TMJ Disorders

Temporomandibular Joint Disorders (TMD or TMJD), commonly referred to as TMJ after the temporomandibular joint itself, encompass a variety of conditions that affect the joint connecting the lower jaw (mandible) to the skull. The temporomandibular joint facilitates movements necessary for chewing, speaking, and yawning. Disorders of this joint can lead to pain and dysfunction in the jaw joint and muscles that control jaw movement. More than 10 million Americans live with jaw pain and dysfunction. TMJ disorders are more common in women between the ages of 35 and 44. These disorders affect general health, psychological status, and well-being.

There are three main classes of TMDs:

  1. Disorders of the joint
  2. Disorders of the muscles of mastication (Chewing)
  3. Headaches associated with TMDs

What causes TMJ?

The exact cause of TMJ disorder is often difficult to determine. For most people, there is no obvious cause. Research suggests that a combination of factors, such as genetics, arthritis, and psychological and life stressors, may play a role in why TMJ starts and whether it will be long-lasting. Research does not support the belief that a bad bite or orthodontics can cause TMJ. Some people who have jaw pain also tend to clench or grind their teeth (bruxism), although many people habitually clench or grind their teeth and never develop TMJ disorders.

Potential causes and contributing factors include:

  • Physical injury to the jaw, temporomandibular joint, or head and neck muscles, such as from a heavy blow or whiplash.
  • Pressure on the TMJ from grinding or clenching the teeth puts excessive pressure on the joint.
  • Movement of the soft cushion or disc between the ball and socket of the joint.
  • Arthritis in the TMJ can result from wear and tear or inflammatory disorders.
  • Stress can lead to tightening facial and jaw muscles or teeth clenching. 

Note that other conditions that can coexist with TMJ include chronic fatigue syndrome, sleep disturbances, and fibromyalgia.

What are the symptoms of TMJ disorders?

Symptoms of TMJ disorders may include:

  • Pain in the chewing muscles and/or jaw joint. This is the most common symptom.
  • Pain that spreads to the face or neck.
  • Jaw stiffness.
  • Limited jaw movements or locking of the jaw makes it difficult to open or close the mouth.
  • Ringing in the ears, hearing loss, or dizziness.
  • Speech and voice difficulties.
  • Painful clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth may or may not be accompanied by pain.
  • A change in the way the upper and lower teeth fit together.

How is TMJ diagnosed?

Your Ortho Illinois doctor will review your medical history and inquire about the onset of your symptoms, including the locations, when the pain occurs, what makes it better or worse, and whether the pain remains in one area or spreads to other parts of the body. They will inquire about other conditions such as back pain and headaches, whether there are any known jaw or face injuries, prior treatments, and other health conditions that could contribute to your symptoms.

They will perform a thorough physical examination of the jaw joint, head, face, and neck, checking for pain, tenderness, swelling, and any abnormalities. They will also check the jaw’s range of motion and listen for clicks, pops, and grating sounds associated with jaw movements.

The mouth, jaw, or face pain may not be due to TMJ. They will rule out other conditions.

Your doctor may review dental X-rays and order imaging studies such as X-rays, an MRI, or a CT scan. Cone beam CT scans offer detailed 3D images of the bones and are especially useful for diagnosing TMJ disorders.

How are TMJ disorders treated?

Non-Pharmacological Therapies

Several therapeutic options do not involve medication:

  • Physical Therapy involves exercises to stretch and strengthen jaw muscles, increase mobility, and reduce pain. Physical therapists may also use ultrasound, moist heat, and ice treatments.
  • Oral Splints or Mouth Guards: A physician or a dentist can recommend these devices, worn over the teeth, to help reduce clenching or grinding and correct bite issues. Splints are the most widely used treatment for TMJ disorders.
  • Dietary changes to rest the joint include avoiding hard foods and chewing gum.
  • Sitting with your chin in your hand should be corrected.
  • Hot and cold compresses.
  • Stress reduction with meditation and yoga.
  • Jaw exercises, including stretching, strengthening, and relaxation, can help improve joint mobility.
  • Cognitive Behavior Therapy

Medications

Medications that can be used to manage symptoms include:

  • Over-the-counter and prescription pain relievers and Anti-inflammatory medications can relieve muscle pain.
  • Muscle relaxers can be used for short periods to relieve pain from muscle spasms.
  • Tricyclic antidepressants in low doses can help relieve pain and control bruxism (teeth grinding) and sleeplessness due to TMJ.
  • Steroid injections into the TMJ can reduce inflammation and pain in more severe cases.
  • Botox injected into the masseter (chewing muscles) can help alleviate symptoms and reduce teeth grinding.
  • Acupuncture is beneficial to treat pain.
  • Low-level laser therapy (LLLT) is an efficient, non-invasive therapeutic modality for TMJ disorders to treat pain.

Surgical Procedures

There are no long-term studies of surgery for TMJ disorders. However, there are some treatments for persistent symptoms. Surgery is considered to be the last resort.

  • Arthrocentesis: A minimally invasive procedure that involves inserting needles into the joint to irrigate fluid through the joint to remove debris and inflammatory byproducts.
  • TMJ Arthroscopy: A surgical procedure involves a small thin tube (cannula) and camera (arthroscope) to diagnose or treat some TMJ conditions.

A multi-disciplinary approach involving dentists, oral surgeons, physiotherapists, chiropractors, and sometimes psychologists is often the most effective way to manage TMJ disorders. Regular follow-up is essential to adjust treatment plans as needed.

At Ortho Illinois, we specialize in finding solutions for our patients with chronic pain to improve their quality of life and function. Ortho Illinois is the leading bone and joint provider in Northern Illinois. We have offices in five convenient clinic locations. Call us to find a location near you and begin your journey to top-quality, one-stop, multi-specialty orthopedic care.

References

  • https://www.nidcr.nih.gov/sites/default/files/2017-12/tmj-disorders.pdf
  • https://www.nidcr.nih.gov/health-info/tmd
  • https://medlineplus.gov/temporomandibularjointdysfunction.html
  • Ahmad SA, Hasan S, Saeed S, Khan A, Khan M. Low-level laser therapy in temporomandibular joint disorders: a systematic review. J Med Life. 2021 Mar-Apr;14(2):148-164. doi: 10.25122/jml-2020-0169. PMID: 34104237; PMCID: PMC8169142.
  • Dietrich L, Rodrigues IVS, Assis Costa MDM, Carvalho RF, Silva GRD. Acupuncture in Temporomandibular Disorders Painful Symptomatology: An Evidence-Based Case Report. Eur J Dent. 2020 Oct;14(4):692-696. Doi: 10.1055/s-0040-1716631. Epub 2020 Oct 1. PMID: 33003235; PMCID: PMC7536091.