Temporomandibular Disorder

(TMD; Temporomandibular Joint Disorder; Temporomandibular Joint Dysfunction; TMJ Syndrome; TMJ Osteoarthritis)

Definition

Temporomandibular disorder (TMD) is a painful problem of the joint in the jaw. These are the small joints in front of each ear. They attach the lower jaw to the skull. TMD may be in the joint in the jaw or the muscles around it.

The Temporomandibular Joint

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Causes    TOP

The cause of TMD is often not clear. It may be due to:

  • Injury of the jaw or face
  • Too much tension in the jaw muscles
  • Displacement or poor position of the jaw joint or cartilage disc inside it
  • The upper and lower teeth not being in line
  • Disturbed movement of the jaw joint
  • Arthritis or a swelling in the joint
  • Too much or not enough motion of the joint

Risk Factors    TOP

TMD is more common in women aged 30-50 years old. Other things that raise your chance of TMD are:

  • Injury of the jaw and neck
  • Clenching or grinding of teeth
  • Poorly fitting dentures or crowns
  • Stress
  • Smoking

Symptoms    TOP

TMD may cause:

  • Pain in the jaw, or face
  • Pain may be worse with chewing, yawning, or opening and closing the mouth
  • Clicking, popping, or grating sounds with movement of the jaw
  • A feeling of the jaw catching or locking briefly, while attempting to open or close the mouth, or while chewing
  • Headache
  • Earache
  • Neck or shoulder pain

Diagnosis    TOP

You will be asked about your symptoms and health history. A physical exam will be done. This may mean:

  • Range of motion of the jaw tests
  • Listening for sounds of popping or clicking in the temporomandibular joints
  • An exam of your teeth, temporomandibular joints, and muscles of your face and head
  • Moving of the joints and the muscles of the face and head

Pictures may be needed of your jaw to check for abnormalities causing TMD. This can be done with:

Treatment    TOP

The most basic treatments will be tried first. This may mean:

Lifestyle Measures

The site will need time to heal:

  • Rest the jaw by eating soft foods.
  • Limit movement with smaller bites.
  • Do not open your mouth too wide.
  • Do not chew gum.
  • Apply ice or heat packs to help with the pain.
  • Do gentle jaw stretching and exercises.

Medications

The most often used medicines are:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
  • Muscle relaxers
  • Antidepressants

Some medicine may be injected into the jaw such as:

  • Pain relievers, such as cortisone
  • Botulinum toxin (Botox)—may help in the short term with pain

Physical Therapy    TOP

To help lower pain and let muscles relax:

  • Gentle massage or stretching exercises
  • Gentle strengthening or muscle balance exercises to keep alignment
  • Transcutaneous electrical nerve stimulation (TENS)

Stress Reduction    TOP

Counseling may help you learn how to manage stress and relax with:

Dental Procedures    TOP

A splint or mouth guard can be made to relax the jaw muscles and prevent the teeth from clenching and grinding. The guard is usually worn at night. Unfortunately, there is not a lot of proof it works.

Correction of bite abnormalities by a dentist or orthodontist may be needed.

Surgical Procedures    TOP

Surgery is a last resort. Many of the current surgeries have not been well-studied.

Prevention    TOP

There is no way to prevent TMD.

RESOURCES:

Mouth Healthy—American Dental Association
http://www.mouthhealthy.org
The TMJ Association
http://www.tmj.org

CANADIAN RESOURCES:

Canadian Dental Association
http://www.cda-adc.ca
Canadian Society of Otolaryngology—Head & Neck Surgery
http://www.entcanada.org

References:

Borodic GE, Acquadro MA. The use of botulinum toxin for the treatment of chronic facial pain. J Pain. 2002;3(1):21-27.
Haley DP, Schiffman EL, Lindgren BR, Anderson Q, Andreasen K. The relationship between clinical and MRI findings in patients with unilateral temporomandibular joint pain. J Am Dent Assoc. 2001;132(4):476-481.
Temporomandibular joint (TMJ) dysfunction . EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated February 20, 2018. Accessed July 12, 2018.
TMJ. American Academy of Otolaryngology—Head and Neck Surgery website. Available at:
...(Click grey area to select URL)
Updated July 13, 2018. Accessed July 13, 2018.
TMJ. American Dental Association Mouth Healthy website. Available at:
...(Click grey area to select URL)
Accessed July 13, 2018.
TMJ (temporomandibular joint and muscle disorders). National Institute of Dental and Craniofacial Research website. Available at:
...(Click grey area to select URL)
Updated February 2018. Accessed July 13, 2018.
Temporomandibular disorders. American Association of Oral and Maxillofacial Surgeons website. Available at: https://www.aaoms.org/docs/practice_resources/clinical_resources/tmd_disorders.pdf. Published 2017. Accessed July 13, 2018.
DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
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 reviewed June 2018 by James P. Cornell, MD
Last Updated: 7/16/2018

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