What Is It?
Temporomandibular Joint Syndrome (TMJ) or more accurately Temporomandibular Joint Dysfunction (TMD) is a pain disorder related to the “jaw joint.” Pain is not only felt in the joint but can be felt elsewhere on the face.
It is more common in women than men, can be permanent or temporary, can occur on either sides of the face (or one side), and occurs most commonly between the ages of 20 years to 40 years old.
How Does It Feel?
It is characterized by pain in the jaw joint, face, neck, shoulders, and even the ear. The pain is typically made worse with speaking, chewing, or talking. A person with TMJ may notice a clicking in the jaw joint, swelling, tenderness, grinding, or even jaw locking.
Symptoms can be also be rather misleading with headaches, toothaches, dizziness, hearing problems (such as ringing in the ears called tinnitus), or even upper shoulder pain. In the image depicted you can see the myriad of symptoms that can occur with TMJ. These symptoms can be separate disorders from TMJ or may be TMJ masquerading as other symptoms.
What Causes It?
The main cause of TMJ is inflammation of the jaw joint, jaw muscles, jaw muscle tendons, jaw muscle ligaments, or a combination of these structures. At times, the cause is rather mysterious.
The following are known to cause TMJ:
- Direct injury: such as a blow to the jaw.
- Indirect injury: such as in whiplash.
- Grinding of Teeth: such as at night called “bruxism.”
- Nearly any cause of arthritis: the temporo-mandibular joint is a sliding hinge joint with synovial cartilage. It is susceptible to disease from Rheumatoid Arthritis and Systemic Lupus Erythematosus just as other joints are.
- Stress: usually due to “clenching” of the teeth
- Dental Caries: especially when there is asymmetrical motion of the jaw joint.
How Is It Diagnosed?
This particular disorder is best diagnosed by a good Dentist. After taking a thorough history, your Dentist will perform an examination of your entire mouth and jaw looking for possible causes of your pain.
There are a few diagnostic studies that your Dentist may perform to confirm the diagnosis of TMJ:
- Facial X-Rays: these will yield what the facial structure is and if there is asymmetry.
- MRI: this study is particularly well suited to evaluate the disc in the center of the jaw joint.
- CT of the face and jaw: this will give a more detailed evaluation of the boney structures.
On occasion your Dentist may refer you to an Oral Maxillo-facial surgeon (this is not an ENT surgeon).
How Is Tmj Treated?
The treatments are usually effective, with most people obtaining relief with home remedies:
- NSAIDS: Advil and Aleve, or their equivalent, are usually very effective for pain relief.
- Night Guard: this can be obtained without a prescription and is very effective when used regularly at night. It keeps the jaw slightly open (which rests it) and keeps the teeth from grinding at night. A football mouth guard can substitute if a night guard is too expensive.
- Hot/Cold packs to the jaw joint.
- Jaw Stretches: gentle opening of the mouth will your fingers to stretch the jaw muscles.
- Soft Foods: reduces the stress on the jaw joint.
- Avoidance of extreme movements of the jaw: such as in singing, yelling, or yawning.
- Avoid resting the chin in the hand
- Relaxation Techniques
In the event that these simple modalities do not work then the following can be pursued at the direction of a Dentist or specialist:
- Dental Work
- TENS unit (click here to see my post on this topic)
- Anxiety Medications
- Ultrasound to the jaw joint and other painful areas.
- Cool laser treatments
- Radio-frequency treatments
In the event these non-invasive therapies don’t work, then the indication for invasive treatment becomes necessary:
- Trigger Point injections or direct TMJ injections
- TMJ Arthroscopy: a small scope is put into the TMJ (while under anesthesia) to evaluate and treat the joint.
- Open surgery to the TMJ: this is the final, most aggressive therapy and is reserved for the most severe cases.
We have reviewed the definition, causes, and treatments for TMJ. Most people will get better with the home remedies. It will be the minority of people who will require surgery. If you follow the basic guidelines outlined in this monograph you will discover the best therapy for you and your pain will be relieved. Do not lose hope…
This post is not meant to replace the thorough history and physical by a licensed medical practitioner and is not a medical recommendation.
I would also love to hear from you. Please leave me a comment or question below and I will answer you promptly.
To your health.