- TMJ Treatment, Symptoms, Pain Relief, Surgery, Causes, Remedies
- Facts you should know about temporomandibular joint (TMJ) syndrome
- What is temporomandibular joint (TMJ) syndrome?
- What are the risk factors for TMJ syndrome?
- What causes TMJ syndrome?
- What are TMJ syndrome symptoms and signs?
- How do health care professionals diagnose TMJ syndrome?
- What is the treatment for TMJ syndrome? Are there any home remedies that provide TMJ pain relief?
- What types of doctors treat TMJ?
- What is the prognosis for TMJ syndrome?
- Is it possible to prevent TMJ syndrome?
- Temporomandibular Disorder (TMD)
- What is temporomandibular disorder (TMD)?
- What causes TMD?
- What are the signs and symptoms of TMD?
- What are the treatments for TMD?
- Temporomandibular Joint Disorders
- Temporomandibular Disorders (TMJ & TMD)
- Diagnosis and Treatment of Temporomandibular Disorders
- TMJ (Temporomandibular Joint) Disorders
TMJ Treatment, Symptoms, Pain Relief, Surgery, Causes, Remedies
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Facts you should know about temporomandibular joint (TMJ) syndrome
- The temporomandibular joint is the joint that connects your jaw to your skull. When this joint is injured or damaged, it can lead to a localized pain disorder called temporomandibular joint (TMJ) syndrome or temporomandibular disorder (TMD).
- Causes of TMJ disorders include injury to the teeth or jaw, misalignment of the teeth or jaw, teeth grinding or clenching, poor posture, stress, arthritis, and gum chewing.
- Signs and symptoms of temporomandibular joint (TMJ) syndrome include
- jaw pain,
- jaw clicking and popping,
- ear pain/earache,
- popping sounds in ears,
- stiff or sore jaw muscles,
- pain in the temple area, or
- locking of the jaw joint.
- TMJ disorders often responds to home remedies, including ice packs to the joint, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), avoiding chewing gum, massage or gentle stretches of the jaw and neck, and stress reduction.
- When home treatment does not work, medical treatment for temporomandibular joint (TMJ) syndrome includes dental splints, Botox injections, physical therapy, prescription medications, and in severe cases, surgery.
- The prognosis for TMD is generally good as people usually can manage the disorder with self-care and home remedies.
The temporomandibular joints are complex structures containing muscles, tendons, and bones. Injury to or disorders of these structures can all result in pain in the jaw area. Jaw pain may occur on one side or on both sides, depending upon the cause. Also depending upon the exact cause, the pain may occur when chewing or may occur at rest. Additionally, other medical conditions not related to the TMJ may cause perceived pain in the jaw area.
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What is temporomandibular joint (TMJ) syndrome?
Temporomandibular joint (TMJ) syndrome is a disorder of the jaw muscles and nerves caused by injury or inflammation to the temporomandibular joint. The temporomandibular joint is the connection between the jawbone and the skull.
The injured or inflamed temporomandibular joint leads to pain with chewing, clicking, crackling, and popping of the jaw; swelling on the sides of the face; nerve inflammation; headaches, including migraines; tooth grinding (bruxism); Eustachian tube dysfunction; and sometimes dislocation of the temporomandibular joint.
Temporomandibular joint syndrome is also known as temporomandibular joint disorder.
What are the risk factors for TMJ syndrome?
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There are several risk factors for TMD:
- Poor posture in the neck and upper back muscles may lead to neck strain and abnormalities of jaw muscle function.
- Stress may increase muscle tension and jaw clenching.
- Women 18-44 years of age have increased risk.
- Patients with other chronic inflammatory arthritis have increased risk.
- People with jaw trauma or poorly positioned teeth have increased risk.
- People who have a genetic predisposition to pain sensitivity and increased stress responses may be more susceptible.
What causes TMJ syndrome?
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Medical professionals do no completely understand the causes of TMD. Multiple factors contribute to the muscle tightness and dysfunction that characterize this condition. It is not clear whether some of these causes directly lead to TMJ syndrome or if they are a result of the disorder. Causes may include
- misalignment (malocclusion) of or trauma to the teeth or jaw,
- teeth grinding (bruxism),
- poor posture,
- stress or anxiety,
- arthritis and other inflammatory musculoskeletal disorders,
- orthodontic braces, and
- excessive gum chewing.
What are TMJ syndrome symptoms and signs?
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The main TMD symptom is pain in the jaw joint. This joint is located just in front of the ear, and pain associated with TMD may involve the face, eye, forehead, ear, or neck. Signs and symptoms of temporomandibular joint dysfunction include the following:
- Pain or tenderness in the jaw, especially at the area of the joint
- Popping/clicking of the jaw (crepitus)
- Pain that feels a toothache
- Ear pain (earache) or sounds of cracking in the ears
- Ringing or popping sounds in the ears (tinnitus) or a sense of fullness in the ears
- Headaches, including migraines
- Blurred vision
- Tight, stiff, or sore jaw or neck muscles
- Muscle spasms in the jaw
- Facial pain, mouth pain, jaw pain, cheek pain, or chin numbness or tingling
- Pain at the base of the tongue
- Pain, swelling, or a lump in the temple area
- Difficulty chewing
- Shoulder pain
- Locking or dislocation of the jaw (usually after widely yawning), referred to as lockjaw
- Dizziness or vertigo
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How do health care professionals diagnose TMJ syndrome?
