Temporomandibular Disorder

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

Definition

Temporomandibular disorder (TMD) is a painful condition in the joint that opens and closes the mouth. These temporomandibular joints are the small joints in front of each ear. They attach the lower jaw (mandible) to the skull. The disorder may affect the jaw joint or the muscles surrounding it. The disorder can include:

  • damage to the joint surface or intra-articular disk
  • displacement or complete dislocation of jaw bones

The Temporomandibular Joint

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Causes    TOP

The exact cause of TMD is often unclear. Possible causes include:

  • Injury of the jaw or face
  • Excess tension in the jaw muscles
  • Faulty alignment between the upper and lower teeth
  • Disturbed movement of the jaw joint
  • Displacement or abnormal position of the jaw joint or cartilage disc inside the jaw joint
  • Arthritis or similar inflammatory process in the joint
  • Excess or limited motion of the joint

Risk Factors    TOP

TMD is more common in women aged 30-50 years old. Other factors that increase your chance of TMD include:

Symptoms    TOP

Symptoms may include:

  • Pain in the temporomandibular joint, jaw, or face
  • Pain may be worse with chewing, yawning, or opening the mouth
  • Clicking, popping, or grating sounds with movement of the jaw
  • A sensation of the jaw catching or locking briefly, while attempting to open or close the mouth, or while chewing
  • Difficulty opening the mouth completely
  • A bite that feels off, uncomfortable, or as though it is frequently changing
  • Headache
  • Earache
  • Neck pain

Diagnosis    TOP

The doctor will ask about your symptoms and medical history. A physical exam will be done. The physical exam may include:

  • Range of motion of the jaw tests
  • Listening for sounds of popping or clicking in the temporomandibular joints
  • Visual inspection of your teeth, temporomandibular joints, and muscles of your face and head
  • Palpation of the joints and the muscles of the face and head

Tests may include:

  • X-rays
  • Arthrography—jaw movements videotaped with x-rays taken after dye is injected into the joint
  • MRI
  • CT scan

Treatment    TOP

Usually the least invasive measures will be tried first. Treatment may include:

Lifestyle Measures

  • Rest the jaw with a soft diet
  • Restrict movement with smaller bites, avoiding wide yawning, and gum chewing
  • Apply ice or heat packs for pain relief
  • Gentle jaw stretching and exercises

Medications

The most commonly used medications include:

  • Nonsteroidal anti-inflammatory drugs, such as acetaminophen or ibuprofen
  • Muscle relaxants
  • Antidepressants

Some medication may be injected into the jaw such as:

  • Pain relievers, such as cortisone or lidocaine
  • Botulinum toxin (Botox)—may offer temporary relief if pain or clicking are major symptoms

Physical Therapy    TOP

To help reduce pain and allow muscles to relax:

  • Gentle massage or stretching exercises
  • Transcutaneous electrical nerve stimulation (TENS)

Stress Reduction    TOP

Some may benefit from counseling to learn stress management and relaxation techniques, such as:

Dental Procedures    TOP

A splint or mouth guard can be made to relax your jaw muscles. This will prevent clenching and grinding of your teeth. The guard is usually worn at night. Correction of bite abnormalities by a dentist or orthodontist is sometimes needed.

Surgical Procedures    TOP

Surgical correction is a last resort. Many of the available procedures have not been well-studied for their effectiveness.

Prevention    TOP

There are no current guidelines to prevent TMD.

RESOURCES:

American Dental Association
http://www.ada.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/default.asp

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.
National Institute of Dental and Craniofacial Research website. Available at: http://www.nidcr.nih.gov/oralhealth/topics/tmj . Updated March 21, 2013. Accessed July 12, 2013.
Temporomandibular joint (TMJ) dysfunction . EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what . Updated May 31, 2013. Accessed July 12, 2013.
DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what : 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 July 2013 by Peter Lucas, MD; Brian Randall, MD
Last Updated: 5/11/2013