Temporomandibular joint disorder (TMJ)
Temporomandibular joint disorders (TMJ) occur as a result
of problems with the jaw, jaw joint and surrounding facial
muscles that control chewing and moving the jaw.
Is the Temporomandibular Joint?
joint is the hinge joint that connects the lower jaw (mandible)
to the temporal bone of the skull, which is immediately in
front of the ear on each side of your head. The joints are
flexible, allowing the jaw to move smoothly up and down and
side to side and enabling you to talk, chew, and yawn. Muscles
attached to and surrounding the jaw joint control the position
and movement of the jaw.
of TMJ is not clear, but dentists believe that symptoms arise
from problems with the muscles of the jaw or with the parts
of the joint itself.
the jaw, temporomandibular joint, or muscles of the head and
neck – such as from a heavy blow or whiplash – can cause TMJ.
Other possible causes include:
• Grinding or clenching the teeth, which puts a lot of pressure
on the TMJ
• Dislocation of the soft cushion or disc between the ball
• Presence of osteoarthritis or rheumatoid arthritis in the
• Stress, which can cause a person to tighten facial and jaw
muscles or clench the teeth
Are the Symptoms of TMJ?
TMJ can experience severe pain and discomfort that can be
temporary or last for many years. More women than men experience
TMJ and TMJ is seen most commonly in people between the ages
of 20 and 40.
symptoms of TMJ include:
• Pain or
tenderness in the face, jaw joint area, neck and shoulders,
and in or around the ear when you chew, speak or open your
• Limited ability to open the mouth very wide
• Jaws that get "stuck" or "lock" in the
open- or closed-mouth position
• Clicking, popping, or grating sounds in the jaw joint when
opening or closing the mouth (which may or may not be accompanied
• A tired feeling in the face
• Difficulty chewing or a sudden uncomfortable bite – as if
the upper and lower teeth are not fitting together properly
• Swelling on the side of the face
symptoms include toothaches, headaches, neckaches, dizziness,
earaches, hearing problems, upper shoulder pain, and ringing
in the ears (tinnitis).
Is TMJ Diagnosed?
other conditions can cause similar symptoms – including a
toothache, sinus problems, arthritis, or gum disease – your
dentist will conduct a careful patient history and clinical
examination to determine the cause of your symptoms.
He or she
will examine your temporomandibular joints for pain or tenderness;
listen for clicking, popping or grating sounds during jaw
movement; look for limited motion or locking of the jaw while
opening or closing the mouth; and examine bite and facial
panoramic X-rays will be taken. These full face X-rays allow
your dentist to view the entire jaws, TMJ, and teeth to make
sure other problems aren't causing the symptoms. Sometimes
other imaging tests, such as magnetic resonance imaging (MRI)
or a computer tomography (CT), are needed. The MRI views the
soft tissue such as the TMJ disc to see if it is in the proper
position as the jaw moves. A CT scan helps view the bony detail
of the joint.
Your dentist may decide to send you to an oral surgeon (also
called an oral and maxillofacial surgeon) for further care
and treatment. This oral healthcare professional specializes
in surgical procedures in and about the entire face, mouth
and jaw area.
Treatments Are Available for TMJ?
range from simple self-care practices and conservative treatments
to injections and surgery. Most experts agree that treatment
should begin with conservative, nonsurgical therapies first,
with surgery left as the last resort. Many of the treatments
listed below often work best when used in combination.
• Apply moist
heat or cold packs. Apply an ice pack to the side of your
face and temple area for about 10 minutes. Do a few simple
stretching exercises for your jaw (as instructed by your dentist
or physical therapist). After exercising, apply a warm towel
or washcloth to the side of your face for about 5 minutes.
Perform this routine a few times each day.
• Eat soft
foods. Eat soft foods such as yogurt, mashed potatoes, cottage
cheese, soup, scrambled eggs, fish, cooked fruits and vegetables,
beans and grains. In addition, cut foods into small pieces
to decrease the amount of chewing required. Avoid hard and
crunchy foods (like hard rolls, pretzels, raw carrots), chewy
foods (like caramels and taffy) and thick and large foods
that require your mouth to open wide to fit.
• Take medications.