A doctor will diagnose TMD by taking the patient's medical history and doing a physical exam to find the cause of the symptoms. There is no specific test to diagnose TMD.
A doctor may send the patient to an oral and maxillofacial specialist, an otolaryngologist (also called an ear, nose, and throat doctor or ENT specialist), or a dentist specializing in jaw disorders to confirm the diagnosis.
Sometimes a health care professional may order an MRI of the temporomandibular joint to detect damage to the cartilage of the jaw joint and to rule out other medical problems.
A condition that may have some similar symptoms to TMD is trigeminal neuralgia. The trigeminal nerve supplies nerve impulses to the temporomandibular joint, and when irritated, it can cause facial pain. Other causes of face or neck pain include swollen lymph nodes (swollen glands), giant cell arteritis, salivary gland disease, sore throat, ill-fitting dentures, or dental braces.
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What is the treatment for TMJ syndrome? Are there any home remedies that provide TMJ pain relief?
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Many symptoms of TMJ disorders can respond well to home remedies or stress reduction and relaxation techniques. The following home remedies may provide some relief:
- Ice or cold packs to the area of the joint
- Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve), and other pain relievers, including aspirin (Ecotrin) and acetaminophen (Tylenol)
- Eating soft foods and avoiding chewing gum
- Massage or gentle self-stretching of the jaw and neck muscles (A doctor or physical therapist can recommend appropriate stretches.)
- Relaxation techniques and stress management and reduction
- Some sedative essential oils (such as lavender, chamomile, sweet marjoram, and clary sage) may provide temporary relief from the pain and discomfort of TMJ.
When home remedies are not effective, medical treatment options may be necessary. Most of these types of treatments and remedies will not cure TMD, but they can provide temporary and even long-term relief from the pain symptoms. These include the following:
- Dental splint (occlusal splint or stabilization splint or bite guard), which is a dental appliance placed in the mouth that keeps the teeth in alignment and prevents tooth grinding. This resembles a mouth guard and is usually prescribed and fitted by a jaw specialist.
- A medical professional may use Botox to relax the muscles of the jaw. However, this is not currently an FDA-approved treatment for TMD.
- Physical therapy with jaw exercises can strengthen muscles, improve flexibility, and range of motion.
- In states where medical marijuana is legal, a physician may prescribe it to help with severe TMJ pain.
- Biobehavioral management (biofeedback, cognitive behavioral therapy [CBT]) may help diminish pain intensity.
- Trigger point acupuncture can sometimes be helpful.
- In severe cases, surgery on the jaw or dental surgery may be necessary.
- TMJ arthroscopy or arthrocentesis is a minimally invasive procedure usually done in an outpatient setting. Recovery time for this procedure is about a week.
- Sometimes a total joint replacement may be necessary. This generally requires a stay in the hospital for several days, and surgery recovery time is four to six weeks.
- The following prescription-strength medicines may be used to treat TMJ:
- Muscle relaxants: metaxalone (Skelaxin), cyclobenzaprine (Flexeril)
- Anti-inflammatory drugs: nabumetone (Relafen), meloxicam (Mobic), celecoxib (Celebrex)
- Steroid injections: beclomethasone (Qvar)
- Tricyclic antidepressants: nortriptyline (Pamelor), amitriptyline (Elavil, Endep), and desipramine (Norpramin), imipramine (Norfranil, Tipramine, Tofranil)
- Benzodiazapines: diazepam (Valium), clonazepam (Klonopin), alprazolam (Xanax)
- Sleep medications: doxepin (Silenor)
- Nerve pain medications: gabapentin (Neurontin), topiramate (Topamax), levetiracetam (Keppra), pregabalin (Lyrica)
- Opiate pain medications hydrocodone and acetaminophen (Vicodin, Lortab), oxycodone and acetaminophen (Percocet)
What types of doctors treat TMJ?
A primary care provider (PCP), such as a family practitioner, internist, or a child's pediatrician, may first diagnose your TMJ.
Your doctor may refer you to an oral and maxillofacial specialist, an otolaryngologist (also called an ear, nose, and throat doctor or ENT specialist), or a dentist specializing in jaw disorders (prosthodontist, also called a prosthetic dentist) for further treatment. You may also see a pain-management specialist if your TMJ pain is severe.
What is the prognosis for TMJ syndrome?
The prognosis for TMJ syndrome is generally good. There are numerous causes for TMJ syndrome, so the outlook depends on the cause, if known. Most people can manage the discomfort with self-care and home remedies.
Complications of long-term TMJ syndrome include chronic face pain or chronic headaches. In severe situations, where pain is chronic, or associated with other inflammatory disorders, long-term treatment may be necessary.
Is it possible to prevent TMJ syndrome?
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Symptoms of TMJ syndrome tend to be episodic and related to stress and lifestyle.
Prevention of TMJ syndrome symptoms can often be achieved using self-care at home, such as
- eating soft foods;
- avoiding chewing gum;
- maintaining proper posture;
- practicing stress reduction and relaxation techniques;
- using dental splint appliances as recommended by a jaw care professional;
- using proper safety equipment to prevent jaw fractures and dislocations while exercising, working, or participating in sports.
