Temporomandibular Disorder

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(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 Temporomandibular Joint

Causes

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

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
Injury of the jaw or face

Risk Factors

Factors that increase your chance of TMD include:

Sex: female
Age: 30-50 years old
Clenching or grinding of teeth
Poorly fitting dentures or crowns
Fibromyalgia
Stress
Arthritis

Symptoms

Symptoms 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
Swelling in the affected side of the face or mouth
Painful muscle spasm in the area of the temporomandibular joint
Headache
Earache
Neck, back, and/or shoulder pain

Diagnosis

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

Other tests may include:

X-rays—plain x-rays or panoramic dental x-rays of the jaw and jaw joint
Arthrography—jaw movements videotaped with x-rays taken after dye is injected into the joint
MRI scan—a test that uses magnetic waves to create detailed images of the joint

Treatment

Treatment may include:

Lifestyle Measures

Rest the jaw with a soft diet
Restrict movement with smaller bites
Apply warm packs for pain relief
Cognitive behavior therapy may help some learn to avoid clenching and grinding their teeth

Medications

The most commonly used medicines include:

Acetaminophen (Tylenol)
Nonsteroidal anti-inflammatory drugs
Muscle relaxants
Low-dose antidepressants

Some medication may be injected into the jaw such as:

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

Physical Therapy

To help reduce pain and allow muscles to relax:

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

Stress Reduction

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

Dental Procedures

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

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

Prevention

There are no guidelines for preventing TMD. If you have TMD, the following may help prevent symptoms:

Ask your dentist if you need a night guard for grinding and clenching of the teeth.
Try to limit jaw movements. Learn to relax your jaw. Block a yawn by putting your fist under your chin.
Avoid extensive movements of the jaw.
Don't chew gum.
Learn relaxation techniques. Develop effective ways to cope with stress.

BE = This therapy has the best evidence available showing that it is effective.

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

References

Borodic GE, Acquadro MA. The use of botulinum toxin for the treatment of chronic facial pain. J Pain. 2002;3(1):21-27.

DynaMed Editorial Team. Temporomandibular joint (TMJ) dysfunction . EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated March 8, 2011. Accessed March 10, 2011

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. Accessed July 7, 2009.

DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: 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.

Revision Information

Reviewer: Peter Lucas, MD
Review Date: 09/2012 -
Update Date: 00/93/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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