the jaw works in central relation – a position where the joints are best centered, and the muscles are maximally relaxed. How long to wear it? Usually overnight, daily, for 3-6 months, though sometimes longer. In the initial period with severe symptoms, it is recommended to wear it during the day as well. Most patients feel improvement after 2-4 weeks, but full tissue adaptation requires several months. The splint is a diagnostic and therapeutic stage, not a definitive solution. After completing therapy, if the source was malocclusion or tooth loss, causal treatment (prosthetics, orthodontics) is necessary to stabilize the correct position achieved with the splint. Without this, the dysfunction may recur.

Unfortunately, yes – TMJ dysfunctions are affecting increasingly younger people, even teenagers. Just 20-30 years ago, this was the domain of patients over 40-50 years old; now the epidemic has spread to younger age groups. Main causes: chronic stress (school, academic pressure, social media, anxiety) leading to bruxism; postural defects caused by prolonged sitting at computers, smartphones – forward head posture, overloaded cervical spine; improper eating habits – soft, processed diet, poorly developed muscles; orthodontic treatment without considering joint function; sports injuries. In young people, dysfunctions have a better prognosis – tissues are more plastic, regenerate faster, and degenerative changes have not yet developed. The earlier the problem is detected and treatment begins, the greater the chance of full recovery. Parents should be vigilant – if a teenager complains of headaches, difficulty opening their mouth, or hears clicking sounds when eating, it's a signal to see a dentist.
Unfortunately, yes – TMJ dysfunctions are affecting increasingly younger people, even teenagers. Just 20-30 years ago, this was the domain of patients over 40-50 years old; now the epidemic has spread to younger age groups. Main causes: chronic stress (school, academic pressure, social media, anxiety) leading to bruxism; postural defects caused by prolonged sitting at computers, smartphones – forward head posture, overloaded cervical spine; improper eating habits – soft, processed diet, poorly developed muscles; orthodontic treatment without considering joint function; sports injuries. In young people, dysfunctions have a better prognosis – tissues are more plastic, regenerate faster, and degenerative changes have not yet developed. The earlier the problem is detected and treatment begins, the greater the chance of full recovery. Parents should be vigilant – if a teenager complains of headaches, difficulty opening their mouth, or hears clicking sounds when eating, it's a signal to see a dentist.

The ideal solution is cooperation between a dentist and a physiotherapist. TMJ dysfunction is a multifactorial problem requiring treatment from both a dental perspective (occlusion, bite, restorations) and a musculoskeletal perspective (tension, trigger points, mobility). The dentist addresses the structural cause – analyzes the bite, detects premature contacts, makes splints, corrects restorations, and plans orthodontics. This is the foundation – if the jaw works in a faulty position, no amount of physiotherapy will provide a lasting effect. The physiotherapist addresses functional symptoms – relaxes muscles (massage, intraoral and extraoral manual therapy), restores mobility, eliminates trigger points, and teaches exercises. In practice, the best results come from an integrated approach: the dentist performs diagnostics, fits a splint, and plans treatment; simultaneously, the patient attends physiotherapy to alleviate symptoms. After a few weeks/months, the dentist proceeds with definitive treatment. At Prodent, we cooperate with selected physiotherapists in Gdańsk and can refer patients. Standalone physiotherapy without causal treatment may provide temporary relief, but if the bite is not corrected, the dysfunction will return.

Yes, untreated, chronic dysfunction can lead to permanent degenerative changes (TMJ osteoarthritis), which are irreversible. Mechanism: overloaded joints are subjected to excessive forces and microtraumas. Initially, the body tries to adapt – the disc displaces, the capsule thickens, muscles contract. If the overload continues, the disc is damaged – perforation, fragmentation, destruction. When the disc ceases to function as a shock absorber, the load is transferred directly to the articular surfaces. Cartilage begins to wear away (cartilage erosion), followed by pain and stiffness. Over time, exposed bone begins to rub against bone, leading to bone defects, flattening of the mandibular condyle, and osteophytes. These changes are irreversible. Symptoms of osteoarthritis: chronic dull pain worsening with chewing, significant restriction of movement (often 25 mm opening), crepitus, grinding, facial deformities. In advanced cases, joint surgery may be necessary. The good news: early treatment prevents degenerative changes. If dysfunction is detected at the stage of disc displacement without bony changes and therapy is implemented, function can be restored and degeneration halted.

Stress is one of the main factors causing TMJ dysfunction. The relationship is multifaceted. Firstly, stress causes involuntary muscle tension, including in the masticatory muscles. People under stress clench their jaws during the day (daytime bruxism) – while working, in traffic, during difficult conversations – often unconsciously. This tension persists for many hours, leading to chronic overload. At night, stress manifests as nocturnal bruxism – grinding teeth during sleep, especially in the REM phase. Muscles generate forces 5-10 times greater than during conscious chewing, damaging teeth and overloading joints. Secondly, chronic stress lowers the pain threshold – people under stress are more sensitive to pain and tolerate it less well. Thirdly, stress disrupts sleep – and poor sleep means less regeneration. Does stress management help? Absolutely. Studies show that patients who implement stress reduction techniques achieve better and faster results. Effective methods: relaxation techniques (deep breathing, meditation, mindfulness), physical activity (yoga, swimming), cognitive-behavioral therapy, regular sleep (7-8 hours), limiting caffeine and alcohol. A splint protects against the effects of bruxism but does not eliminate its cause – stress must be addressed holistically.

When the joints are undergoing treatment or are in an inflammatory phase, activities that overload the masticatory system must be strictly limited. Chewing gum is one of the most destructive habits – it causes continuous, monotonous, prolonged loading of the same structures, leading to exhaustion and inflammation. Gum does not give a feeling of "end of chewing"; it can be chewed for hours, which is catastrophic for dysfunction. Hard foods (raw carrots, nuts, hard bread, meat) require significant chewing forces and wide opening, overloading the joints. During treatment, we recommend a soft diet: soups, smoothies, yogurts, scrambled eggs, fish, well-cooked vegetables and meat, grains, soft fruits. Avoid foods that require prolonged chewing, or are hard or gummy. Yawning widely can cause acute pain, and in extreme cases, joint locking (luxation – dislocation of the mandibular condyle). If you feel a yawn coming, support your chin with your hand to limit the opening. Other habits to avoid: biting nails, pencils; resting your head on your hand; biting lips; holding the phone between your head and shoulder. Rule: the fewer movements, the less load, the better for regeneration. After symptoms subside, gradually return to a normal diet, but permanently avoid chewing gum and excessive overloading.

The treatment duration is highly individual and depends on the cause, stage of advancement, patient's age, and cooperation. In simple cases (fresh dysfunction, acute overload, no permanent damage), treatment takes 2-4 months – an occlusal splint + physiotherapy + habit modification are sufficient. In more advanced cases (dysfunction lasting months/years, disc dislocations, coexisting malocclusion or tooth loss), the process takes 6-12 months or longer: diagnostic phase and splint therapy (3-6 months), followed by causal treatment – prosthetic reconstruction, orthodontics (6-24 months). In cases with advanced degenerative changes (osteoarthritis), full recovery may not be possible, but symptoms can be significantly reduced, and progression halted. Often, the splint becomes a permanent part of therapy. Can it be completely cured? Yes, in most cases, dysfunction is reversible, especially when detected early and treated comprehensively. The key is to eliminate the cause. After treatment, the patient returns to full, pain-free function. It is important to maintain healthy habits and regular check-ups (every 6 months) – dysfunction tends to recur with a return to destructive habits or new bite problems. At Prodent, we monitor patients and react immediately to warning signs.