Temporomandibular Joint Syndrome (TMJ) See pictures of dental procedures and oral health conditions See Images
Medically Reviewed on 3/27/2020
American College of Prosthodontists. “Temporomandibular Joint Disorder & Facial/Jaw Pain.” . Scrivani, J., and Noshir R. Mehta. “Temporomandibular Disorders in Adults.” UpToDate.com. Feb. 2020. . “Study Evaluates Risk Factors for Chronic Temporomandibular Joint and Muscle Disorders.” National Institute of Dental and Craniofacial Research. 10 Nov. 2011. “TMJ.” Amerian Academy of Otolaryngology – Head and Neck Surgery. Dec. 2010. The TMJ Association. “Arthroscopy.” June 18, 2014. . “TMJ Disorders.” National Institute of Dental and Craniofacial Research. Aug. 2013. TMJ Hope. “TMJD Pain Management.” .
Temporomandibular Disorder (TMD)
The temporomandibular joints (TMJ) are the 2 joints that connect your lower jaw to your skull. More specifically, they are the joints that slide and rotate in front of each ear, and consist of the mandible (the lower jaw) and the temporal bone (the side and base of the skull). The TMJs are among the most complex joints in the body.
These joints, along with several muscles, allow the mandible to move up and down, side to side, and forward and back. When the mandible and the joints are properly aligned, smooth muscle actions, such as chewing, talking, yawning, and swallowing, can take place.
When these structures (muscles, ligaments, disk, jaw bone, temporal bone) are not aligned, nor synchronized in movement, several problems may occur.
What is temporomandibular disorder (TMD)?
Temporomandibular disorders (TMD) are disorders of the jaw muscles, temporomandibular joints, and the nerves associated with chronic facial pain. Any problem that prevents the complex system of muscles, bones, and joints from working together in harmony may result in temporomandibular disorder.
The National Institute of Dental and Craniofacial Research classifies TMD by the following:
- Myofascial pain. This is the most common form of TMD. It results in discomfort or pain in the fascia (connective tissue covering the muscles) and muscles that control jaw, neck and shoulder function.
- Internal derangement of the joint. This means a dislocated jaw or displaced disk, (cushion of cartilage between the head of the jaw bone and the skull), or injury to the condyle (the rounded end of the jaw bone that articulates with the temporal skull bone).
- Degenerative joint disease. This includes osteoarthritis or rheumatoid arthritis in the jaw joint.
You can have one or more of these conditions at the same time.
What causes TMD?
In many cases, the actual cause of this disorder may not be clear. Sometimes the main cause is excessive strain on the jaw joints and the muscle group that controls chewing, swallowing, and speech. This strain may be a result of bruxism.
This is the habitual, involuntary clenching or grinding of the teeth. But trauma to the jaw, the head, or the neck may cause TMD. Arthritis and displacement of the jaw joint disks can also cause TMD pain.
In other cases, another painful medical condition such as fibromyalgia or irritable bowel syndrome may overlap with or worsen the pain of TMD.
A recent study by the National Institute of Dental and Craniofacial Research identified clinical, psychological, sensory, genetic, and nervous system factors that may put a person at higher risk of developing chronic TMD.
What are the signs and symptoms of TMD?
The following are the most common signs and symptoms of TMD:
- Jaw discomfort or soreness (often most prevalent in the morning or late afternoon)
- Pain spreading behind the eyes, in the face, shoulder, neck, and/or back
- Earaches or ringing in the ears (not caused by an infection of the inner ear canal)
- Clicking or popping of the jaw
- Locking of the jaw
- Limited mouth motions
- Clenching or grinding of the teeth
- Sensitivity of the teeth without the presence of an oral health disease
- Numbness or tingling sensation in the fingers
- A change in the way the upper and lower teeth fit together
The symptoms of TMD may look other conditions or medical problems. See a dentist or your doctor for a diagnosis.
What are the treatments for TMD?
Your healthcare provider will figure out the best treatment :
- How old you are
- Your overall health and medical history
- How well you can handle specific medicines, procedures, or therapies
- How long the condition is expected to last
- Your opinion or preference
Treatment may include:
- Resting the temporomandibular joint (TMJ)
- Medicine or pain relievers
- Relaxation techniques and stress management
- Behavior changes (to reduce or stop teeth clenching)
- Physical therapy
- An orthopedic appliance or mouthguard worn in the mouth (to reduce teeth grinding)
- Posture training
- Diet changes (to rest the jaw muscles)
- Ice and hot packs
Temporomandibular Joint Disorders
1. Dworkin SF, Huggins KH, LeResche L, Von Korff M, Howard J, Truelove E, et al. Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls. J Am Dent Assoc. 1990;120:273–81….
2. Koh H, Robinson PG. Occlusal adjustment for treating and preventing temporomandibular joint disorders. J Oral Rehabil. 2004;31:287–92.
3. Rutkiewicz T, Kononen M, Suominen-Taipale L, Nord-blad A, Alanen P. Occurrence of clinical signs of temporomandibular disorders in adult Finns. J Orofac Pain. 2006;20:208–17.
4. Hentschel K, Capobianco DJ, Dodick DW. Facial pain. Neurologist. 2005;11:244–9.
5. Pertes RA, Gross SG. Functional anatomy and biomechanics of the temporomandibular joint. In: Pertes RA, Gross SG. Clinical Management of Temporomandibular Disorders and Orofacial Pain. Chicago, Ill.: Quintessence Pub, 1995:1–12.
6. McNamara JA Jr, Seligman DA, Okeson JP. Occlusion, orthodontic treatment, and temporomandibular disorders: a review. J Orofac Pain. 1995;9:73–90.