To relieve muscle pain and swelling, try nonsteroidal anti-inflammatory
drugs (NSAIDs), such as aspirin or ibuprofen (Advil, Motrin,
Aleve), which can be bought over-the-counter. Your dentist
can prescribe higher doses of these or other NSAIDs or other
drugs for pain such as narcotic pain relievers. Muscle relaxants,
especially for people who grind or clench their teeth, can
help relax tight jaw muscles. Anti-anxiety medications can
help relieve stress that is sometimes thought to aggravate
TMJ. Antidepressants, when used in low doses, can also help
reduce or control pain. Muscle relaxants, anti-anxiety drugs
and antidepressants are available by prescription only.
laser therapy. This is used to reduce the pain and inflammation
as well as increase range of motion to the neck and in opening
• Wear a
splint or night guard. Splints and night guards are plastic
mouthpieces that fit over the upper and lower teeth. They
prevent the upper and lower teeth from coming together, lessening
the effects of clenching or grinding the teeth. They also
correct the bite by positioning the teeth in their most correct
and least traumatic position. The main difference between
splints and night guards is that night guards are only worn
at night and splints are worn full time (24 hours a day for
7 days). Your dentist will discuss with you what type of mouth
guard appliance you may need.
corrective dental treatments. Replace missing teeth; use crowns,
bridges or braces to balance the biting surfaces of your teeth
or to correct a bite problem.
• Avoid extreme
jaw movements. Keep yawning and chewing (especially gum or
ice) to a minimum and avoid extreme jaw movements such as
yelling or singing.
• Don't rest
your chin on your hand or hold the telephone between your
shoulder and ear. Practice good posture to reduce neck and
• Keep your
teeth slightly apart as often as you can to relieve pressure
on the jaw. To control clenching or grinding during the day,
place your tongue between your teeth.
relaxation techniques to help control muscle tension in the
jaw. Ask your dentist about the need for physical therapy
or massage. Consider stress reduction therapy, including biofeedback.
More Controversial Treatments
When the basic
treatments listed above prove unsuccessful, your dentist may
suggest one or more of the following:
• Transcutaneous electrical nerve stimulation (TENS). This
therapy uses low-level electrical currents to provide pain
relief by relaxing the jaw joint and facial muscles. This
treatment can be done at the dentist's office or at home.
• Ultrasound. Ultrasound treatment is deep heat that is applied
to the TMJ to relieve soreness or improve mobility.
• Trigger-point injections. Pain medication or anesthesia
is injected into tender facial muscles called "trigger
points"" to relieve pain.
• Radio wave therapy. Radio waves create a low level electrical
stimulation to the joint, which increases blood flow. The
patient experiences relief of pain in the joint.
only be considered after all other treatment options have
been tried and you are still experiencing severe, persistent
pain. Because surgery is irreversible, it is wise to get a
second or even third opinion from other dentists.
three types of surgery for TMJ: arthrocentesis, arthroscopy
and open-joint surgery. The type of surgery needed depends
on the TMJ problem.
This is a minor procedure performed in the office under general
anesthesia. It is performed for sudden-onset, closed lock
cases (restricted jaw opening) in patients with no significant
prior history of TMJ problems. The surgery involves inserting
needles inside the affected joint and washing out the joint
with sterile fluids. Occasionally, the procedure may involve
inserting a blunt instrument inside of the joint. The instrument
is used in a sweeping motion to remove tissue adhesion bands
and to dislodge a disc that is stuck in front of the condyle
(the part of your TMJ consisting of the "ball" portion
of the "ball and socket")
Patients undergoing arthroscopic surgery first are given general
anesthesia. The surgeon then makes a small incision in front
of the ear and inserts a small, thin instrument that contains
a lens and light. This instrument is hooked up to a video
screen, allowing the surgeon to examine the TMJ and surrounding
area. Depending on the cause of the TMJ, the surgeon may remove
inflamed tissue or realign the disc or condyle.
Compared with open surgery, this surgery is less invasive,
leaves less scarring, and is associated with minimal complications
and a shorter recovery time. Depending on the cause of the
TMJ, arthroscopy may not be possible, and open-joint surgery
may be necessary.
surgery. Patients undergoing open-joint surgery also are first
given a general anesthesia. Unlike arthroscopy, the entire
area around the TMJ is opened so that the surgeon can get
a full view and better access. There are many types of open-joint
surgeries. This treatment may be necessary if:
• The bony structures that comprise the jaw joint are deteriorating
• There are tumors in or around your TMJ
• There is severe scarring or chips of bone in the joint
Compared with arthroscopy, open-joint surgery results in a
longer healing time and there is a greater chance of scarring
and nerve injury.