Temporomandibular disorders (TMD) occur as a result of problems with the jaw, jaw joint and surrounding facial muscles that control chewing and moving the jaw. These disorders are often called TMJ, which stands for temporomandibular joint.
What Is the Temporomandibular Joint (TMJ)?
The temporomandibular joint (TMJ) is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull, which is immediately in front of the ear on each side of your head. The joints are flexible, allowing the jaw to move smoothly up and down and side to side and enabling you to talk, chew, and yawn. Muscles attached to and surrounding the jaw joint control the position and movement of the jaw.
What Causes TMD?
The cause of TMD is not clear, but dentists believe that symptoms arise from problems with the muscles of the jaw or with the parts of the joint itself.
Injury to the jaw, temporomandibular joint, or muscles of the head and neck – such as from a heavy blow or whiplash – can cause TMD. Other possible causes include:
Grinding or clenching the teeth, which puts a lot of pressure on the TMJ
Dislocation of the soft cushion or disc between the ball and socket
Presence of osteoarthritis or rheumatoid arthritis in the TMJ
Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth
What Are the Symptoms of TMD?
People with TMD can experience severe pain and discomfort that can be temporary or last for many years. More women than men experience TMD, and TMD is seen most commonly in people between the ages of 20 and 40.
Common symptoms of TMD include:
Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide
Limited ability to open the mouth very wide
Jaws that get “stuck” or “lock” in the open- or closed-mouth position
Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain) or chewing
A tired feeling in the face
Difficulty chewing or a sudden uncomfortable bite – as if the upper and lower teeth are not fitting together properly
Swelling on the side of the face
May occur on one or both sides of the face
Other common symptoms of TMD include toothaches, headaches, neck aches, dizziness, earaches, hearing problems, upper shoulder pain, and ringing in the ears (tinnitis).
How Is TMD Diagnosed?
Because many other conditions can cause similar symptoms to TMD – including a toothache, sinus problems, arthritis, or gum disease – your dentist will conduct a careful patient history and physical examination to determine the cause of your symptoms.
Basic Treatments for TMD
Some basic, conservative treatments for TMD include:
Apply 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 stretching exercises for your jaw (as instructed by your dentist or physical therapist). After exercising, apply 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. Eat soft foods such as yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans, and grains. In addition, cut foods into small pieces to decrease the amount of chewing required. Avoid hard and crunchy foods (like hard rolls, pretzels, raw carrots), chewy foods (like caramels and taffy) and thick and large foods that require your mouth to open wide to fit.
Take medications. To relieve muscle pain and swelling, try nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen (Advil, Motrin, Aleve). Your dentist can prescribe higher doses of these or other drugs for pain relief. Muscle relaxants, especially for people who grind or clench their teeth, can help relax tight jaw muscles. Anti-anxiety medications can help relieve stress that is sometimes thought to aggravate TMD. Antidepressants, when used in low doses, can also help reduce or control pain. Muscle relaxants, anti-anxiety drugs, and antidepressants are available by prescription only.
Low-level laser therapy. This is used to reduce the pain and inflammation, as well as increase range of motion to the neck and in opening the mouth.
Wear a splint or night guard. Splints and night guards are plastic mouthpieces that fit over the upper and lower teeth. They prevent the upper and lower teeth from coming together, lessening the effects of clenching or grinding the teeth. They also correct the bite by positioning the teeth in their most correct and least traumatic position. The main difference between splints and night guards is that night guards are only worn at night and splints are worn all the time. Your dentist will discuss with you what type of mouth guard appliance you may need.
Undergo corrective dental treatments. Corrective treatments including replacing missing teeth and using crowns, bridges, or braces to balance the biting surfaces of your teeth or to correct a bite problem.
Avoid extreme jaw movements. Keep yawning and chewing (especially gum or ice) to a minimum and avoid extreme jaw movements such as yelling or singing.
Don’t rest your chin on your hand or hold the telephone between your shoulder and ear. Practice good posture to reduce neck and facial pain.
Keep your teeth slightly apart as often as you can to relieve pressure on the jaw. To control clenching or grinding during the day, place your tongue between your teeth.
Learning relaxation techniques to help control muscle tension in the jaw. Ask your dentist about the need for physical therapy or massage. Consider stress reduction therapy, including biofeedback.
Additional TMJ Resources
Jul 3, 2012
We have selected the following sites so that you may have access to other quality on-line information resources. These links provide excellent opportunities to further investigate issues of particular interest to TMJ patients and their families. Although we are unable to list every organization, we would like to acknowledge all of those who have helped change the face of TMJ.
The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering by Melanie Thernstrom http://www.amazon.com/Pain-Chronicles-Mysteries-Prayers-Suffering/dp/0865476810
Me and My Pain: The Challenges of Being in Chronic Pain by Abbey Strauss, MSW, MD http://www.amazon.com/Me-My-Pain-Challenges-Chronic/dp/1439238634/ref=sr_1_7?s=books&ie=UTF8&qid=1284579696&sr=1-7
In the Face of Pain: Resource Guide for People with Pain. This booklet can be downloaded or you can request a free copy.
These sites address disorders affecting the structure and function of the head and face.
