Temporomandibular Joint Disorder (TMJD)

The temporomandibular joint is actually two pairs of joints that make it possible for the jawbone to both rotate and slide. This joint connects the lower jaw to the skull. The temporomandibular joints can be found on either side of the head in front of the ears. These joints allow us to talk, chew and yawn.

When one or more of these joints become inflamed or painful, the condition is called temporomandibular joint disorder (TMJD, TMJ or TMD).

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Symptoms

The symptoms of TMJD can be varied and complex. Some of the symptoms that a person with TMJD might experience include:

  • Pain, including tenderness in the jaw, aching pain in or around the ear, aching facial pain or nearly constant pain. Pain may be present whether the temporomandibular joint is moving or not.
  • Difficulty opening the mouth fully
  • Difficulty or discomfort while chewing
  • A clicking or popping sensation in the joint
  • Locking of the joint that makes it hard to open or close the mouth
  • Headache
  • Uncomfortable bite
  • An uneven bite because one or more teeth are making contact with each other before the other teeth do.

Causes and Risk Factors

Anything that causes pain in any other joint of the body can be a factor in temporomandibular joint.

In a healthy joint, the ends of the bones are covered with smooth cartilage. This allows the bones to glide easily when the lower jaw is moved.

TMJD can happen due to wear and tear on the cartilage, arthritis, injuries, dislocations, structural problems in the joint, dental problems infections or tumors.

If there is a problem in the temporomandibular joint, a person may feel pain in the surrounding muscles, nerves, tendons and ligaments. If the joint is inflamed, there may be pain even when the joint isn't moving.

The lower jaw has rounded ends that glide in and out of the joint socket when you talk, chew or yawn. (These are called the condyles.) They are covered with cartilage and are separated by a small shock-absorbing disk, which keeps the movement smooth.

TMJ disorders can occur from:

  • Damage to the surfaces of the teeth due to neglect or injury
  • Loose or lost teeth that have led to damage of the jawbone or poor alignment of the upper and lower jaws. This can affect the muscles of the jaw as well.
  • Poor alignment of the teeth or jaw when biting down. This can cause sensitivity of the teeth as well as affecting the muscles and the temporomandibular joint.
  • Overuse of the muscles of chewing. This may occur if a person chews gum continuously, bites fingernails or pencils, grinds the teeth, has a habit of clenching the jaw, biting the cheek or lip or thrusting the jaw out when speaking, exercising or other actions.
  • The disk erodes or moves out of its proper place
  • The joint is damaged by a blow or other impact
  • The joint's cartilage is damaged by arthritis
  • Trigger points in the muscle tissue that cause myofascial pain syndrome
  • Infections deep in the jaw
  • Tumors

Often, it isn't clear what is causing the TMJ symptoms.

TMJ disorders most commonly occur in women between the ages of 30 and 50.

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Diagnosis

A doctor will take a medical history to learn how long you have had the symptoms, whether you have had a recent injury to the jaw or recent dental treatment.

He or she will do a physical examination. This will include listening to and feeling your jaw when you open and close your mouth and checking to see what range of motion you have in the joint. The doctor will ask whether you have felt a clicking, popping or rough crackling sound when the lower jaw moves.

The doctor will press on areas of your jaw and face to find where the pain or discomfort is located. He or she may also ask about whether you are under stress or anxious and how you cope with such feelings. You will be asked about habits such as clenching your teeth, chewing gum, etc.

The doctor will check your bite to look for problems in how your upper and lower teeth come together. Specifically, he or she will looking for lost teeth, unusual placement of teeth, signs of chronic teeth grinding. It may be necessary to follow up with X-rays of the teeth, if a problem is suspected.

In some cases, a computed tomography (CT) scan may be done to check the bones of the joint. A magnetic resonance imaging (MRI) scan may be done to reveal problems with the disk in the joint.

TMJD is diagnosed based on the patient's symptoms.

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Treatments

Treatment of TMJD varies, depending on what is causing the symptoms. Treatment may include:

  • Arthocentisis, a procedure that flushes debris and the byproducts of inflammation out of the joint
  • Correcting poor habits such as grinding the teeth or chewing gum. Sometimes a device (a night guard) inserted in the mouth can help control grinding of the teeth.
  • Corrective dental treatment.
  • Drugs to relieve pain and reduce swelling and inflammation.
  • Splints that reposition the jaw, ligaments and muscles into better alignment
  • Surgery to correct abnormalities of the jaw
  • Stress management such as meditation, deep breathing and progressive muscle relaxation may be used to help relax the jaw muscles and prevent teeth clenching or grinding.
  • Stretching or massaging the jaw muscles.
  • Applying heat or cold to the muscles to relieve the inflammation and pain.