Temporomandibular Disorder (TMD): Understanding, Diagnosis, Treatment, and Relief

Key facts

The Temporomandibular Joints (TMJ) are the hinges that connect your jaw to the temporal bones of your skull

Temporomandibular Disorder (TMD) encompasses various conditions that affect the TMJ, the muscles of the jaw, or both

TMD can cause pain in the jaw joint and muscles, difficulty in opening and closing the mouth, and a clicking or popping sound when the jaw moves

Various factors contribute to TMD including genetics, arthritis, jaw injuries, and habits such as teeth grinding

There are different types of TMD, including muscle disorders, joint derangement disorders, and degenerative joint disorders

Management and treatment options range from self-care practices and physical therapy to medications and, in some cases, surgery

What are the temporomandibular joints (TMJ)?

The temporomandibular joints (TMJ) are a pair of hinge joints that connect your mandible, or lower jaw, to the temporal bones of your skull. These joints are located on each side of your head, just in front of your ears. They are among the most complex joints in the body, allowing for a broad range of motion so that you can talk, chew, yawn, and make various facial expressions.
Each TMJ has a disc made of soft cartilage that acts as a cushion between the two bones, ensuring that the jaw can move smoothly. This disc also helps to accommodate the jaw’s movements, whether it’s gliding forward, backward, or side-to-side.
The TMJ is stabilized by a system of muscles, ligaments, and bones. If any of these components become damaged or stressed, it can lead to a condition known as temporomandibular joint disorder (TMD), which causes pain and reduced function in the jaw joint and the surrounding muscles. The temporomandibular joints are essential for many daily functions like speaking and eating. They provide the jaw with the necessary flexibility and strength to carry out these tasks.

What is Temporomandibular Disorder (TMD)?

Temporomandibular Disorder (TMD) is a term that refers to a group of conditions affecting the function and comfort of the temporomandibular joints and the muscles controlling jaw movement. It’s important to make a distinction between TMJ, which refers to the joints themselves, and TMD, which refers to disorders or problems associated with these joints.
Symptoms of TMD can vary but often include:

Pain or tenderness in the jaw, especially near the joint area
Pain in and around the ear
Difficulty or discomfort while chewing
Aching facial pain
Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth
Locking of the jaw, making it difficult to open or close the mouth

These symptoms can be temporary or last for many years and can affect one or both sides of the face. It’s also more common in women than in men and is most frequently diagnosed in individuals between the ages of 20 and 40.

Types of TMD (Temporomandibular Joint Dysfunction)

TMD can be classified into different types based on the underlying cause and the structures involved.
The main categories are:

Muscle Disorders (Myogenous): This type refers to TMDs that primarily involve discomfort or pain in the muscles that control jaw function and the surrounding areas. One common example is myofascial pain syndrome, which involves pain in the muscles and the fascia (connective tissue) around the jaw. Muscle disorders can be caused by overuse of jaw muscles, tension from stress, or bruxism (teeth grinding).
Joint Derangement Disorders: This category includes disorders related to the structural components of the joint itself. For instance, a dislocated jaw, a displaced disc, or injured bones in the TMJ area. Patients with this type of TMD might experience irregular jaw movements, clicking or popping sounds, and in some cases, limited jaw opening.
Degenerative Joint Disorders: This category refers to TMDs characterized by deterioration of the joint. Osteoarthritis is one example, where the cartilage in the TMJ wears down over time. Rheumatoid arthritis affecting the TMJ is another example. These disorders can cause pain and limited range of motion in the jaw.

The type of TMD can dictate the treatment approach. In many cases, a combination of therapies may be needed to effectively manage symptoms.

What are the Symptoms of TMJ Dysfunction?

Temporomandibular Joint (TMJ) Dysfunction, or TMD, can present with a range of symptoms, which can vary in severity from mild to disabling.
The common symptoms include:

Jaw Pain and Tenderness: This is often the most noticeable symptom. The pain can be sharp or dull and is usually felt in the jaw joint area, but can also radiate to the cheeks, temples, or neck.
Clicking, Popping, or Grating Sounds: These sounds or sensations are often experienced when opening or closing the mouth, or when chewing. While these sounds are common even in healthy individuals, they are a concern when accompanied by pain or limited jaw movement.
Limited Range of Motion: Difficulty opening the mouth wide, often accompanied by pain. This can affect eating and speaking.
Jaw Locking: The jaw may lock in an open or closed position, and it might be hard or painful to move.
Ear Pain or Tinnitus: Pain around the ear, sometimes mistaken for an ear infection, as well as ringing in the ears.
Headaches and Neck Pain: Chronic headaches, especially upon waking, and neck pain can be associated with TMD.
Changes in Bite: Some people notice that their upper and lower teeth no longer fit together properly, which can affect the way they bite down on food.
Facial Muscle Fatigue or Discomfort: The muscles on the side of the face may feel tired or achy.

