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Definition
Temporomandibular joint syndrome, also known as temporomandibular joint disorder or TMD, is a painful condition involving the joint that opens and closes the mouth. The temporomandibular joints are the small joints in front of each ear that attach the lower jaw (mandible) to the skull. The disorder may affect the jaw joint or the muscles surrounding it.
The Temporomandibular Joint
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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 and jaws
- 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
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
- Sex: female
- Age: 30 to 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 facePain may be worse with chewing, yawning, or opening the mouthClicking, popping, or grating sounds with movement of the jawA sensation of the jaw catching or locking briefly, while attempting to open or close the mouth, or while chewingDifficulty opening the mouth completelyA bite that feels "off," uncomfortable, or as though it is frequently changingSwelling in the affected side of the face or mouthPainful muscle spasm in the area of the temporomandibular jointHeadacheEaracheNeck, back, and/or shoulder pain Diagnosis The doctor will ask about your symptoms and medical history, and perform a physical exam. The physical exam may include: Range of motion testsListening for sounds of popping or clicking in the temporomandibular jointsVisual inspection of your teeth, temporomandibular joints, and muscles of your face and headPalpation of the joints and the muscles of the face and headOther tests may include:X-rays plain x-rays or panoramic dental x-rays of the jaw and jaw joint; they show the teeth. Arthrographyjaw movements videotaped with x-rays taken after dye is injected into the jointMRI scan a test that uses magnetic waves to create detailed images of the joint TreatmentTreatment may include:
Lifestyle MeasuresResting the jaw with a soft diet, restricting its movement through smaller bites, and applying warm packs may offer considerable relief. Cognitive behavior therapy can help some patients learn to avoid clenching and grinding their teeth. MedicationsThe most commonly used medicines include:AcetaminophenNonsteroidal anti-inflammatory drugsMuscle relaxantsLow-dose antidepressantsIn some cases, the jaw joint may be injected with pain relieving medicine such as cortisone or lidocaine. When pain or clicking are major symptoms, injections of botulinum toxin (Botox) may offer temporary relief that responds to retreatment. Physical TherapyGentle massage or stretching exercises, and transcutaneous electrical nerve stimulation (TENS) may reduce pain and help muscles relax in some patients. Stress Reduction Counseling to learn stress management and relaxation techniques, including biofeedback and cognitive behavioral therapy , * may help some patients with TMD. Dental ProceduresA splint or mouth guard, usually worn at night, can be made to relax your jaw muscles and prevent clenching and grinding of your teeth. Correction of bite abnormalities by a dentist or orthodontist is sometimes recommended.
Surgical ProceduresSurgical correction is a last resort if other treatments have not succeeded and the pain persists. 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 and 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 and effective ways to cope with stress. RESOURCES: American Dental Associationhttp://www.ada.org The TMJ Associationhttp://www.tmj.org CANADIAN RESOURCES: Canadian Dental Associationhttp://www.cda-adc.ca/ Canadian Society of OtolaryngologyHead & Neck Surgeryhttp://www.entcanada.org References: Borodic GE, Acquadro MA. The use of botulinum toxin for the treatment of chronic facial pain. J Pain . 2002 Feb;3(1):21-7. 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):476-81.
National Institute of Dental and Craniofacial Research website. Available at: http://www.nidcr.nih.gov/ . *Updated section on Stress Reduction on 6/29/06 according to the following study, as cited by DynaMed's Systematic Literature Surveillance : 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):171-2. Last reviewed October 2007 by Laura Morris-Olson, DMDPlease 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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