7. Al-Ani MZ, Davies SJ, Gray RJ, Sloan P, Glenny AM. Stabilisation splint therapy for temporomandibular pain dysfunction syndrome. Cochrane Database Syst Rev. 2004;(1):CD002778.
8. Okeson JP, for the American Academy of Orofacial Pain. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. Chicago, Ill.: Quintessence Pub, 1996.
9. Friction JR, Gross SG. Muscle disorders. In: Pertes RA, Gross SG. Clinical Management of Temporomandibular Disorders and Orofacial Pain. Chicago, Ill.: Quintessence Pub, 1995:91–108.
10. Pertes RA, Gross SG. Disorders of the temporomandibular joint. In: Pertes RA, Gross SG. Clinical Management of Temporomandibular Disorders and Orofacial Pain. Chicago, Ill.: Quintessence Pub, 1995:69–89.
11. Pertes RA, Bailey DR. General concepts of diagnosis and treatment. In: Pertes RA, Gross SG. Clinical Management of Temporomandibular Disorders and Orofacial Pain. Chicago, Ill.: Quintessence Pub, 1995:59–68.
12. Wright EF, Clark EG, Paunovich ED, Hart RG. Headache improvement through TMD stabilization appliance and self-management therapies. Cranio. 2006;24:104–11.
13. International Consortium for RDC/TMD-Based Research. Accessed May 4, 2007, at http://www.rdc-tmdinternational.org.
14. John MT, Dworkin SF, Mancl LA. Reliability of clinical temporomandibular disorder diagnoses. Pain. 2005;118:61–9.
15. DuPont JS Jr. Simplified anesthesia blocking of the temporomandibular joint. Gen Dent. 2004;52:318–20.
16. American Society of Temporomandibular Joint Surgeons. Guidelines for diagnosis and management of disorders involving the temporomandibular joint and related musculoskeletal structures. Cranio. 2003;21:68–76.
17. Mannheimer JS. Overview of physical therapy modalities and procedures. In: Pertes RA, Gross SG. Clinical Management of Temporomandibular Disorders and Orofacial Pain. Chicago, Ill.: Quintessence Pub, 1995:227–44.
18. Gerber PE, Lynd LD. Selective serotonin-reuptake inhibitor-induced movement disorders. Ann Pharmacother. 1998;32:692–8.
19. Shi Z, Guo C, Awad M. Hyaluronate for temporomandibular joint disorders. Cochrane Database Syst Rev. 2003;(1):CD002970.
20. Shankland WE II. Temporomandibular disorders: standard treatment options. Gen Dent. 2004;52:349–55.
21. Conti PC, dos Santos CN, Kogawa EM, de Castro Ferreira Conti AC, de Araujo Cdos R. The treatment of painful temporomandibular joint clicking with oral splints: a randomized clinical trial. J Am Dent Assoc. 2006;137:1108–14.
22. Truelove E, Huggins KH, Mancl L, Dworkin SF. The efficacy of traditional, low-cost and nonsplint therapies for temporomandibular disorder: a randomized controlled trial. J Am Dent Assoc. 2006;137:1099–107.
23. Wassell RW, Adams N, Kelly PJ. The treatment of temporomandibular disorders with stabilizing splints in general dental practice: one-year follow-up. J Am Dent Assoc. 2006;137:1089–98.
Temporomandibular Disorders (TMJ & TMD)
Your temporomandibular joint is a hinge that connects your jaw to the temporal bones of your skull, which are in front of each ear. It lets you move your jaw up and down and side to side, so you can talk, chew, and yawn.
Problems with your jaw and the muscles in your face that control it are known as temporomandibular disorders (TMD). But you may hear it wrongly called TMJ, after the joint.
We don’t know what causes TMD. Dentists believe symptoms arise from problems with the muscles of your jaw or with the parts of the joint itself.
Injury to your jaw, the joint, or the muscles of your head and neck — from a heavy blow or whiplash — can lead to TMD. Other causes include:
- Grinding or clenching your teeth, which puts a lot of pressure on the joint
- Movement of the soft cushion or disc between the ball and socket of the joint
- Arthritis in the joint
- Stress, which can cause you to tighten facial and jaw muscles or clench the teeth
TMD often causes severe pain and discomfort. It can be temporary or last many years. It might affect one or both sides of your face. More women than men have it, and it’s most common among people between the ages of 20 and 40.
Common symptoms include:
- Pain or tenderness in your face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide
- Problems when you try to open your mouth wide
- Jaws that get “stuck” or “lock” in the open- or closed-mouth position
- Clicking, popping, or grating sounds in the jaw joint when you open or close your mouth or chew. This may or may not be painful.
- A tired feeling in your face
- Trouble chewing or a sudden uncomfortable bite — as if the upper and lower teeth are not fitting together properly
- Swelling on the side of your face
You may also have toothaches, headaches, neck aches, dizziness, earaches, hearing problems, upper shoulder pain, and ringing in the ears (tinnitus).
Many other conditions cause similar symptoms — tooth decay, sinus problems, arthritis, or gum disease. To figure out what’s causing yours, the dentist will ask about your health history and conduct a physical exam.
He’ll check your jaw joints for pain or tenderness and listen for clicks, pops, or grating sounds when you move them. He’ll also make sure your jaw works it should and doesn’t lock when you open or close your mouth. Plus he’ll test your bite and check for problems with your facial muscles.
