(TMD; Temporomandibular Joint Disorder; Temporomandibular Joint Dysfunction; TMJ Syndrome; TMJ Osteoarthritis)
Definition
Definition
Temporomandibular disorder (TMD) is a painful condition in the joint that opens and closes the mouth. These temporomandibular joints are the small joints in front of each ear. They attach the lower jaw (mandible) to the skull. The disorder may affect the jaw joint or the muscles surrounding it. The disorder can include:
- Damage to the joint surface or intra-articular disk
- Displacement or complete dislocation of jaw bones
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Causes
Causes
The exact cause of TMD is often unclear. Possible causes include:
- Injury of the jaw or face
- Excess tension in the jaw muscles
- Faulty alignment between the upper and lower teeth
- Disturbed movement of the jaw joint
- Displacement or abnormal position of the jaw joint or cartilage disc inside the jaw joint
- Arthritis or similar inflammatory process in the joint
- Excess or limited motion of the joint
Risk Factors
Risk Factors
TMD is more common in women aged 30-50 years old. Other factors that increase your chance of TMD include:
- Clenching or grinding of teeth
- Poorly fitting dentures or crowns
- Fibromyalgia
- Stress
- Arthritis
Symptoms
Symptoms
TMD may cause:
- Pain in the temporomandibular joint, jaw, or face
- Pain may be worse with chewing, yawning, or opening the mouth
- Clicking, popping, or grating sounds with movement of the jaw
- A sensation of the jaw catching or locking briefly, while attempting to open or close the mouth, or while chewing
- Difficulty opening the mouth completely
- A bite that feels off, uncomfortable, or as though it is frequently changing
- Headache
- Earache
- Neck pain
Diagnosis
Diagnosis
You will be asked about your symptoms and medical history. A physical exam will be done. The physical exam may include:
- Range of motion of the jaw tests
- Listening for sounds of popping or clicking in the temporomandibular joints
- Visual inspection of your teeth, temporomandibular joints, and muscles of your face and head
- Palpation of the joints and the muscles of the face and head
Images may be needed of your jaw. This can be done with:
Treatment
Treatment
Usually, the least invasive measures will be tried first.
Treatment may include:
Lifestyle Measures
The area will need time to heal:
- Rest the jaw with a soft diet
- Restrict movement with smaller bites, avoiding wide yawning, and gum chewing
- Apply ice or heat
packs for pain relief
- Gentle jaw stretching and exercises
Medications
The most commonly used medications include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
- Muscle relaxants
- Antidepressants
Some medication may be injected into the jaw such as:
- Pain relievers, such as cortisone or lidocaine
- Botulinum toxin (Botox)—may offer temporary relief if pain or clicking are major symptoms
Physical Therapy
To help reduce pain and allow muscles to relax:
- Gentle massage or stretching exercises
- Gentle strengthening exercises or muscle balance exercises to retain alignment
- Transcutaneous electrical nerve stimulation (TENS)
Stress Reduction
Some may benefit from counseling to learn stress management and relaxation techniques, such as:
Dental Procedures
A splint or mouth guard can be made to relax the jaw muscles. This will prevent clenching and grinding of the teeth. The guard is usually worn at night. Correction of bite abnormalities by a dentist or orthodontist is sometimes needed.
Surgical Procedures
Surgical correction is a last resort. Many of the available procedures have not been well-studied for their effectiveness.
Prevention
Prevention
There are no current guidelines to prevent TMD.
RESOURCES:
The TMJ Association http://www.tmj.org
CANADIAN RESOURCES:
Canadian Society of Otolaryngology—Head & Neck Surgery http://www.entcanada.org
References:
Haley DP, Schiffman EL, et al. The relationship between clinical and MRI findings in patients with unilateral temporomandibular joint pain. J Am Dent Assoc. 2001;132(4):476-481.
National Institute of Dental and Craniofacial Research website. Available at:
http://www.nidcr.nih.gov/oralhealth/topics/tmj
Updated July 10, 2014. Accessed June 20, 2015.
Temporomandibular joint (TMJ) dysfunction . EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated May 11, 2015. Accessed June 29, 2015.
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.
Last Updated: 5/13/2014