TMJ Disorder (TMJD)


What is TMJ Disorder? TMJ Disorder (TMD or TMJD) is the general term used to describe conditions characterized by pain and/or dysfunction of the jaw, temporomandibular joint (TMJ) and surrounding tissues. TMD can also describe pain or clicking in the temporomandibular joint (TMJ) area, or dysfunction of the jaw or temporomandibular joint. TMJ disorder may affect one or both sides of the jaw. TMJ disorder includes 3 main conditions: 
  • Pain in the muscles around and near the jaw and TMJ. Muscle pain is also called myofascial pain. 
  • Joint damage, including displacement of the disc, dislocation of the joint, injury to the condyle, or osteoarthritis. 
  • Degeneration or inflammation of the joint from arthritis or other systemic disease, including juvenile rheumatoid arthritis (JRA or juvenile idiopathic arthritis). 
Synonyms - TMJ, TMJD, TMD, jaw hypomobility, cranial mandibular syndrome 

Symptoms 
  • Aching pain or tenderness in the face or TMJ area, often on one side by the temple and sometimes radiating down into the neck and shoulders. 
  • Constant pain in the face, neck or shoulders. 
  • Pain in the TMJ joint or ear while opening or closing the mouth. 
  • Limited or disjointed movement of the jaw. Sometimes with the jaw shifting slightly to one side as it is opened. 
  • Dislocation and locking of joint when mouth is open or closed. 
  • Painful clicking, popping or grating of the joint while in motion or while chewing. This may occur with or without pain. (Pop out--What causes the sounds in the jaw) 
  • Fatigue or a tired feeling of the face. 
  • Difficulty chewing. 
  • An uncomfortable bite or a significant changes in the fitting of the upper and lower teeth together (occlusion). 
  • Swelling over the joint or on the side on the side of the face. 
  • Headaches, ear aches, dizziness, ringing of the ears (tinnitus)
Causes 
  • The TMJ is a complicated, unique joint. General TMD usually involves more than one symptom and rarely has a single cause. Boston specialists wrote recently in The New England Journal of Medicine “the cause is now considered multifactorial, with biologic, behavioral, environmental, social, emotional and cognitive factors, alone or in combination, contributing to the development of signs and symptoms of temporomandibular disorders.” However, TMD caused by osteoarthritis or rheumatoid arthritis has different causes and therapies. Click for more details on TMD from osteoarthritis or rheumatoid arthritis, including juvenile rheumatoid arthritis (JRA).
  • Injury like car accidents, falls, extended or overstretching (often during an oral or dental treatment). 
  • More rarely, tumors or infection. 
  • Occlusion and Malocclusion 
    1. Occlusion is how well your upper and lower teeth fit and align against each other when the mouth and jaw are closed. 
    2. Malocclusion is when the upper and lower teeth were misaligned. Malocclusion was previously thought to cause a movement and repositioning of the jaw and joint that would lead to TMD from the body trying to get the jaw back into alignment. However, more recent studies have shown that malocclusion is a rare cause of facial pain and TMD. 
Behavorial factors 
    1. Habitual clenching or grinding
    2. Hard foods 
    3. Biting the lips, fingernails, or chewing gum or other objects like a pen 
Mechanical Factors 
  1. Displacement of the disc 
  2. Congenital or developmental abnormalities 
  3. Arthritis 
  4. Teeth grinding 
Psychological factors 
Stress, anxiety and depression, can often cause behavioral factors and/or make TMD worse. 

Risk Factors 
  • TMD affects women significantly more often than men, approximately 4-1, and is especially prevalent in young adults, i.e. women aged 20-40 years. 
  • About 10% of the TMD sufferers develop limited jaw range-of-motion or trismus. 
  • The National Institutes of Dental and Cranial Research estimate that 10 million Americans have TMJ, usually women 20 to 50. 
  • A deep overbite, which holds the lower teeth back and keeps the jaw from relaxing, increases the risk. 
Development 
Since TMJD may concur with many other symptoms, it can be difficult to pinpoint which area is the source of the problem and which is the site of the problem. Insufficient airway in nasal passages, a poor dental bite, improper growth of the jaw, improper posture, injuries such as motor vehicle accidents, and stress can all contribute to the onset of TMJ dysfunction. 