Your dentist may take full face X-rays so he can view your jaws, temporomandibular joints, and teeth to rule out other problems. He may need to do other tests, magnetic resonance imaging (MRI) or computer tomography (CT). The MRI can show if the TMJ disc is in the proper position as your jaw moves. A CT scan shows the bony detail of the joint.
You may get referred to an oral surgeon (also called an oral and maxillofacial surgeon) for further care and treatment. This doctor specializes in surgery in and around the entire face, mouth, and jaw area. You may also see an orthodontist to ensure your teeth, muscles, and joints work they should.
There are things you can do on your own to help relieve TMD symptoms. Your doctor may suggest you try some of these remedies together.
Take over-the-counter medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), naproxen or ibuprofen, can relieve muscle pain and swelling.
Use moist heat or cold packs. Apply an ice pack to the side of your face and temple area for about 10 minutes. Do a few simple jaw stretches (if your dentist or physical therapist OKs them). When you’re done, hold a warm towel or washcloth to the side of your face for about 5 minutes. Perform this routine a few times each day.
Eat soft foods. Add yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans, and grains to your menu. Cut foods into small pieces so you chew less. Skip hard, crunchy foods ( pretzels and raw carrots), chewy foods ( caramels and taffy), and thick or large bites that require you to open wide.
Avoid extreme jaw movements. Keep yawning and chewing (especially gum or ice) to a minimum and don’t yell, sing, or do anything that forces you to open wide.
Don't rest your chin on your hand. Don’t hold the phone between your shoulder and ear. Practice good posture to reduce neck and facial pain.
Keep your teeth slightly apart as often as you can. This will relieve pressure on your jaw. Put your tongue between your teeth to control clenching or grinding during the day.
Learn relaxation techniques to help loosen up your jaw. Ask your dentist if you need physical therapy or massage. Consider stress reduction therapy as well as biofeedback.
Talk to your dentist about these tried-and-true treatments for TMD:
Medications. Your dentist can prescribe higher doses of NSAIDs if you need them for pain and swelling. He might suggest a muscle relaxer to relax your jaw if you grind or clench your teeth.
Or an anti-anxiety medication to relieve stress, which may bring on TMD. In low doses they can also help reduce or control pain.
Muscle relaxants, anti-anxiety drugs, and antidepressants are available by prescription only.
A splint or night guard. These plastic mouthpieces fit over your upper and lower teeth so they don’t touch. They lessen the effects of clenching or grinding and correct your bite by putting your teeth in a more correct position. What’s the difference between them? You wear night guards while you sleep. You use a splint all the time. Your dentist will tell you which type you need.
Dental work. Your dentist can replace missing teeth and use crowns, bridges, or braces to balance the biting surfaces of your teeth or to correct a bite problem.
If the treatments listed above don’t help, your dentist may suggest one or more of the following:
Transcutaneous electrical nerve stimulation (TENS). This therapy uses low-level electrical currents to provide pain relief by relaxing your jaw joint and facial muscles. It can be done at the dentist's office or at home.
Ultrasound. Deep heat applied to the joint can relieve soreness or improve mobility.
Trigger-point injections. Pain medication or anesthesia is injected into tender facial muscles called “trigger points” to give relief.
Radio wave therapy. Radio waves stimulate the joint, which increases blood flow and eases pain.
Low-level laser therapy. This lowers pain and inflammation and helps you move your neck more freely and open your mouth wider.
If other treatments can’t help you, surgery is an option. Once it’s done, it can’t be undone, so get a second or even third opinion from other dentists.
There are three types of surgery for TMD. The type you need depends on the problem.
Arthrocentesis is used if you have no major history of TMJ but your jaws are locked. It’s a minor procedure that your dentist can do in his office. He’ll give you general anesthesia, then insert needles into the joint and wash it out. He may use a special tool to get rid of damaged tissue or dislodge a disc stuck in the joint, or to unstick the joint itself.
Arthroscopy is surgery done with an arthroscope. This special tool has a lens and a light on it. It lets your doctor see inside your joint. You’ll get general anesthesia, then the doctor will make a small cut in front of your ear and insert the tool.
It’ll be hooked up to a video screen, so he can examine your joint and the area around it. He may remove inflamed tissue or realign the disc or joint.
This type of surgery, known as minimally invasive, leaves a smaller scar, has fewer complications, and requires a shorter recovery time than a major operation.
Open-joint surgery. Depending on the cause of the TMD, arthroscopy may not be possible. You may need this type of surgery if:
- The bony structures in your jaw joint are wearing down
- You have tumors in or around the joint
- Your joint is scarred or full of bone chips
You’ll get general anesthesia, then the doctor will open up the entire area around the joint so he can get a full view and better access. You’ll need longer to heal after open-joint surgery, and there is a greater chance of scarring and nerve injury.
American Academy of Otolaryngology – Head and Neck Surgery.
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Diagnosis and Treatment of Temporomandibular Disorders
1. Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med. 2008;359(25):2693–2705….
2. Gonçalves DA, Camparis CM, Speciali JG, et al. Temporomandibular disorders are differentially associated with headache diagnoses: a controlled study. Clin J Pain. 2011;27(7):611–615.
3. Lim PF, Smith S, Bhalang K, et al. Development of temporomandibular disorders is associated with greater bodily pain experience. Clin J Pain. 2010;26(2):116–120.
4. Maixner W, Diatchenko L, Dubner R, et al. Orofacial pain prospective evaluation and risk assessment study—the OPPERA study. J Pain. 2011;12(11 suppl):T4–T11.e1–2.
