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Temporomandibular Joint Disorders (TMJ)

The Temporomandibular Joint (TMJ) is the small joint located in front of your ear where your skull and your lower jaw meet. The TMJ moves every time you talk, yawn, chew or swallow. It is one of the most frequently used joints in your body.

If you place your fingers in front of your ears, on the triangular structure in front of your ear, you can feel the joints on the left and right sides of your head. Then move your finger just slightly forward and press firmly while you open your jaw all the way open and shut. The motion you feel is in the TMJ.

There are three classifications of TMJ Disorders:

Internal Derangement of the Joint
This occurs due to a dislocated jaw, displaced TMJ disc or injury to the lower jaw

Degenerative Joint Disease
This occurs due to osteoarthritis, rheumatoid arthritis or a perforated TMJ disc

Myofascial Pain Disorders
When pain and discomfort in the muscles around the jaw joints, neck and shoulder occurs, this can cause TMJ dysfunction

Causes of TMJ Disorders

The causes of TMJ disorders are often considered multi-factorial and may be related to the following:

  • Trauma to the head or neck
  • Stress
  • Oral habits such as clenching or grinding of the teeth
  • Bad bite or missing teeth
  • Arthritis
  • Malalignment of the upper and lower jawbones

Symptoms of TMJ Disorders

  • Pain in the face or jaw joint area
  • Headaches
  • Earaches
  • Dizziness
  • Limited mouth opening
  • Clicking or popping sounds in the jaw joint
  • Locking of the jaw joint in the opened or closed position
  • The bite feels abnormal

The severity of these conditions may range from mildly noticeable to seriously debilitating pain. These symptoms are not all inclusive for TMJ disorders, but represent some of the most common complaints that clinicians hear from their patients. Some of these symptoms are observed in many divergent clinical conditions and it is important that the patient undergo a thorough clinical examination and history by a qualified maxillofacial surgeon.


Dr. Valauri's treatment of your temporomandibular joint disorder may range from conservative dental and medical care to complex surgery. Your treatment may include short term care such as pain medication, muscle relaxation, bite plate or splint therapy and, at times, stress reduction counseling.

If non-surgical treatment is unsuccessful or if there is joint damage, surgery may be indicated. Surgery can involve, from the least invasive arthocentesis, to arthroscopy or open joint surgery.

Oral Pathology

Our mouths allow us to eat and drink. With our mouths we are able to communicate with other people either through talking, laughing, shouting or even smiling. We are able to taste food and kiss loved ones with our mouths. Still, we do not realize how much we use our mouths until oral cancer strikes.

Over 30,000 Americans will be diagnosed with oral or pharyngeal (throat) cancer this year. It will cause over 8,000 deaths, killing approximately 1 person per hour, 24 hours per day. The death rate for oral cancer is higher than that of cervical cancer, Hodgkins disease, cancer of the brain, liver, testes, kidney, ovary or malignant melanoma (skin cancer).

Who is at risk?

While most of the people, when they are diagnosed, are over the age of 40, it does occur at an earlier age. There have been links to "smokeless" chewing tobacco or spit tobacco. At least 75% of those diagnosed are tobacco users, either by smoking or by chewing tobacco. In addition, the combination of alcohol use with tobacco usage causes your risk factors to be even higher. It has been shown that prolonged exposure to sunlight has been shown to be a cause of cancer of the lip.

Also, the Human Papilloma Virus (HPV), specifically strains 16 and 18 have been linked to oral cancer. A diet low in fruits and vegetables has also shown to be a risk factor along with poor oral hygiene and ill-fitting dentures.

How can I perform my own examination?

You should examine yourself on a monthly basis. But, even though you can perform your own oral examination, please be sure to contact Dr. Valauri for a professional exam.

Follow these steps:

  • Remove any dentures
  • Look and feel the inside of your lips, and the front of your gums
  • Tilt your head back to look at and feel the roof of your mouth
  • Pull out your cheek to see the inside and the back gums
  • Pull out your tongue and look at all surfaces
  • Feel both sides of your neck and under the lower jaw for lumps or enlarged lymph nodes (glands)

What should I look for in my self-examination?

Dr. Valauri recommends that you perform your oral cancer self-examination monthly. Performing a self-examination regularly will help in early diagnosis. Please do not ignore any suspicious lumps or sores. If you are at high risk for oral cancer - smoker, consumer of alcohol, user of smokeless tobacco - you should see Dr. Valauri annually.

Look for the following symptoms in your monthly self-examination:

  • White or red patches of tissue in your mouth
  • Small ulcers which may look like canker sores (if it does not heal in 14 days, see Dr. Valauri)
  • Lump or mass that can be felt inside your mouth or neck
  • Pain or difficulty swallowing, speaking or chewing
  • Wart like masses on your oral/facial region
  • Hoarseness which lasts for a long time

Dental Anesthesia

Dr. Valauri is fully trained and equipped to provide the full spectrum of anesthesia services for patients under going oral surgical procedures. He is licensed to practice anesthesia and is certified in basic and advanced life support. Your comfort and safety is of the utmost concern to us. Several anesthesia options are available to you for your in-office surgery.

Local anesthesia injection of medicine "novocaine", provides complete numbness of the surgical area so your procedure can be performed pain-free. This anesthesia can be used alone, or in conjunction with sedation or general anesthesia techniques.

Sedation techniques are also available to provide an altered state of consciousness, thereby reducing the stress, pain, and anxiety of the surgical procedure. Several techniques are available including inhalational analgesia, intravenous conscious sedation, and deep sedation/general anesthesia.

Inhalational analgesia (nitrous oxide, laughing gas) is administered through a nasal mask during the procedure. Clear nasal passages are thus required for this technique to be successful. Nitrous oxide provides a relaxed, awake state in which anxiety is reduced and pain tolerance is increased. Local anesthesia is used in conjunction with this anesthetic to provide complete pain relief.

Intravenous conscious sedation is a state of reduced consciousness (awakeness). This technique provides relaxation, stress reduction, amnesia, and increased pain tolerance, and is accomplished by administering medications through an intravenous catheter (IV). Local anesthesia is also normally used to further increase the comfort of the procedure.

Intravenous deep sedation/general anesthesia is a state of unconsciousness whereby the patient is not aware of any aspect of the surgical procedure. Besides providing a sleep-like state, amnesia and pain control are also provided. This technique is administered through an intravenous catheter (IV).

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