Things that Make TMJ Dysfunction Worse

Certain habits or conditions can exacerbate the symptoms of TMJ dysfunction:

Continuous Teeth Grinding or Clenching: This can increase pressure on the TMJ and worsen pain and discomfort.
Excessive Gum Chewing or Nail Biting: These habits can overwork the jaw muscles and aggravate TMD.
Poor Posture: Straining neck muscles due to poor posture, especially during work or using a phone, can put extra stress on the TMJ.
Stress and Anxiety: These emotional states can cause muscle tension and involuntary jaw clenching.
Eating Hard or Crunchy Foods: This requires more effort from the jaw muscles and can strain the TMJ.
Extreme Jaw Movements: Wide yawning, singing, or any activity that involves opening the mouth too widely can make TMD worse.
Lack of Treatment for Arthritis: If arthritis is a contributing factor, not properly managing the arthritis can make TMD symptoms worse.

Understanding and addressing the contributing factors is essential in managing TMJ dysfunction effectively.

Complications of TMJ Dysfunction

While Temporomandibular Joint (TMJ) Dysfunction can be quite uncomfortable and sometimes painful, it generally does not lead to life-threatening complications.
However, if left untreated, it can potentially result in:

Chronic Pain: The discomfort in the jaw, face, neck, or shoulders may become persistent and affect the person’s overall quality of life.
Chronic Headaches and Earaches: TMD can cause frequent tension-type headaches or pain around the ear, which can be debilitating.
Jaw Mobility Issues: TMD can result in chronic jaw stiffness or locking, making it difficult to fully open or close the mouth, which can impact eating, speaking, and other daily activities.
Sleep Disruption: Chronic pain from TMD can affect sleep quality, leading to fatigue and other health issues associated with sleep deprivation.
Nutrition Problems: If pain or limited jaw mobility affects the ability to chew certain foods, it could potentially lead to dietary restrictions and nutrition issues.
Impact on Mental Health: Chronic pain conditions, including TMD, can have a significant impact on mental health, potentially contributing to conditions such as depression and anxiety.

Diagnosis: How is Temporomandibular Joint Dysfunction (TMD) Diagnosed?

TMD is primarily diagnosed based on symptoms and physical examination.
Your healthcare provider will:

Discuss Your Health History: They will ask about your symptoms, their onset, and what aggravates or relieves them. They will also discuss any history of jaw injuries, dental procedures, or habits like teeth grinding.
Conduct a Physical Examination: Your healthcare provider will examine your jaw to check for pain or tenderness, listen for clicking, popping or grating sounds during jaw movement, assess your bite, and measure how wide you can open your mouth.
Imaging: Depending on the findings, they may also order imaging tests like dental X-rays, CT scan, or MRI to get a detailed view of the bones, disc, and soft tissues of the joint.
Referral to a Specialist: If necessary, your primary care provider may refer you to a dentist or a specialist in oral and maxillofacial issues for further evaluation and treatment.

What is the Main Cause of TMJ Dysfunction?

There is no single cause for TMJ dysfunction; it can be attributed to a combination of factors.
Some of the common factors include:

Bruxism or Teeth Grinding: Constant clenching or grinding of the teeth puts pressure on the joint, which can lead to TMD.
Trauma or Injury: Direct trauma to the jaw or the muscles of the head and neck, such as a heavy blow, can cause TMD.
Arthritis: Inflammatory joint disorders like rheumatoid arthritis or osteoarthritis can affect the TMJ.
Structural Jaw Issues: Some individuals may have an irregular jaw structure or misalignment which can contribute to TMD.
Stress and Anxiety: These can cause muscle tension and might lead to habits such as clenching that contribute to TMD.
Disc Displacement: The soft disc in the TMJ that allows for smooth movement may erode or move out of its proper alignment.

Treatment of TMJ Dysfunction

The treatment for TMJ Dysfunction depends on the severity of your symptoms and the underlying cause.
Treatment usually starts with conservative therapies, which can include:

Medications: Pain relievers, anti-inflammatories, muscle relaxants, or even antidepressants for pain relief can be prescribed.
Physical Therapy: Exercises to stretch and strengthen jaw muscles, massage, heat and cold therapy, and ultrasound treatment can help improve joint mobility and reduce pain.
Oral Appliances: Dentists can provide devices such as oral splints or mouth guards, especially for patients who grind or clench their teeth.
Counseling: Understanding behaviors and habits that aggravate TMD symptoms can help you avoid them. These may include teeth clenching, nail-biting, or certain jaw movements.

