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Five years ago, Stephen, a 40-year-old business manager, started having occasional pain in his jaw and the muscles of his face and neck. Sometimes he would have trouble moving his jaw and would hear clicking sounds while he was chewing. His doctor and dentist told him to reduce the stress in his life and make sure he was not clenching his teeth. Despite his best efforts, the symptoms got so bad that his work performance suffered. Another doctor suggested he see a dentist who had experience treating orofacial pain. This dentist diagnosed Steve's problem as a temporomandibular disorder (TMD) and recommended a combination of treatments that finally relieved his pain and chewing difficulties.

What Is in a Name?

There has been a great deal of controversy among clinicians and researchers about the name, definition, symptoms, causes, and treatment of temporomandibular disorders. As a result, many people with TMD have gone to several medical and dental providers before getting a correct diagnosis and treatment.

The temporomandibular joint (TMJ) is the jaw joint. Temporomandibular disorders (TMD) refers to a group of conditions that affect the temporomandibular joint, as well as the muscles that control chewing. Although the terms "TMJ" and "TMJ disorder" are sometimes still used to describe disorders associated with this joint, "TMD" is becoming the accepted term.

Because of a lack of agreement about these disorders, we do not really know how many people have TMD. For most people, the discomfort is temporary and fluctuates over time. Only a small percentage develop serious, long-term problems, and TMD appears to affect women more than men.

Details of the Temporomandibular Joint

The temporomandibular joint connects your lower jaw (mandible) to the temporal bone on the side of your head. You can feel it on each side of your head by placing your fingers just in front of your ears and opening your mouth or moving your jaw from side to side.

The TMJ is made up of two sections separated by a disc, which absorbs shock to the joint from chewing and other movements. This system, along with the muscles attached to and surrounding the joint, allows the jaw to move up and down, forward, and sideways. This movement enables you to talk, chew, and swallow. Anything that prevents the joints and muscles from working together properly may contribute to TMD.

Contributing Factors

Experts feel that TMD is caused by several interacting factors. However, there is disagreement about the specific factors involved and the roles they each play. These factors may play a role in developing TMD:

  • Trauma to the jaw or neck
  • Arthritis of the joint
  • Oral habits (eg, teeth grinding, teeth clenching, lip biting)
  • Bite problems that affect how the teeth fit together
  • Muscle tension

Psychological conditions such as depression and anxiety are also associated with TMD.

What Are the Symptoms?

  • Pain or discomfort in and around the jaw joints, ears, or muscles of the jaw, face, temples, or neck
  • Headaches
  • Limited movement or locking of the jaw
  • Chewing problems
  • Painful clicking, popping, or grating sounds when moving the jaw joint

A Complex Diagnosis

Diagnosing TMD can be difficult due to the lack of scientific evidence and the controversies over the disorder. Most cases are diagnosed based on your own description of symptoms, your medical and dental history, and a physical examination of the jaw, head, and neck.

Tailored Treatment

Treatment should be tailored to your symptoms and contributing factors. Since it is often difficult to cure, treatment focuses on management of the disorder. Simple treatment to relieve the discomfort and restore proper functioning is often all that is needed. Most clinicians and researchers strongly recommend conservative, reversible treatment that causes no permanent changes in the structure or position of the jaw or teeth.

Self-care practices that often ease TMD symptoms include applying heat or ice, and avoiding movements that strain the jaw, such as chewing gum and laughing or yawning with your mouth wide open. Other conservative treatments include stress management, physical therapy with exercises you can do at home, and medicines to reduce pain and inflammation. Oral appliances, commonly referred to as splints or night guards, are sometimes used to help decrease clenching and grinding and ease the strain on the joints and muscles.

Getting Help

If you think you have TMD, talk with your dentist or doctor. If necessary, they will refer you to a dentist who specializes in orofacial pain.

RESOURCES:

American Academy of Craniofacial Pain
http://www.aacfp.org/index.cfm

TMJ/TMJD—Jaw Joints & Allied Musculo-Skeletal Disorders Foundation
http://www.tmjoints.org/

CANADIAN RESOURCES:

Canadian Dental Association
http://www.cda-adc.ca/

Health Canada
http://www.hc-sc.gc.ca/index_e.html/

References:

Nilsson IM, Drangsholt M. Incidence and temporal patterns of temporomandibular disorder pain among Swedish adults. J Orofac Pain. 2007:21(2):127-32.

Temporomandibular joint (TMJ) dysfunction. EBSCO DynaMed website. Available at: http://www.ebscohost.com. Updated April 16, 2012. Accessed July 5, 2012.

TMJ disorders. National Institute of Dental and Craniofacial Research website. Available at: http://www.nidcr.nih.gov/OralHealth/Topics/TMJ/. Updated March 2010. Accessed July 5, 2012.

TMD Tutorial. American Academy of Orofacial Pain (AAOP) website. Available at: http://documents.clubexpress.com/documents.ashx?key=aNhu63X5hSYllH29rnl%2fSy1kYmmUYJsLoI0v%2b%2fa2M7mE134KjmcZzhocykb%2bdDeq. Accessed July 5, 2012..



Last reviewed July 2012 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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