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TMJ Disorders

TMJ (Temporomandibular Joint and Muscle) Disorders

What is TMJ?

Temporomandibular joint and muscle disorders, commonly called "TMJ," are a group of conditions that cause pain and dysfunction in the jaw joint and the muscles that control jaw movement. The condition appears to be more common in women than men.

For most people, pain in the area of the jaw joint or muscles does not signal a serious problem. Generally, discomfort from these conditions is occasional and temporary, often occurring in cycles. The pain eventually goes away with little or no treatment. Some people however, develop significant, long-term symptoms.

The temporomandibular joint connects the lower jaw, called the mandible, to the bone at the side of the head - the temporal bone. If you place your fingers just in front of your ears and open your mouth, you can feel the joints. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. Muscles control jaw position and movement to the jaw joint.

Disorders of the jaw joint and chewing muscles - and how people respond to them - vary widely. Researchers generally agree that the conditions fall into three main categories:

  1. Myofascial pain involves discomfort or pain in the muscles that control jaw function.
  2. Internal derangement of the joint involves a displaced disc, dislocated jaw, or injury to the condyle.
  3. Arthritis refers to a group of degenerative/inflammatory joint disorders that can affect the temporomandibular joint.

A person may have one or more of these conditions at the same time. Some people have other health problems that co-exist with TMJ disorders, such as chronic fatigue syndrome, sleep disturbances or fibromyalgia, a painful condition that affects muscles and other soft tissues throughout the body. Rheumatic disease, such as arthritis, may also affect the temporomandibular joint as a secondary condition.

What causes TMJ?

Trauma to the jaw or temporomandibular joint plays a role in some TMJ disorders. But for most jaw joint and muscle problems, scientists don't know the causes. Because the condition is more common in women than in men, scientists are exploring a possible link between female hormones and TMJ disorders.

For many people, symptoms seem to start without obvious reason. Research disputes the popular belief that a bad bite or orthodontic braces can trigger TMJ disorders. There is no scientific proof that sounds - such as clicking - in the jaw joint lead to serious problems. In fact, jaw sounds are common in the general population. Jaw noises alone, without pain or limited jaw movement, do not indicate a TMJ disorder and do not warrant treatment.

How does TMJ affect me?

A variety of symptoms may be linked to TMJ disorders. Pain, particularly in the chewing muscles and/or jaw joint, is the most common symptom. Other likely symptoms include:

  • radiating pain in the face, jaw, or neck
  • jaw muscle stiffness
  • limited movement or locking of the jaw
  • painful clicking, popping or grating in the jaw joint when opening or closing the mouth
  • a change in the way the upper and lower teeth fit together

How are TMJ disorders diagnosed?

There is no widely accepted, standard test now available to correctly diagnose TMJ disorders. Because the exact causes and symptoms are not clear, identifying these disorders can be difficult and confusing. Currently, health care providers note the patient's description of symptoms, take a detailed medical and dental history, and examine problem areas, including the head, neck, face, and jaw. Imaging studies may also be recommended.

You may want to consult your doctor to rule out other known causes of pain. Facial pain can be a symptom of many conditions, such as sinus or ear infections, various types of headaches, and facial neuralgias (nerve-related facial pain). Ruling out these problems helps in identifying TMJ disorders.

What can I do about TMJ?

Because more studies are needed on the safety and effectiveness of most treatments for jaw joint and muscle disorders, experts strongly recommend using the most conservative, reversible treatments possible. Conservative treatments do not invade the tissues of the face, jaw, or joint, or involve surgery. Reversible treatments do not cause permanent changes in the structure or position of the jaw or teeth.

Conservative Treatments

Because the most common jaw joint and muscle problems are temporary and do not get worse, simple treatment may be all that is necessary to relieve discomfort.

Self-Care Practices

There are steps you can take that may be helpful in easing symptoms, such as:

  • eating soft foods
  • applying ice packs
  • avoiding extreme jaw movements (such as wide yawning, loud singing, and gum chewing)
  • learning techniques for relaxing and reducing stress
  • practicing gentle jaw stretching and relaxing exercises that may help increase jaw movement. Your health care provider or a physical therapist can recommend exercises if appropriate for your particular condition

Pain Medications

For many people with TMJ disorders, short-term use of over-the-counter pain medicines or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may provide temporary relief from jaw discomfort. When necessary, your dentist or physician can prescribe stronger pain or anti-inflammatory medications, muscle relaxants, or anti-depressants to help ease symptoms.

Stabilization Splints

Your physician or dentist may recommend an oral appliance, also called a stabilization splint or bite guard, which is a plastic guard that fits over the upper or lower teeth. Stabilization splints are the most widely used treatments for TMJ disorders. Studies of their effectiveness in providing pain relief, however, have been inconclusive. If a stabilization splint is recommended, it should be used only for a short time and should not cause permanent changes in the bite. If a splint causes or increases pain, or affects your bite, stop using it and see your health care provider.

The conservative, reversible treatments described are useful for temporary relief of pain - they are not cures for TMJ disorders. If symptoms continue over time, come back often, or worsen, tell your doctor.

Irreversible Treatments

Irreversible treatments that have not been proven to be effective - and may make the problem worse - include orthodontics to change the bite; crown and bridge work to balance the bite; grinding down teeth to bring the bite into balance, called "occlusal adjustment"; and repositioning splints, also called orthotics, which permanently alter the bite.

Surgery

Other types of treatments, such as surgical procedures, invade the tissues. Surgical treatments are controversial, often irreversible, and should be avoided where possible. There have been no long-term clinical trials to study the safety and effectiveness of surgical treatments for TMJ disorders.

Implants

Surgical replacement of jaw joints with artificial implants may cause severe pain and permanent jaw damage. Some of these devices may fail to function properly or may break apart in the jaw over time.

Information sources:

National Institute of Dental and Craniofacial Research