Temporomandibular joint and muscle disorders (TMJ/TMD)

Overview

Definition

Temporomandibular disorder (TMD) is a painful problem of the joint in the jaw. These are the small joints in front of each ear. They attach the lower jaw to the skull. TMD may be in the joint in the jaw or the muscles around it.

The Temporomandibular Joint
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Causes

The cause of TMD is often not clear. It may be due to:

  • Injury of the jaw or face
  • Too much tension in the jaw muscles
  • Displacement or poor position of the jaw joint or cartilage disc inside it
  • The upper and lower teeth not being in line
  • Disturbed movement of the jaw joint
  • Arthritis or a swelling in the joint
  • Too much or not enough motion of the joint

Risk Factors

TMD is more common in women aged 30-50 years old. Other things that raise your chance of TMD are:

  • Injury of the jaw and neck
  • Clenching or grinding of teeth
  • Poorly fitting dentures or crowns
  • Stress
  • Smoking

SymptomsandDiagnosis

Symptoms

TMD may cause:

  • Pain in the jaw, or face
  • Pain may be worse with chewing, yawning, or opening and closing the mouth
  • Clicking, popping, or grating sounds with movement of the jaw
  • A feeling of the jaw catching or locking briefly, while attempting to open or close the mouth, or while chewing
  • Headache
  • Earache
  • Neck or shoulder pain

Diagnosis

You will be asked about your symptoms and health history. A physical exam will be done. This may mean:

  • Range of motion of the jaw tests
  • Listening for sounds of popping or clicking in the temporomandibular joints
  • An exam of your teeth, temporomandibular joints, and muscles of your face and head
  • Moving of the joints and the muscles of the face and head

Pictures may be needed of your jaw to check for abnormalities causing TMD. This can be done with:

  • X-rays
  • CT scan
  • MRI scan
  • Ultrasound

Treatments

Treatment

The most basic treatments will be tried first. This may mean:

Lifestyle Measures

The site will need time to heal:

  • Rest the jaw by eating soft foods.
  • Limit movement with smaller bites.
  • Do not open your mouth too wide.
  • Do not chew gum.
  • Apply ice or heat packs to help with the pain.
  • Do gentle jaw stretching and exercises.

Medications

The most often used medicines are:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
  • Muscle relaxers
  • Antidepressants

Some medicine may be injected into the jaw such as:

  • Pain relievers, such as cortisone
  • Botulinum toxin (Botox)—may help in the short term with pain

Physical Therapy

To help lower pain and let muscles relax:

  • Gentle massage or stretching exercises
  • Gentle strengthening or muscle balance exercises to keep alignment
  • Transcutaneous electrical nerve stimulation (TENS)

Stress Reduction

Counseling may help you learn how to manage stress and relax with:

  • Biofeedback
  • Cognitive behavioral therapy

Dental Procedures

A splint or mouth guard can be made to relax the jaw muscles and prevent the teeth from clenching and grinding. The guard is usually worn at night. Unfortunately, there is not a lot of proof it works.

Correction of bite abnormalities by a dentist or orthodontist may be needed.

Surgical Procedures

Surgery is a last resort. Many of the current surgeries have not been well-studied.

Prevention

There is no way to prevent TMD.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

a (TMD; Temporomandibular Joint Disorder; Temporomandibular Joint Dysfunction; TMJ Syndrome; TMJ Osteoarthritis)

RESOURCES

Mouth Healthy—American Dental Association http://www.mouthhealthy.org 

The TMJ Association http://www.tmj.org 

CANADIAN RESOURCES

Canadian Dental Association http://www.cda-adc.ca 

Canadian Society of Otolaryngology—Head & Neck Surgery http://www.entcanada.org 

References

Borodic GE, Acquadro MA. The use of botulinum toxin for the treatment of chronic facial pain. J Pain. 2002;3(1):21-27.

Haley DP, Schiffman EL, Lindgren BR, Anderson Q, Andreasen K. The relationship between clinical and MRI findings in patients with unilateral temporomandibular joint pain. J Am Dent Assoc. 2001;132(4):476-481.

Temporomandibular joint (TMJ) dysfunction . EBSCO DynaMed Plus website. Available at:  https://www.dynamed.com/topics/dmp~AN~T114703/Temporomandibular-disorders  . Updated February 20, 2018. Accessed July 12, 2018.

TMJ. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/content/tmj. Updated July 13, 2018. Accessed July 13, 2018.

TMJ. American Dental Association Mouth Healthy website. Available at: http://www.mouthhealthy.org/en/az-topics/t/tmj. Accessed July 13, 2018.

TMJ (temporomandibular joint and muscle disorders). National Institute of Dental and Craniofacial Research website. Available at: http://www.nidcr.nih.gov/OralHealth/Topics/TMJ. Updated February 2018. Accessed July 13, 2018.

Temporomandibular disorders. American Association of Oral and Maxillofacial Surgeons website. Available at: https://www.aaoms.org/docs/practice%5Fresources/clinical%5Fresources/tmd%5Fdisorders.pdf. Published 2017. Accessed July 13, 2018.

DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Turner JA, Mancl L, Aaron LA. Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: a randomized, controlled trial Pain. 2006;121(3):171-172.