Diagnosis 
If you believe you have TMJ disorder see your primary care doctor, general practitioner, or internal medicine specialist. Since many patients do not require in depth treatment and surgery for TMJ, primary care physicians can assist with pain concerns, physical therapy, and referrals to other specialists as needed. 
  • Physical Exam - A thorough examination may involve: 
    1. A dental examination to show if you have poor bite alignment 
    2. Feeling the joint and muscles for tenderness 
    3. Pressing around the head to locate areas that are sensitive or painful
    4. Sliding the teeth from side to side 
    5. Watching, feeling, and listening to the jaw open and shut 
  • Imaging X-rays or MRI of the jaw Treatment options 
Treatment Options There are two types of treatment for TMD--conservative and non-conservative (irreversible) therapy. Ninety percent of TMJ cases improve by themselves or with conservative treatment. However, TMD can persist as a chronic disease even after multiple jaw operations, depending on the cause. For immediate pain relief and treatment of pain from a minor injury or painful dental visit, try: 
  • Try to relax and ease the tension in your jaw. People forget this simple TMJ treatment and tense up which prolongs your TMJ pain. 
  • Apply soft pressure using a warm damp cloth on the affected area. Count from one to ten and back again. The counting process forces you to breathe and relax to get through the pain. 
For general TMD, experts recommend trying a conservative therapy first to see if it helps with the problems or the disorder goes away on its own. Conservative therapies include:
  • Rest 
  • Behavorial changes 
    • stop bad habits like biting and chewing on things 
    • avoid wide mouthing (like yawning or laughing). 
    • avoid leaning or sleeping on the jaw 
    • avoid playing wind, bass or string instruments that stress or thrust the jaw backward. 
  • Soft Diet 
  • Heat therapy 
  • Non-steroidal anti-inflammatories (NSAIDS) like acetaminophen (tylennol), aspirin, ibuprofen (Advil) and naproxen (Nuprin). 
  • Physical Therapy 
  • Massage 
  • Ultrasound and short-wave diathermy 
  • medication, including anti-depressants and anti-anxiety drugs. 
  • Stress management and relaxation techniques, yoga, biofeedback, cognitive therapy and counselling. 
  • Night Guards or mouthguards or splints for clenching or grinding. 
Non-conservative therapies - These should be treatments of last-resort, and should only be used when conservative therapies have proved ineffective. 
  • Dental or orthodontic work Surgery  
  • Surgery is primarily for patients with jaw malformations, osteoarthritis, loose bone fragments, or damaged joint structures like the condyle. 
Do you think you have TMD
  • Who treats it
    1. TMD is treated by a wide selection of specialists, including dentists, oral surgeons, physical therapists, speech pathologists, chiropractors, and massage therapists. There is not certified specialty in TMJ disorders in medicine or dentistry, and finding a provider can be difficult. Look for a provider that understands musculoskeletal disorders and is trained in treating pain conditions. 
  • What should I do next
    1. Visit a specialist willing to do a thorough assessment before choosing a therapy, especially if you have tinnitus (ear ringing) or migraine headaches. The assessment should include a history, physical exam for pain in the muscles or jaw, limited jaw opening and jaw noises. 
    2. For more complicated problems or possible osteoarthritis, try to find a multidisciplinary TMJ clinic, often available at hospitals or dental schools; or an oral surgeon who specializes in TMJ surgery (See the ASTMJS for possible specialists).
Similar Conditions 
Other conditions that cause similar symptoms to TMD include toothaches, sinus problems, gum disease, and back pain. These conditions can often have pain that radiates or is referred to nearby locations. 
The face and jaw is a small area and correctly determining the underlying cause to pain is difficult with so many overlapping and related tissues and body parts. In this area pain can often be “referred” or feels like it is coming from somewhere other than the actual painful tissue. 
Other conditions that can mimic symptoms of TMD include Dystonia, Temporal Arteritis, and Trigeminal Neuralgia. Dystonia is a movement disorder causing constant or spasmodic contractions of the muscles. Temporal Arteritis is an inflammation of the artery running over the temple next to the eye, and occurs most-commonly in people over 60. Trigeminal neuralgia is caused by interaction between a blood vessel and a nerve at the base of the brain. Trigeminal neuralgia is often triggered by touch and causes temporary sharp, stabbing pains, and not aching or throbbing pain.

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