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TMJ Disorders

TMJ disorders cause tenderness and pain in the temporomandibular joint (TMJ) — the joint on each side of your head in front of your ears, where your lower jawbone meets your skull. This joint allows you to talk, chew and yawn.

Causes

According to the National Institute of Dental and Craniofacial Research, part of the National Institutes of Health, 5-15% of people in the United States experience pain associated with TMJ disorders. Women between the ages of 30 and 50 are more likely to suffer from TMJ disorders than men.

Many times, pain and discomfort associated with TMJ disorders can be relieved with self-managed care or nonsurgical treatments, however more-severe cases may need to be treated with dental or surgical interventions.

The temporomandibular joint combines a hinge action with sliding motions, making it one of the most complex joints in the body. When you talk, chew or yawn, the lower jaw has rounded ends that glide in and out of the joint socket. Cartilage covers the parts of the bones that interact in the joint. The bones are separated by a small shock-absorbing disk, which keeps the movement smooth.

Possible causes of TMJ disorders:

  • The disk becomes worn or is moved out of proper alignment.
  • Arthritis damages the joint's cartilage.
  • The joint is damaged by a hit or other trauma.
  • Clenching or grinding of your teeth can result in the muscles that stabilize the joint becoming fatigued from overwork

Oftentimes, the cause of TMJ symptoms isn't clear.

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Symptoms

Signs and symptoms of TMJ disorders may include:

  • Tenderness or discomfort of your jaw
  • Aching pain in and around your ear
  • Difficulty chewing or pain while chewing
  • Facial pain
  • Locking of the joint, difficulty opening or closing your mouth
  • Headache
  • Uncomfortable or uneven bite

Other symptoms associated with TMJ disorders may include a clicking sound or grating sensation when you open your mouth or chew. If there's no pain or limitation of movement associated with your jaw clicking, you probably don't have a TMJ disorder.

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Diagnosis

If you have persistent pain or tenderness in your TMJ, if you have facial pain and experience clicking or grating when you chew or move your jaw, or if you can't open or close your jaw completely, seek medical attention.

Depending on your symptoms, it may be necessary to be examined by more than one medical specialty in order to diagnose TMJ pain and symptoms. Possible specialties may include your primary care provider, a dentist, or an ear, nose, and throat (ENT) doctor. Some dentists specialize in TMJ diagnosis and treatment.

An examination may involve:

  • Assess the joint and connecting muscles for tenderness
  • Watch, touch, and listen to the jaw open and shut
  • Slide the teeth from side to side
  • Press around the head for areas that are sensitive or painful
  • X-rays may be taken and may show abnormalities, however can be difficult to read
  • In some cases, an MRI of the jaw area may be performed
  • A dental examination may indicate mis-alignment of the bite (crossbite, malocclusion)

The results of the physical examination may appear normal, in some cases.

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Treatment

Simple, gentle therapies are usually recommended first. If those don't work, mouth guards and more aggressive treatments may be considered. Surgery is generally considered a last resort. Fortunately, there are many steps you can take at home long before that point.

Home treatment. Start with massaging the various muscles that may be involved. Explore all of the muscles of the face, shoulders, and back of the neck. (Avoid the area around the throat.) Press on the muscles to identify extremely painful points. Massage the painful spot with hard, slow, short strokes. Do this several times a day until the muscle is no longer painful when pressed.

Here are some other steps to consider:

  • Maintain good posture while working at a computer, watching TV, and reading. Take frequent breaks to relieve stressed muscles.
  • Try to relax your facial and jaw muscles throughout the day.
  • Avoid eating hard foods, like nuts, candies, and steak.
  • Get plenty of rest and drink plenty of water every day.
  • Explore relaxation techniques to reduce overall stress and muscle tension in your back, neck, and body.

Other home-care therapies are useful for some people, such as moist heat or cold packs on the face, vitamin supplements, or biofeedback. Incorporating regular exercise into your schedule may help you relax, strengthen your body, increase flexibility, and increase your pain threshold.

In some cases, the symptoms of TMJ disorders may go away without treatment. If your symptoms persist, your doctor may recommend medications or a bite guard to help keep you from grinding your teeth at night. In very rare cases, surgery may be required to repair or replace the joint.

Medications

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as aspirin or ibuprofen, typically don't provide enough relief for pain caused by TMJ disorders. However, in some cases, naproxen (Aleve, others) may be helpful if combined with specific exercises designed to stretch jaw muscles.
  • Tricyclic antidepressants. Used at bedtime, antidepressants, such as amitriptyline or nortriptyline, have proved effective in relieving TMJ pain.
  • Muscle relaxants. Drugs, such as carisoprodol (Soma, others), may be used for a short period of time (few days or weeks) to help relieve pain caused by TMJ disorders. It is important to note that these drugs can be habit-forming and should be withdrawn gradually.
  • Corticosteroid drugs. In cases of significant pain and joint inflammation, corticosteroid drugs injected into the joint space may provide relief.
  • Botulism toxin. Botox injections into the jaw muscles used for chewing may relieve pain associated with TMJ disorders.

Therapies

  • Bite guard. In cases where the patient grinds their teeth during sleep, it may be beneficial to wear a soft or firm device inserted over the teeth. This bite guard prevents the teeth from meshing together. However, bite guards may aggravate sleep apnea symptoms.
  • Cognitive behavioral therapy. Interventions by a psychotherapist to help manage stress, anxiety and learn relaxation techniques, may be used to help relieve symptoms of TMJ disorders.

Surgical or other procedures

  • Corrective dental treatment. Your dentist may improve your bite by balancing the biting surfaces of your teeth, replacing missing teeth, or replacing needed fillings or crowns.
  • Arthrocentesis. In this procedure, a needle is inserted into the joint so that fluid is irrigated through the joint to remove debris and inflammatory byproducts by inserting a needle into the joint using this procedure.
  • Surgery. If less invasive approaches don't work, your doctor or dentist may refer you to an oral and maxillofacial surgeon. Surgery to repair or remove the disk between your mandible and temporal bone may be beneficial. In cases when advanced osteoarthritis is present, a partial or total joint replacement may help remove bone-on-bone contact and improve joint mechanics and motion.

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