Overview | Symptoms and Causes | Treatment | Resources

 

Temporomandibular Joint Disorder (TMJD)


Overview

 

TMJ Disorder, often called just "TMJ", " TMD" or " TMJD" is a collection of conditions characterized by pain and/or dysfunction of the jaw, temporomandibular joint ( "TMJ" or "TM joint", and surrounding tissues. TMJD affects women significantly more often than men, approximately 4-1, and is especially prevalent in young adults, i.e. women aged 20-40 years. About 10% of the TMJD sufferers develop limited jaw range-of-motion or trismus.

 

Some injuries and other conditions like arthritis, scleroderma, fibromyalgia, cancer, and congenital defects can affect the TM joint, and are discussed in other pages.

 

Other condiditons that can mimic symptoms of TMJD include Dystonia, Temporal Arteritis, and Trigeminal Neuralgia. Dystonia is a movement disorder causing constant or spasmadic contractions of the muscles. Temporal Arteritis is an inflamation of the artery running over the temply next to the eye, and occurs most-commonly in people over 60. Trigeminal neuralgia is caused by interaction between a blood vessel and a nerve at the base of the brain. Trigeminal neuralgia is often triggered by touch and causes temporary sharp, stabbing pains, and not aching or throbbing pain.

 

 

Symptoms and Causes

 

Common symptoms of TMJD include:

  • Severe or chronic headaches

  • Pain in the jaw joints, ears, behind the temples or in the neck and shoulders

  • Limited opening and lateral movement of the jaw

  • Popping, clicking or grating sound when the mouth is opened or closed

  • Stiffness of joint after eating

  • Locking and/or dislocation of the jaw

  • Ringing, itching or pain in the ear

  • Difficulty with vision, hearing or balance

  • Pain when chewing food

  • Teeth that do not “match up” when mouth closes

  • Dental pain

  • Difficulty in swallowing

  • Clenching

  • Bruxism or grinding of teeth
  • Neck, shoulder or back pain
  • Facial swelling

 

Some potential causes of TMJD include:

 

  • Trauma after-effects, such as an automobile accident or a blow to the head
  • Neuromuscular imbalance which causes misalignment of the mandible with the bones of the head
  • Malocclusion (bad bite) and/or missing teeth
  • Oral habits, such as clenching and grinding of the teeth, and postural habits, such as cradling a
  • Synovitis (inflammation of the joint lining)
  • Jaw deformities
  • Dislocation of the meniscus disc out from between the jaw and skull.
  • Hereditary joint weakness
  • Stress
  • Bruxism, grinding and clenching
  • Sporting injuries

 

Treatment

 

Treatment of TMJ disorders varies from extremely simple measures to extensive surgical treatment. Treatments are generally divided between conservative therapy and non-conservative therapy. Conservative therapies are reversible techniques  

 

Conservative Treatments of TMJD: Non-Conservative Treatment of TMJD:
  • Medication –
    • anti-inflammatory drugs
    • muscle relaxants
    • pain killers
    • anti-depressents for chronic pai
  • Diet and behavior modification
  • Moist heat
  • Cryotherapy and cold packs
  • Practicing good posture
  • Biofeedback/stress reduction
  • Physical therapy/exercise
  • Botox for muscle problems
  • Ultrasound
  • High volt galvanic stimulation
  • TENS

  • Splint therapy and nightguards (some)

  • Manual exercisers (TheraBite, etc.)
  • Continuous passive motion therapy (CPM)
  • Corticosteroid drugs
  • Arthrocentesis (joint "flushing" or "irrigation")

  • Splint therapy (some cause irreversible changes to the jaw and teeth)

  • Corrective dental work

  • Orthodontics

  • Occlusal equilibration
  • Surgery

 

If the problem is of very short duration and occurs only once in a while, very simple measures such as using heat, very soft diet and aspirin or aspirin-type drugs (such as Advil) may be prescribed.  Occasionally, stronger pain medications are used for short periods of time.

 

Common behavior and diet modification recommended to alleviate symptoms include:

  • Avoid clenching or grinding your teeth.
  • Avoid chewing gum, objects or your lip.
  • Maintain good posture in your back.
  • Maintain good jaw posture - jaw muscles relaxed with teeth slightly apart and your tongue resting against the roof of your mouth behind your upper teeth.
  • Avoid tough, sticky and chewy foods, like steak, taffy, apples, nuts, corn, larger sandwiches, bagels.
  • Avoid yawning too wide--push against your chin while yawning to help.
  • Avoid cradling the phone between your ear and shoulder.
  • Avoid long dental procedures, take breaks to relax the jaw.

 

Physical therapy is often beneficial for muscular contraction pain around the joint, head and neck region, and for increasing joint mobility and oral opening.  Physical therapy modalities include TENS (transcutaneous electrical nerve stimulation), application of heat, cold, massage, electro-galvanic stimulation, ultrasound, iontophoresis (cortisone like medication ), and cold laser therapy.  

 

Because of the size and location of the TM joint, stretching and moving the joint can be hard for therapists. The use of manual exercisers or a CPM unit can assist patients in stretching their mouth and jaw, and can provide the necessary movement to facilitate joint healing.

 

If symptoms persist beyond these simple measures, the most common form of treatment is splint therapy.  A dental splint is a clear piece of hard (or sometimes soft) plastic worn on either your upper or lower teeth.  This splint functions to “unload” the joint from the stresses of occlusion.  It may also function to even out an irregular bite.  Splint therapy in the majority of cases offers prompt improvement in symptomatology.  It may be required anywhere from a few months to years, and in some cases is required indefinitely.  Usually,  whether or not splint therapy will work is determined within 4-6 weeks.  

 

After exhausting all conservative therapy options, non-conservative treatments are considered. These include treatments that affect the muscle and joint tissues, bone and joint, and the dentition. Non-conservative dental therapies include othodontics, shaping of the teeth, implants, tooth removal, and bite-chaning splints. Therapies affecting the muscle and joint tissues include corticosteroid shots to reduce inflamation, arthrocentesis to clear provide healthy fluid, space in the joint for the disc move and heal. Larger joint surgeries include arthroscopies and arthrotomies to fix the joint or disc, and total joint replacement to replace a severly damaged joint.

 

 

Resources

 

The TMJ Association - Patient advocacy organization