5. Kindler S, Samietz S, Houshmand M, et al. Depressive and anxiety symptoms as risk factors for temporomandibular joint pain: a prospective cohort study in the general population. J Pain. 2012;13(12):1188–1197.
6. Sanders AE, Maixner W, Nackley AG, et al. Excess risk of temporomandibular disorder associated with cigarette smoking in young adults. J Pain. 2012;13(1):21–31.
7. Okeson JP. Joint intracapsular disorders: diagnostic and nonsurgical management considerations. Dent Clin North Am. 2007;51(1):85–103.
8. Reiter S, Goldsmith C, Emodi-Perlman A, et al. Masticatory muscle disorders diagnostic criteria: the American Academy of Orofacial Pain versus the research diagnostic criteria/temporomandibular disorders. J Oral Rehabil. 2012;39(12):941–947.
9. Stohler CS. Muscle-related temporomandibular disorders. J Orofac Pain. 1999;13(4):273–284.
10. De Leeuw R, Klasser GD; American Academy of Orofacial Pain. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. 5th ed. Chicago, Ill.: Quintessence Publ.; 2013.
11. Okeson JP, de Leeuw R. Differential diagnosis of temporomandibular disorders and other orofacial pain disorders. Dent Clin North Am. 2011;55(1):105–120.
12. Zakrzewska JM. Differential diagnosis of facial pain and guidelines for management. Br J Anaesth. 2013;111(1):95–104.
13. Cooper BC, Kleinberg I. Examination of a large patient population for the presence of symptoms and signs of temporomandibular disorders. Cranio. 2007;25(2):114–126.
14. Scrivani SJ, Mehta NR. Temporomandibular disorders in adults. UpToDate http://www.uptodate.com/contents/temporomandibular-disorders-in-adults?source=search_result&search=temporomandibular&selectedTitle=1%7E74 (subscription required). Accessed July 20, 2014.
15. Emshoff R, Innerhofer K, Rudisch A, et al. Clinical versus magnetic resonance imaging findings with internal derangement of the temporomandibular joint: an evaluation of anterior disc displacement without reduction. J Oral Maxillofac Surg. 2002;60(1):36–41.
16. Hunter A, Kalathingal S. Diagnostic imaging for temporomandibular disorders and orofacial pain. Dent Clin North Am. 2013;57(3):405–418.
17. Rawlani S, Rawlani S, Motwani M, et al. Imaging modality for temporomandibular joint disorder—a review. J Datta Meghe Inst Med Sci University. 2010;5(2):126–133.
18. Lewis EL, Dolwick MF, Abramowicz S, et al. Contemporary imaging of the temporomandibular joint. Dent Clin North Am. 2008;52(4):875–890.
19. Bertram S, Rudisch A, Innerhofer K, et al. Diagnosing TMJ internal derangement and osteoarthritis with magnetic resonance imaging. J Am Dent Assoc. 2001;132(6):753–761.
20. Maizlin ZV, Nutiu N, Dent PB, et al. Displacement of the temporomandibular joint disk: correlation between clinical findings and MRI characteristics. J Can Dent Assoc. 2010;76:a3.
21. Lamot U, Strojan P, Šurlan Popovič K. Magnetic resonance imaging of temporomandibular joint dysfunction-correlation with clinical symptoms, age, and gender. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(2):258–263.
22. Kircos LT, Ortendahl DA, Mark AS, et al. Magnetic resonance imaging of the TMJ disc in asymptomatic volunteers. J Oral Maxillofac Surg. 1987;45(10):852–854.
23. Bas B, Yilmaz N, Gökce E, et al. Diagnostic value of ultrasonography in temporomandibular disorders. J Oral Maxillofac Surg. 2011;69(5):1304–1310.
24. Nascimento MM, Vasconcelos BC, Porto GG, et al. Physical therapy and anesthetic blockage for treating temporomandibular disorders: a clinical trial. Med Oral Patol Oral Cir Bucal. 2013;18(1):e81–e85.
25. Garefis P, Grigoriadou E, Zarifi A, et al. Effectiveness of conservative treatment for craniomandibular disorders: a 2-year longitudinal study. J Orofac Pain. 1994;8(3):309–314.
26. Indresano A, Alpha C. Nonsurgical management of temporomandibular joint disorders. In: Fonseca RJ, Marciani RD, Turvey TA, eds. Oral and Maxillofacial Surgery. 2nd ed. St. Louis, Mo.: Saunders/ Elsevier; 2009:881–897.
27. Hoffmann RG, Kotchen JM, Kotchen TA, et al. Temporomandibular disorders and associated clinical comorbidities. Clin J Pain. 2011;27(3):268–274.
28. Management of temporomandibular disorders. National Institutes of Health Technology Assessment Conference Statement. J Am Dent Assoc. 1996;127(11):1595–1606.
29. Dimitroulis G. Temporomandibular disorders: a clinical update. BMJ. 1998;317(7152):190–194.
30. Miloro M, Peterson LJ. Peterson's Principles of Oral and Maxillofacial Surgery. 3rd ed. Shelton, Conn.: People's Medical Pub House; 2012.
31. McNeely ML, Armijo Olivo S, Magee DJ. A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. Phys Ther. 2006;86(5):710–725.
32. Melis M, Di Giosia M, Zawawi KH. Low level laser therapy for the treatment of temporomandibular disorders: a systematic review of the literature. Cranio. 2012;30(4):304–312.