If conservative treatments do not provide relief, more invasive procedures may be considered. These can include:

Arthrocentesis: A minor procedure that involves inserting small needles into the joint to irrigate it and remove inflammatory byproducts.
Injections: Corticosteroid or hyaluronic acid injections can be made into the joint to reduce pain and inflammation.
Surgery: If other treatments fail and the pain is severe, surgical options such as arthroscopy or open-joint surgery might be considered. However, these options carry higher risks and are generally considered as a last resort.

Healthcare providers adopt a comprehensive approach to treat Temporomandibular Joint Dysfunction (TMD), depending on the severity and underlying cause. Treatment can be categorized into medications, nonsurgical interventions, and surgical treatments.

Medications

Pain Relievers and Anti-inflammatories: Over-the-counter pain medications such as ibuprofen can be used. For more severe pain, prescription pain relievers might be recommended.
Muscle Relaxants: These might be used for a few days or weeks to help relieve pain caused by muscle spasms.
Tricyclic Antidepressants: Medications like amitriptyline, originally used to treat depression, can be used in low doses for pain relief, bruxism control, and sleep regulation.

Nonsurgical TMJ Treatments

Oral Appliances: Dental splints or mouth guards can be provided, especially for patients who grind or clench their teeth. These devices can help provide relief by distributing the forces exerted on the jaw and by creating a barrier between the upper and lower teeth.
Physical Therapy: Physical therapy, including exercises to strengthen jaw muscles, improve flexibility, and promote relaxation, can be beneficial. Therapists might also use heat and ice therapy or ultrasound.
Counseling and Education: This can help you understand the factors and behaviors that may aggravate your pain so that you can avoid them. Counseling can also address any underlying mental health issues that might be contributing to TMD.
Transcutaneous Electrical Nerve Stimulation (TENS): This therapy uses low-level electrical currents to provide pain relief by relaxing the jaw joint and facial muscles.
Trigger Point Injections: Pain medication or anesthesia is injected into tender facial muscles called “trigger points” to alleviate pain.
Occlusal Adjustments: Your dentist might recommend adjustments to the bite by reshaping some of the teeth. This procedure is controversial and should be approached cautiously.

Surgical TMJ Treatments

Surgical intervention is usually considered the last resort, only for severe cases or when conservative treatments have not been effective.

Arthrocentesis: It is a minimally invasive procedure that involves the insertion of small needles into the joint to irrigate and remove inflammatory debris.
TMJ Arthroscopy: In certain cases, arthroscopic surgery can be performed. A thin tube (cannula) is placed into the joint space, and an arthroscope is then inserted, and various small surgical instruments are used to perform the surgery.
Open-Joint Surgery: If your jaw pain is caused by a structural issue in the joint, your doctor might suggest open-joint surgery (arthrotomy) to repair or replace the joint. This procedure has a longer healing time and carries more risks compared to arthroscopy.
Joint Replacement: In extreme cases, a total joint replacement might be necessary. This involves replacing the natural joint with an artificial implant and is generally considered a final option.

When considering treatment options, it’s important to consult with your healthcare provider to discuss the risks and benefits of each option and to make an informed decision.

Who Treats TMJ Disorder?

The treatment of Temporomandibular Joint (TMJ) Disorder can involve a multi-disciplinary approach, and various healthcare professionals may be involved in the management of this condition:

General Dentist: Often the first point of contact, a general dentist can help diagnose the condition and provide initial treatment or referrals to specialists.
Oral and Maxillofacial Surgeon: Specializes in surgery of the face, mouth, and jaws, and may be involved in more complex cases requiring surgical intervention.
Orthodontist: Specializes in correcting teeth and jaws that are positioned improperly and may be involved if misalignment is contributing to TMD.
Physical Therapist: A physical therapist can be involved in providing exercises and therapies to relieve pain and improve the function of the jaw.
Ear, Nose, and Throat (ENT) Specialist: Since TMD can sometimes involve ear pain, an ENT specialist might be consulted for evaluation.
Pain Specialist: For managing chronic pain associated with TMJ disorder.
Rheumatologist: If TMD is suspected to be linked with arthritis or other joint disorders.
Psychologist or Psychiatrist: For addressing any underlying mental health issues such as anxiety or depression which might be contributing to TMD.

Can I Prevent TMJ Dysfunction?

