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Temporomandibular Joint Disorders
You may have read articles in newspapers and magazines about "TMD" --
temporomandibular (jaw) disorders, also called "TMJ syndrome." Perhaps you have
even felt pain sometimes in your jaw area, or maybe your dentist or physician has told you
that you have TMD.
If you have questions about TMD, you are not alone. Researchers, too, are looking for
answers to what causes TMD, what are the best treatments, and how can we prevent these
disorders. The National Institute of Dental Research has written this pamphlet to share
with you what we have learned about TMD.
TMD is not just one disorder, but a group of conditions, often painful, that affect the
jaw joint (temporomandibular joint, or TMJ) and the muscles that control chewing. Although
we don't know how many people actually have TMD, the disorders appear to affect about
twice as many women as men.
The good news is that for most people, pain in the area of the jaw joint or muscles is
not a signal that a serious problem is developing. Generally, discomfort from TMD is
occasional and temporary, often occurring in cycles. The pain eventually goes away with
little or no treatment. Only a small percentage of people with TMD pain develop
significant, long-term symptoms
Symptoms of Temporomandibular Joint Disorders
TMJ syndrome has several possible physical causes:
- Muscle tension. Muscle tightness in the temporomandibular joint usually results from
overuse of muscles. This overuse in turn is often associated with psychological stress and
clenching or grinding of the teeth (bruxism).
- Injury. A direct blow to the jaw or the side of the head can result in bone fracture,
soft tissue bruising, or a dislocation of the temporomandibular joint itself.
- Arthritis. Both osteoarthritis and rheumatoid arthritis can cause TMJ.
- Internal derangement. Internal derangement is a condition in which the cartilage disk
lies in front of its proper position. In most cases of internal derangement, the disc
moves in and out of its correct location, making a clicking or popping noise as it moves.
In a few cases, the disc is permanently out of position, and the patient's range of motion
in the jaw is limited.
- Hypermobility. Hypermobility is a condition in which the ligaments that hold the jaw in
place are too loose and the jaw tends to slip out of its socket.
- Birth abnormalities. These are the least frequent cause of TMJ but do occur in a
minority of patients. In some cases, the top of the jawbone is too small; in others, the
top of the jawbone outgrows the lower part.
- Earache (the joint is located right in front of the ears and can easily be interpreted
as ear pain by the patient)
- Jaw pain or tenderness of the jaw
- Dull, aching facial pain
- Biting or chewing difficulty or discomfort
- Clicking sound while chewing or opening the mouth
- Grating sensation while chewing
- Decreased ability to open or close the mouth
The symptoms of TMJ depend in part on its cause. The most common symptoms are facial
pain in front of the ears; headaches; sore jaw muscles; a clicking sound when chewing; a
grating sensation when opening and closing the mouth; and temporary locking of the jaw.
Some patients also report a sensation of buzzing or ringing in the ears. Usually, the
temporomandibular joint itself is not painful. Most cases of TMJ are seen in women between
20-50 years of age.
Diagnosis of Temporomandibular Joint Disorders
Dental examination and patient history
TMJ disorders are most frequently diagnosed by dentists. The dentist can often diagnose
TMJ based on physical examination of the patient's face and jaw. The examination might
include pressing on (palpating) the jaw muscles for soreness or asking the patient to open
and close the jaw in order to check for misalignment of the teeth in the upper and lower
jaw. This condition is called malocclusion. The dentist might also gently move the
patient's jaw in order to check for loose ligaments.
Imaging studies are not usually necessary to diagnose TMJ. In most cases, x rays and
MRI scans of the temporomandibular joint will be normal. Consequently, these two tests are
not commonly used to diagnose TMJ. If the dentist suspects that the patient has internal
derangement of the disc, he or she can use a technique called arthrography to make the
diagnosis. In an arthrogram, a special dye is injected into the joint, which is then
x-rayed. Arthrography can be used to evaluate the movement of the jaw and the disc as well
as size and shape, and to evaluate the effectiveness of treatment for TMJ.
Treatment of Temporomandibular Joint Disorders
In many cases, the cause of pain in the TMJ area is temporary and disappears without
treatment. About 80% of patients with TMJ will improve in six months without medications
or physical treatments.
Patients with TMJ can be given muscle relaxants if their symptoms are related to muscle
tension. some patients may be given aspirin or nonsteroidal anti-inflammatory drugs
(NSAIDs) for minor discomfort. If the TMJ is related to rheumatoid arthritis, it may be
treated with corticosteroids, methotrexate (MTX, Rheumatrex) or gold sodium (Myochrysine).
Physical therapy and mechanical devices
Patients who have difficulty with bruxism are usually treated with splints. A plastic
splint called a nightguard is given to the patient to place over the teeth before going to
bed. Splints can also be used to treat some cases of internal derangement by holding the
jaw forward and keeping the disc in place until the ligaments tighten. The splint is
adjusted over a period of two to four months.
TMJ can also be treated with ultrasound, electromyographic biofeedback, stretching
exercises, transcutaneous electrical nerve stimulation, stress management techniques, or
Surgery for Temporomandibular Joint Disorders
Surgery is ordinarily used only to treat TMJ caused by birth deformities or certain
forms of internal derangement caused by misshapen discs.
Prognosis of Temporomandibular Joint Disorders
The prognosis for recovery from TMJ is excellent for almost all patients. Most patients
do not need any form of long-term treatment. Surgical procedures to treat TMJ are quite
successful. In the case of patients with TMJ caused by arthritis or infectious diseases,
the progression of the arthritis or the success of eliminating infectious agents
determines whether TMJ can be eliminated.