33. Rosted P. Practical recommendations for the use of acupuncture in the treatment of temporomandibular disorders the outcome of published controlled studies. Oral Dis. 2001;7(2):109–115.
34. Cho SH, Whang WW. Acupuncture for temporomandibular disorders: a systematic review. J Orofac Pain. 2010;24(2):152–162.
35. La Touche R, Goddard G, De-la-Hoz JL, et al. Acupuncture in the treatment of pain in temporomandibular disorders: a systematic review and meta-analysis of randomized controlled trials. Clin J Pain. 2010;26(6):541–550.
36. Aggarwal VR, Lovell K, Peters S, et al. Psychosocial interventions for the management of chronic orofacial pain. Cochrane Database Syst Rev. 2011;(11):CD008456.
37. Mujakperuo HR, Watson M, Morrison R, et al. Pharmacological interventions for pain in patients with temporomandibular disorders. Cochrane Database Syst Rev. 2010;(10):CD004715.
38. Kimos P, Biggs C, Mah J, et al. Analgesic action of gabapentin on chronic pain in the masticatory muscles: a randomized controlled trial. Pain. 2007;127(1–2):151–160.
39. Martin WJ, Perez RS, Tuinzing DB, et al. Efficacy of antidepressants on orofacial pain: a systematic review. Int J Oral Maxillofac Surg. 2012;41(12):1532–1539.
40. Singer E, Dionne R. A controlled evaluation of ibuprofen and diazepam for chronic orofacial muscle pain. J Orofac Pain. 1997;11(2):139–146.
41. DeNucci DJ, Sobiski C, Dionne RA. Triazolam improves sleep but fails to alter pain in TMD patients. J Orofac Pain. 1998;12(2):116–123.
42. Machado E, Bonotto D, Cunali PA. Intra-articular injections with corticosteroids and sodium hyaluronate for treating temporomandibular joint disorders: a systematic review. Dental Press J Orthod. 2013;18(5):128–133.
43. Samiee A, Sabzerou D, Edalatpajouh F, et al. Temporomandibular joint injection with corticosteroid and local anesthetic for limited mouth opening. J Oral Sci. 2011;53(3):321–325.
44. Hersh EV, Balasubramaniam R, Pinto A. Pharmacologic management of temporomandibular disorders. Oral Maxillofac Surg Clin North Am. 2008;20(2):197–210.
45. Shi Z, Guo C, Awad M. Hyaluronate for temporomandibular joint disorders. Cochrane Database Syst Rev. 2003;(1):CD002970.
46. Herman CR, Schiffman EL, Look JO, et al. The effectiveness of adding pharmacologic treatment with clonazepam or cyclobenzaprine to patient education and self-care for the treatment of jaw pain upon awakening: a randomized clinical trial. J Orofac Pain. 2002;16(1):64–70.
47. Ta LE, Dionne RA. Treatment of painful temporomandibular joints with a cyclooxygenase-2 inhibitor: a randomized placebo-controlled comparison of celecoxib to naproxen. Pain. 2004;111(1–2):13–21.
48. Ekberg EC, Kopp S, Akerman S. Diclofenac sodium as an alternative treatment of temporomandibular joint pain. Acta Odontol Scand. 1996;54(3):154–159.
49. Roldan OV, Maglione H, Carreira R, et al. Piroxicam, diazepam and placebo in the treatment of temporomandibular joint dysfunction. Double blind study [in Spanish]. Rev Asoc Odontol Argent. 1990;78(2):83–85.
50. Rizzatti-Barbosa CM, Nogueira MT, de Andrade ED, et al. Clinical evaluation of amitriptyline for the control of chronic pain caused by temporomandibular joint disorders. Cranio. 2003;21(3):221–225.
51. List T, Axelsson S, Leijon G; Pharmacologic interventions in the treatment of temporomandibular disorders, atypical facial pain, and burning mouth syndrome. A qualitative systematic review. J Orofac Pain. 2003;17(4):301–310.
52. Senye M, Mir CF, Morton S, et al. Topical nonsteroidal anti-inflammatory medications for treatment of temporomandibular joint degenerative pain: a systematic review. J Orofac Pain. 2012;26(1):26–32.
53. Fallah HM, Currimbhoy S. Use of botulinum toxin A for treatment of myofascial pain and dysfunction. J Oral Maxillofac Surg. 2012;70(5):1243–1245.
54. von Lindern JJ, Niederhagen B, Bergé S, et al. Type A botulinum toxin in the treatment of chronic facial pain associated with masticatory hyperactivity. J Oral Maxillofac Surg. 2003;61(7):774–778.
55. Freund B, Schwartz M, Symington JM. The use of botulinum toxin for the treatment of temporomandibular disorders: preliminary findings. J Oral Maxillofac Surg. 1999;57(8):916–920.
56. Castro WH, Gomez RS, Da Silva Oliveira J, et al. Botulinum toxin type A in the management of masseter muscle hypertrophy. J Oral Maxillofac Surg. 2005;63(1):20–24.
57. Soares A, Andriolo RB, Atallah AN, et al. Botulinum toxin for myofascial pain syndrome in adults. Cochrane Database Syst Rev. 2014;(7):CD007533.
58. Klasser GD, Greene CS. Oral appliances in the management of tem–poromandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(2):212–223.