•Cleft Palate Foundation
•Let’s Face It
Medical Conditions Associated with TMJ Disorders:
•American Tinnitus Association
•Anxiety Disorders Association of America
•The Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) Association of America
•The Hyperacusis Network – Hyperacusis is a decreased tolerance for sound that some TMJ patients experience.
•International Foundation for Functional Gastrointestinal Disorders
•Interstitial Cystitis Association
•Irritable Bowel Syndrome Association
•Multiple Chemical Sensitivity Syndrome
•National Fibromyalgia Association
•National Fibromyalgia Partnership, Inc.
•National Headache Foundation
•National Vulvodynia Association
•Overlapping Conditions Alliance
•Society for Mitral Valve Prolapse Syndrome
•MedWatch The FDA Safety Information and Adverse Event Reporting Program. MedWatch facilitates the documentation and early identification of product problems. If you are having any kind of problems with a device or other medical product, you or your doctor are encouraged to complete the MedWatch form. The form can be completed online, or printed and mailed/faxed.
National Institutes of Health:
The National Institutes of Health (NIH) is responsible for, among other functions, allocating grant funding dedicated to biomedical research. The NIH is also central to many health reporting systems.
•Converging Pathways of Pain Research at NIDCR
•Office of Research on Women’s Health
•National Heart, Lung and Blood Institute
•National Institute of Allergy and Infectious Diseases (NIAID)
•National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
•NIAMS – Questions and Answers About Fibromyalgia
•NIAMS – Handout on Health: Osteoarthritis
•National Institute of Biomedical Imaging and Bioengineering (NIBIB)
•National Institute of Dental & Craniofacial Research – Patients who browse this site for data on TMJ diseases should consider informing the agency of their health care concerns and the pressing need for more quality research directed toward TMJ problems.
•National Institute of Neurological Disorders and Stroke (NINDS)
•National Oral Health Information Clearinghouse
These sites provide information that may benefit patients who suffer from both chronic and acute pain.
•American Chronic Pain Association
•American Pain Foundation – Provides statement of your rights for pain care “Pain Care Bill of Rights”. APF also has a database on its Web site with searchable lists of pain specialists and clinics.
•American Pain Society
•Campaign to End Chronic Pain in Women
•Mayday Upper Peninsula Pain Project
•Pain.com – has a searchable list of pain specialists and pain clinics all over the globe.
•PainEdu.org – PainEDU is a research-based resource for physicians, nurses, pharmacists, and psychologists. It offers a free case-based continuing education course on the clinical management of pain from a variety of perspectives, along with a free (via download or mail) companion pain management manual. Additional features include clinical tools, updated news and interviews, and distribution of a weekly professional newsletter.
•U.S. Pain Foundation
•Menopause Learning Center
•National Center for Policy Research for Women & Families
•National Women’s Health Network
•Society for Women’s Health Research
Other Informational Sites:
•The Cochrane Collaboration – is an international not for profit and independent organization, dedicated to making up-to-date, accurate information about the effects of healthcare interventions readily available worldwide
•Consumers United For Evidence-Based Healthcare (CUE) – The TMJ Association is a member organization of CUE, a pioneering effort started in 2003, which unites consumer advocates with a common interest in integrating understanding and interpretation of evidence-based healthcare (EBHC) into their advocacy activities. CUE member-organizations work in partnership with the US Cochrane Center and other scientists to communicate the language of EBHC, strengthen the voice of consumers, and provide leadership in healthcare research.
•Ehlers-Danlos National Foundation
•Families for Depression Awareness – Helps families recognize and cope with depressive disorders. From the web site, order free brochures, read Family Profiles, access resources, and sign up for free email alerts.
•FDA Drug-safety – FDA Web site alerting public to drug-safety concerns.
•Help With Prescription Costs – You can get many medications free from drug companies under their “indigent patient” programs. For a list of companies that offer these programs, contact: Pharmaceutical Research and Manufacturers of America, 1100 15th Street, N.W., Washington, DC 20005; 1-800-PMA-INFO; http://www.helpingpatients.org/
•Invisible Disabilities Association
•Lab Tests Online – Provides detailed descriptions of a broad range of tests and offers in-depth articles.
•Lyme Disease Association, Inc.
•Lymphatic Research Foundation, Inc.
•Mercy Medical Airlift for National Patient Travel Center – A charitable long-distance medical air transportation service. Helpline 1-800-296-1217.
•National Association of Hospital Hospitality Houses – Provides lodging assistance for persons receiving medical treatment away from home. Helpline 1-800-542-9730.
•National Family Caregivers Association
•National Organization for Rare Disorders
•National Sleep Foundation
•Patient, Consumer, and Public Health Coalition – An informal coalition of individuals and nonprofit organizations representing the interests of patients, consumers, health-care professionals, scientists, and public health experts and advocates.
•Procter and Gamble’s Global Dental Resource – TMJ information written in 17 languages.
•Patient Advocate Foundation
•Restless Legs Syndrome Foundation
•Social Security Disability Resource
•Trigeminal Neuralgia Association – Some TMJ patients also suffer from trigeminal neuralgia, and some trigeminal neuralgia patients have been misdiagnosed with TMJ or other craniofacial problems.
•United States Bone & Joint Initiative- U.S. National Action Network of the worldwide Bone and Joint Decade which is comprised of similar networks in more than 60 countries.