While not all cases of TMJ dysfunction are preventable, particularly those caused by structural abnormalities or arthritis, there are steps that can be taken to reduce the risk or mitigate symptoms:

Avoid Overuse of Jaw Muscles: Cut food into smaller pieces to reduce the need to open your mouth wide and avoid excessive chewing like chewing gum.
Manage Stress: Since stress can contribute to clenching and grinding of teeth, stress reduction and relaxation techniques can be helpful.
Use Proper Posture: Maintain proper alignment of the head and neck, especially during work or using electronic devices.
Dental Care: Regular dental check-ups to ensure that your teeth and jaw are properly aligned.
Avoid Clenching or Grinding Teeth: Be mindful of clenching or grinding during the day, and discuss with your dentist if a nightguard is needed for nighttime teeth grinding.
Jaw Exercises: Some gentle jaw exercises can help keep the jaw muscles flexible and relaxed.

What Can I Expect If I Have TMJ Dysfunction?

If you have TMJ Dysfunction, the journey can vary. Some individuals experience mild and temporary symptoms that may improve on their own or with minimal intervention. For others, TMJ Dysfunction can be a chronic issue that requires a multi-faceted approach for management.
In chronic cases:

Multiple Visits to Healthcare Providers: As mentioned earlier, the management of TMD can involve various healthcare professionals. You may need to consult with more than one specialist.
Lifestyle Adjustments: You might need to make changes to your eating habits, posture, and how you manage stress.
Continuous Management: In some cases, TMD can be a long-term issue that requires ongoing management strategies including physical therapy, medication, and the use of oral appliances.
Possible Surgery: In severe cases that don’t respond to conservative treatments, surgical options may be considered.
Follow-up and Monitoring: Regular follow-up appointments will likely be necessary to monitor your condition.

Remember that communication with your healthcare team is key in managing TMJ Dysfunction. Be open and honest about your symptoms, and don’t hesitate to ask questions or seek second opinions if necessary.

How Do I Know If I Have TMD?

If you’re experiencing persistent pain or tenderness in your jaw, or if you have difficulty opening or closing your mouth, it’s important to consult a healthcare provider. These are common symptoms of TMD, and a dentist, oral surgeon, or even a primary care doctor can conduct an evaluation to determine if you have this condition.

How Can I Get Relief From TMD?

Many self-care practices can help alleviate TMD symptoms. Over-the-counter pain relievers, moist heat or cold packs applied to the jaw, and relaxation techniques can provide temporary relief. Avoiding extreme jaw movements, such as wide yawning, loud singing, and chewing gum, can also be beneficial.

How Long Does TMJ Dysfunction Last?

The duration of Temporomandibular Joint (TMJ) Dysfunction can vary widely among individuals. For some, symptoms may be temporary and last only for a few weeks to months; for others, TMD can be a chronic condition that persists for many years. The duration often depends on the underlying cause, the severity of the condition, and the effectiveness of the treatment and management strategies implemented.

Can TMJ Disorder Be Cured?

Whether TMJ Disorder can be cured depends on the underlying cause. Some cases, especially those caused by temporary factors such as stress or muscle strain, may resolve completely with conservative treatments. However, in cases where there is a structural issue with the joint, or if it is associated with a chronic condition like arthritis, TMD may not be completely curable and instead may require ongoing management to control symptoms.

When Should I See My Healthcare Provider?

You should consider seeing a healthcare provider for TMJ Dysfunction if you experience:

Persistent pain in the jaw, face, or around the ear
Difficulty or discomfort while chewing
Locking of the jaw joint, making it difficult to open or close your mouth
Persistent headaches or earaches
A clicking or popping sound in the jaw joint during movement that is associated with pain
Symptoms that interfere with your daily activities or quality of life

What Questions Should I Ask My Healthcare Provider?

When consulting your healthcare provider about TMJ Dysfunction, consider asking the following questions:

What is the likely cause of my symptoms?

Are there any tests or imaging studies that I need to undergo for a proper diagnosis?

What treatment options are available for my condition?

Are there any lifestyle changes I can make to alleviate the symptoms?

What can I do to manage pain or discomfort at home?

Will I need to see a specialist for my condition?

Are there any long-term complications associated with TMJ Dysfunction that I should be aware of?

Is there a possibility that my symptoms will resolve on their own with time?

What should I do if my symptoms worsen?

How can I monitor the progress or changes in my condition?

Bottom Line

Temporomandibular Joint Dysfunction is a condition that can vary significantly in terms of cause, severity, and duration. While some cases may be temporary and manageable with conservative treatments, others may be chronic and require a more comprehensive approach for management. It’s essential to communicate openly with your healthcare provider, understand the available treatment options, and actively participate in managing your condition. Regular monitoring and adjustments to treatment, along with lifestyle changes, can often significantly improve the quality of life for individuals with TMJ Dysfunction.

This article is complete and was published on May 24, 2023, and last updated on August 25, 2023.

Key facts