59. Fricton J, Look JO, Wright E, et al. Systematic review and meta-analysis of randomized controlled trials evaluating intraoral orthopedic appliances for temporomandibular disorders. J Orofac Pain. 2010;24(3):237–254.
60. Al-Ani MZ, Davies SJ, Gray RJ, et al. Stabilisation splint therapy for temporomandibular pain dysfunction syndrome. Cochrane Database Syst Rev. 2004;(1):CD002778.
61. Koh H, Robinson PG. Occlusal adjustment for treating and preventing temporomandibular joint disorders. Cochrane Database Syst Rev. 2003;(1):CD003812.
62. American Society of Temporomandibular Joint Surgeons. Guidelines for diagnosis and management of disorders involving the temporomandibular joint and related musculoskeletal structures. Cranio. 2003;21(1):68–76.
63. Guo C, Shi Z, Revington P. Arthrocentesis and lavage for treating temporomandibular joint disorders. Cochrane Database Syst Rev. 2009;(4):CD004973.
64. Rigon M, Pereira LM, Bortoluzzi MC, et al. Arthroscopy for temporomandibular disorders. Cochrane Database Syst Rev. 2011;(5):CD006385.
TMJ (Temporomandibular Joint) Disorders
The temporomandibular joint (TMJ) is the joint that connects your mandible (lower jaw) to your skull. The joint can be found on both sides of your head in front of your ears. It allows your jaw to open and close, enabling you to speak and eat.
This abbreviation has also been used to refer to a group of health problems related to your jaw, but this is becoming more commonly abbreviated as TMD or TMJD to distinguish the temporomandibular joint itself from TMJ disorders. These disorders can cause tenderness at the joint, facial pain, and difficulty moving the joint.
According to the National Institute of Dental and Craniofacial Research, as many as 10 million Americans suffer from TMJD. TMJD is more common among women than men. These disorders are treatable, but there are many different possible causes. This can make diagnosis difficult.
Keep reading to learn more about TMJD. You should discuss any concerns with your doctor.
In many cases, it’s not known what causes a TMJ disorder. Trauma to the jaw or joint may play a role. There are also other health conditions that may contribute to the development of TMJD. These include:
- erosion of the joint
- habitual grinding or clenching of the teeth
- structural jaw problems present at birth
There are some other factors that are often associated with the development of TMJD, but they haven’t been proven to cause TMJD. These include:
- the use of orthodontic braces
- poor posture that strains the muscles of the neck and face
- prolonged stress
- poor diet
- lack of sleep
The symptoms of TMJ disorders depend on the severity and cause of your condition. The most common symptom of TMJD is pain in the jaw and surrounding muscles. Other symptoms typically associated with these disorders include:
- pain that can be felt in the face or neck
- stiffness in the muscles of the jaw
- limited movement of the jaw
- locking of the jaw
- clicking or popping sound from the TMJ site
- shift in the jaw, changing the way that the upper and lower teeth align (called malocclusion)
Symptoms may show up on just one side of the face, or both.
TMJ disorders can be difficult to diagnose. There are no standard tests to diagnose these disorders. Your doctor may refer you to a dentist or an ear, nose, and throat (ENT) specialist to diagnose your condition.
Your doctor may examine your jaw to see if there is swelling or tenderness if you have symptoms of a TMJ disorder. Your doctor may also use several different imaging tests. These can include:
- X-rays of the jaw
- CT scan of the jaw to see the bones and joint tissues
- MRI of the jaw to see if there are problems with the structure of the jaw
In most cases, the symptoms of TMJ disorders can be treated with self-care practices at home. To ease the symptoms of TMJ you can:
- eat soft foods
- use ice to reduce swelling
- reduce jaw movements
- avoid chewing gum and tough foods ( beef jerky)
- reduce stress
- use jaw-stretching exercises to help improve jaw movement
You may need help from your doctor if your symptoms don’t improve with these treatments. Depending on your symptoms, your doctor may prescribe or recommend the following:
- pain medications (such as ibuprofen)
- medications to relax the muscles of the jaw (such as Flexeril, Soma, or Valium)
- medications to help reduce swelling in the jaw (corticosteroid drugs)
- stabilization splints or bite guards to prevent teeth grinding
- Botox to reduce tension in the muscle and nerves of the jaw
- cognitive behavioral therapy to help reduce stress
In rare cases, your doctor may recommend surgery or other procedures to treat your condition. Procedures can include:
- corrective dental treatment to improve your bite and align your teeth
- arthrocentesis, which removes fluid and debris from the joint
- surgery to replace the joint
Procedures used to treat this condition may, in some cases, make your symptoms worse. Talk to your doctor about the potential risks of these procedures.
You may not be able to prevent TMJD from developing, but you might be able to reduce symptoms by lowering your stress levels. It could be helpful to try to stop grinding your teeth if this is an issue for you.
Possible solutions for teeth grinding include wearing a mouth guard at night and taking muscle relaxants.
You may also help prevent teeth grinding by reducing your overall stress and anxiety through counseling, exercise, and diet.
The outlook for a TMJ disorder depends on the cause of the problem. TMD can be successfully treated in many people with at-home remedies, such as changing posture or reducing stress. If your condition is caused by a chronic (long-term) disease such as arthritis, lifestyle changes may not be enough. Arthritis can wear down the joint over time and increase pain.
Most cases of TMJD warrant changes in lifestyle habits, possibly combined with medications to ease any pain and discomfort. Aggressive treatments are rarely needed. Talk to your doctor about your options to determine what treatment is right for you.