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TMJ disorders

Also known as temporomandibular joint syndrome, often referred-to as ‘TMJ’, ‘TMJD’ or ‘TMD’

Key points about temporomandibular joint disorders

The temporomandibular joint (TMJ) is one of the most complex and most used joints in the body. Disorders of this joint are complex and can be hard to identify and treat.
TMJ disorders are most common in women of childbearing age.
The TMJ can be found just in front of the ears, where the jaw bone (mandible) meets the temporal bone of the skull.
The joint moves in two ways – a hinge motion and a sliding motion.
This allows for wide opening of the mouth, and for the variety of motions the jaw needs to make in talking, singing, shouting, coughing, chewing and yawning.

The symptoms of TMJ include:

pain in the facial or jaw muscles
localised pain when chewing, talking or yawning
swelling around the affected joint
earache, tinnitus or hearing loss
grating, clicking or popping sounds when the joints move
a strange or uneven bite – feeling like the teeth don’t fit together well
the jaw moves to one side in the process of opening
the jaw locks open or closed
headaches
neck or back pain
trouble swallowing.

Image credit: Jmarchn Wikimedia Commons

Diagnosis of TMJ disorders is not always straightforward. The problems can affect the bones, connective tissue, ligaments, muscles or teeth. Many of the symptoms can also be caused by other health issues.

Diagnosis requires a detailed medical history and physical examination. People with a TMJ disorder may find themselves consulting with many different experts, such as a dentist, their doctor, an oral surgeon or an ear nose and throat specialist, before arriving at a diagnosis and treatment.

It is not always possible to identify what has caused a TMJ problem. However some things that can lead to symptoms include:

external trauma such as a blow to the head or jaw
tooth grinding (bruxism) or jaw clenching
dental problems causing poor alignment between top and bottom teeth
excessive chewing (e.g. gum or fingernails)
excessive thrusting forward of bottom jaw
eating large food items that overextend the TMJ
joint malformations (e.g. caused by degenerative disease or by birth defect)
lack of overbite.

Several symptoms of TMJ disorders can be alleviated with some simple measures at home. In many cases TMJ disorders get better with self-care:

Rest the jaw as much as possible.
Eat soft foods.
Reduce gum-chewing.
Avoid extreme jaw movements (e.g. yawning, shouting, singing).
Use stress management techniques to help you remember to relax your jaw muscles.
Apply warm and cold compresses.
Use anti-inflammatory pain medicines such as ibuprofen or aspirin (children under 16 years of age should not take aspirin-containing medication because of a rare but dangerous complication called Reye’s syndrome).
Do any jaw exercises that your health practitioner may give you.

Reversible treatments

Some of the treatments for TMJ disorders are reversible and it is advisable that you try these first, before considering more expensive and permanent ones.

Muscle and ligament tightness can be helped with jaw stretching and relaxing exercises as advised by your doctor.
If the disorder is caused by jaw clenching or tooth grinding, a stabilisation splint or bite plate may be fitted to reduce the impact of the habit on your teeth and jaws. This is a temporary measure only, as permanent use can change the tooth alignment. If the splint causes pain when worn, stop using it and contact the health professional who fitted it.
Irrigation of the joint under local anaesthetic may clean out any debris and relieve pain. Irrigation involves injecting saline into the joint with one needle and removing it with a second needle.
A cortisone (steroid) injection into the joint can reduce inflammation and relieve pain.
If the jaw becomes locked, it may be necessary to manipulate the joint back into place under a general anaesthetic.

Permanent treatments

There is debate around the use of some permanent treatment methods, as they have not been shown to address the problem effectively and, once they are done, they cannot be easily undone. They are extensive and often expensive options that would require discussion with your dentist or specialist:

Teeth may be polished or ground to make adjustments to the bite.
Orthodontics (.g. plates, braces) may be fitted to adjust the bite.
A repositioning splint may be fitted. In contrast to the stabilisation splint, this kind of splint is designed to move the jaw, ligaments and muscles into a new position. Over time this repositioning becomes permanent, and there may be an effect on the tooth alignment. This may mean that dental work is then required to accommodate the modified bite.
Reconstructive dentistry may be used to change the way teeth bite together and therefore adjust the way the joint moves.
Jaw joint replacement surgery should be considered a last resort and all other options explored beforehand. It involves replacing the joints with artificial implants.

To prevent bouts of pain associated with TMJ disorders, be aware of anything that brings on symptoms.

Reduce gum-chewing or nail biting.
Avoid hard or chewy foods.
Learn to relax your jaw.
Do gentle jaw stretching and relaxing exercises.
When you yawn, support your lower jaw.
See your dentist if you suspect tooth clenching or grinding is a problem at night; he or she can fit you with a splint for occasional use.