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Temporomandibular Disorders

What Is It?
Symptoms
Diagnosis
Expected Duration
Prevention
Treatment
When To Call a Professional
Prognosis
Additional Info

What Is It?

Temporomandibular disorders (TMDs) are problems that affect your temporomandibular joint (TMJ), or jaw joint. They also can affect the muscles of the face that help you to chew.

If you place your fingers just in front of your ears and open your mouth, the movement you feel is your TMJ. It is a small ball-and-socket joint with three parts:

The ball, called the condyle
The socket, called the glenoid fossa
A small, fibrous disk that sits between the condyle and the glenoid fossa

Studies estimate that 20% to 30% of people have TMD symptoms. Women are more three times as likely as men to develop TMDs. This may be because the collagen that holds the disk in position between the ball and socket is structurally different in women. This may cause more women to have dislocated disks, which can lead to TMDs. In addition, some studies have shown that hormones such as estrogen play a role.

TMD is a general term, not a specific condition. There are several types of TMDs, each with its own name. Often, people will say they "have TMJ." TMJ is the name of the joint, not a disease or condition.

The causes of TMD are not understood completely, but can include:

Trauma to the jaw, either by a direct injury to the jaw or long-term clenching or grinding of the teeth (bruxism)
Tension or stress, which triggers muscle spasms
Poor alignment of the teeth (malocclusion)
Arthritis of the jaw joint, such as rheumatoid arthritis or osteoarthritis
Tumors of the jaw joint

Symptoms

TMDs have several symptoms:

You feel pain or tenderness in the area in front of your ear, especially when you chew, speak or open your mouth wide
Your jaw becomes stuck open or closed, or feels stuck
You have spasms in your facial muscles. They may make it difficult to open your mouth or make it feel as though your teeth don't meet normally.
You hear clicking, popping or cracking sounds or feel a grating sensation in your jaw when you open or close your mouth
You get headaches that tend to start in the front of the ear and spread to the rest of the head or neck

Diagnosis

An important part of the diagnosis is reviewing the history of your problem. This includes how long you've had symptoms and when they occur.

Your dentist will:

Look at the way your jaw moves
Examine your teeth for signs of habits such as clenching or grinding (bruxism)
Feel around the TMJ and the muscles of your jaw and neck for signs of tenderness

The dentist might use a stethoscope to listen for joint sounds that would suggest a disorder involving the disk or bones of the joint.

Your dentist will determine whether your problem is a muscle disorder or if it involves the bones or disk of the joint. Usually, a regular X-ray or a panoramic X-ray can rule out a serious disorder within the joint.

If a more detailed view of the joint is necessary, magnetic resonance imaging (MRI) or a computed tomography (CT) scan might be used.

The exam also will be used to check for other conditions that could be causing your symptoms. Examples include arthritis, sinus infections, toothache, earache and neurological problems. These conditions and TMDs have similar symptoms.

If you have a TMD, your dentist or physician will be able to tell you what type it is and how it can be treated. Dentists who are specifically trained to diagnose this condition are called orofacial pain specialists.

Expected Duration

Some TMDs can last for only a few weeks - for example, when they are caused by injury to the jaw. Other types of TMD, such as a problem caused by arthritis or bruxism, can last months or even years, depending on how they respond to treatment.

Prevention

A TMD caused by bruxism or clenching may be corrected by using an occlusal guard or splint. This is a molded piece of acrylic used to change the position of the jaw (it moves the lower jaw forward). The change of position reduces the pressure on the joint. An occlusal guard is also called a night guard, though some people wear it in the daytime. To help you deal with stress, you may want to work with a psychologist. Relaxation therapy or biofeedback may also help reduce stress.

Treatment

The treatment of a TMD depends on its cause.

Most TMDs are related to sore muscles that sometimes have spasms. This type of TMD usually responds to conservative treatment. Examples include:

Soft diet — Avoid hard or crunchy foods. Don't bite into large items, such as a thick sandwich, with your front teeth. Instead, cut food into small pieces and chew with your back teeth.
Physical therapy — This can include heat, massage and ultrasound.
An occlusal guard or splint to help stop teeth clenching and grinding
Stress reduction therapy, including biofeedback and psychological counseling
Over-the-counter pain relievers
Prescription drugs that ease inflammation
Prescription drugs that relax muscles
Bite adjustment — This might include reshaping teeth slightly so that they meet properly.
Replacement of missing teeth

If these measures do not help, surgery might be considered. Arthroscopic surgery often is an option. This technique uses two or three very short incisions around the TMJ. A tiny camera is inserted through one incision. Surgical instruments are inserted through one or two other incisions. Inflamed tissue is removed and the joint is rinsed.

More invasive surgery might be necessary in rare cases, if the jaw locks because of a dislocation or scarring. The surgeon will remove or adjust the obstructing disk.

When To Call a Professional

Call your doctor if:

Your jaw movement is limited.
You have injured your jaw and are taking over-the-counter pain medicine, but the pain doesn't go away after several days.
You have swelling in the area of your TMJ.
Jaw pain keeps you up at night or makes eating difficult.
You have frequent headaches.

Prognosis

With proper care and control of habits, the symptoms should go away. Some cases may go away in less than a month. Other cases, such as those involving arthritis or people with long-standing or severe bruxism, may take longer.

Additional Info

American Academy of General Dentistry
211 East Chicago Ave.
Suite 900
Chicago, IL 60611-1999
Toll-Free: (888) 243-3368
Fax: (312) 440-0559
http://www.agd.org/

National Institute of Dental and Craniofacial Research
National Institutes of Health
Bethesda, MD 20892-2190
Phone: (301) 496-4261
E-Mail: nidcrinfo@mail.nih.gov
http://www.nidcr.nih.gov/

American Association of Oral & Maxillofacial Surgeons
9700 West Bryn Mawr Ave.
Rosemont, IL 60018-5701
Phone: (847) 678-6200
E-Mail: inquiries@aaoms.org
http://www.aaoms.org/

Reviewed by the faculty of Columbia University College of Dental Medicine