TMJ disorders

• Alternative Names

  TMD; Temporomandibular joint disorders; Temporomandibular muscle disorders

• Causes, incidence, and risk factors

  There are two matching temporomandibular joints -- one on each side of your head, located just in front of your ears. The abbreviation "TMJ" literally refers to the joint but is often used to mean any disorders or symptoms of this region.

  Many TMJ-related symptoms are caused by the effects of physical stress on the structures around the joint. These structures include:

  • Cartilage disk at the joint
  • Muscles of the jaw, face, and neck
  • Nearby ligaments, blood vessels, and nerves
  • Teeth

  For many people with temporomandibular joint disorders, the cause is unknown. Some causes given for this condition are not well proven. These included:

  • A bad bite or orthodontic braces
  • Stress and tooth grinding. Many people with TMJ problems do not grind their teeth, and many who have been grinding their teeth for a long time do not have problems with their TMJ joint. For some people, the stress associated with this disorder may be caused by the pain as opposed to being the cause of the problem.

  Poor posture can also be an important factor in TMJ symptoms. For example, holding the head forward while looking at a computer all day strains the muscles of the face and neck.

  Other factors that might make TMJ symptoms worse are stress, poor diet, and lack of sleep.

  Many people end up having "trigger points" -- contracted muscles in your jaw, head, and neck. Trigger points can refer pain to other areas, causing a headache, earache, or toothache.

  Other possible causes of TMJ-related symptoms include arthritis, fractures, dislocations, and structural problems present since birth.

• Symptoms

  Symptoms associated with TMJ disorders may be:

  • Biting or chewing difficulty or discomfort
  • Clicking, popping, or grating sound when opening or closing the mouth
  • Dull, aching pain in the face
  • Earache
  • Headache
  • Jaw pain or tenderness of the jaw
  • Reduced ability to open or close the mouth
• Signs and tests

  You may need to see more than one medical specialist for your TMJ pain and symptoms, such as your primary care provider, a dentist, or an ear, nose, and throat (ENT) doctor, depending on your symptoms.

  A thorough examination may involve:

  • A dental examination to show if you have poor bite alignment
  • Feeling the joint and connecting muscles for tenderness
  • Pressing around the head for areas that are sensitive or painful
  • Sliding the teeth from side to side
  • Watching, feeling, and listening to the jaw open and shut
  • X-rays to show abnormalities

  Sometimes, the results of the physical exam may appear normal.

  Your doctor will also need to consider other conditions, such as infections, ear infections, neuralgias, or nerve-related problems and headaches, as the cause of your symptoms.

• Treatment

  Simple, gentle therapies are usually recommended first.

  • Learn how to gently stretch, relax, or massage the muscles around your jaw. Your doctor, dentist, or physical therapist can help you with these.
  • Avoid actions that cause your symptoms, such as yawning, singing, and chewing gum.
  • Try moist heat or cold packs on your face.
  • Learn stress-reducing techniques.
  • Exercising several times each week may help you increase your ability to handle pain.

  Read as much as you can, as opinion varies widely on how to treat TMJ disorders. Get the opinions of several doctors. The good news is that most people eventually find something that helps.

  Ask you doctor or dentist about medications you can use:

  • Short-term use of acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), or other nonsteroidal anti-inflammatory drugs
  • Muscle relaxant medicines or antidepressants
  • Rarely, corticosteroid shots in the TMJ to treat inflammation

  Mouth or bite guards, also called splints or appliances, have been used since the 1930s to treat teeth grinding, clenching, and TMJ disorders.

  • While many people have found them to be useful, the benefits vary widely. The guard may lose its effectiveness over time, or when you stop wearing it. Other people may feel worse pain when they wear one.
  • There are different types of splints. Some fit over the top teeth, while others fit over the bottom teeth.
  • Permanent use of these items is not recommended. You should also stop if they cause any changes in your bite.

  Failure of more conservative treatments doe not automatically mean you need more aggressive treatment. Be cautious about any nonreversible treatment method, such as orthodontics or surgery, that permanently changes your bite.

  Reconstructive surgery of the jaw, or joint replacement, is rarely required. In fact, studies have shown that the results are often worse than before surgery.

• Support Groups

  For more information, see The TMJ Association -- www.tmj.org

• Expectations (prognosis)

  For many people, symptoms occur only sometimes and do not last long. They will go away in time with little or no treatment. Most cases can be successfully treated. Some cases of pain go away on their own without treatment. TMJ-related pain may return again in the future. If the cause is nighttime clenching, treatment can be very tricky because it is a sleeping behavior that is hard to control.

  Mouth splints are a common treatment approach for teeth grinding. While some splints may silence the grinding by providing a flat, even surface, they may not be as effective at reducing pain or stopping clenching. Splints may be effective in the short-term but could become less effective over time. Some splints can also cause changes in your bite. This may cause a new problem.

• Complications
  • Chronic face pain
  • Chronic headaches
• Calling your health care provider

  See your health care provider right away if you are having trouble eating or opening your mouth. Keep in mind that a wide variety of possible conditions can cause TMJ symptoms, from arthritis to whiplash injuries. Experts who are specially trained in facial pain can help diagnose and treat TMJ.

• Prevention
  Many of the home-care steps to treat TMJ problems can prevent such problems in the first place:

  • Avoid eating hard foods and chewing gum.
  • Learn relaxation techniques to reduce overall stress and muscle tension.
  • Maintain good posture, especially if you work all day at a computer. Pause often to change position, rest your hands and arms, and relieve stressed muscles.
  • Use safety measures to reduce the risk of fractures and dislocations.
• References

  American Dental Association. TMD/TMJ (temporomandibular disorders). Available at: http://www.ada.org/public/topics/tmd_tmj.asp.

  Beuscher JJ. Temporomandibular joint disorders. Am Fam Physician. 2007;76(10):1477

  Hampton T. Improvements needed in management of temporomandibular joint disorders. JAMA. 2008;299(10):1119-1121.

  Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med. 2008;359:2693-2705.

  TMJ Disorders. National Institute of Dental or Craniofacial Research. Bethesda, MD. 2009 Feb 11. NIH Publications No. 06-3487. Available at: www.nidcr.nih.gov/OralHealth/Topics/TMJ/TMJDisorders.htm

Review Date: 3/27/2009

Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, Greg Juhn, MTPW, David R. Eltz. Previously reviewed by Michael Kapner, DDS, General and Cosmetic Dentistry, New Rochelle, NY. Review provided by VeriMed Healthcare Network (1/24/2008).