Temporomandibular Joint Disorder

What is temporomandibular joint disorder?

The temporomandibular joint is actually two pairs of joints that make it possible for the jawbone to rotate and slide. This joint connects the lower jaw to the skull. The temporomandibular joints can be found on either side of the head in front of the ears. These joints allow us to talk, chew and yawn.

When one or more of these joints become inflamed or painful, the condition is called temporomandibular joint disorder (TMJD).

What causes temporomandibular joint disorder?

The lower jaw has rounded ends that glide in and out of the joint socket when you talk, chew or yawn. These are called the condyles. They are covered with cartilage and are separated by a small shock-absorbing disk, which keeps the movement smooth.

TMJD can occur from:

  • Wear and tear on the cartilage.
  • Damage to the surfaces of the teeth due to neglect or injury.
  • Loose or lost teeth that have led to damage of the jawbone or poor alignment of the upper and lower jaws.
  • Poor alignment of the teeth or jaw when biting down. This can cause sensitivity of the teeth as well as affecting the muscles and the temporomandibular joint.
  • Overuse of the muscles of chewing. This may occur if a person chews gum continuously, bites fingernails or pencils, grinds the teeth, has a habit of clenching the jaw, biting the cheek or lip or thrusting the jaw out when speaking, exercising or other actions.
  • Erosion or improper movement of the disk.
  • Damage to the joint from a blow or other impact.
  • Arthritis.
  • Trigger points in the muscle tissue that cause myofascial pain syndrome.
  • Infections deep in the jaw.
  • Tumors.

Often, it isn't clear what is causing the TMJ symptoms.

TMJ disorders most commonly occur in women between the ages of 30 and 50.

What are the symptoms of temporomandibular joint disorder?

Symptoms of TMJD include:

  • Pain, including tenderness in the jaw, aching pain in or around the ear, and aching facial pain. Pain may be present whether the temporomandibular joint is moving or not.
  • Difficulty opening the mouth fully.
  • Difficulty or discomfort while chewing.
  • A clicking or popping sensation in the joint.
  • Locking of the joint that makes it hard to open or close the mouth.
  • Headache.
  • Uncomfortable bite.
  • An uneven bite because one or more teeth are making contact with each other before the other teeth do.

How is temporomandibular joint disorder diagnosed?

TMJD is diagnosed based on the patient's symptoms. A doctor will take a medical history to learn how long you have had the symptoms, whether you have had a recent injury to the jaw or recent dental treatment.

The doctor will do a physical examination. This will include listening to and feeling your jaw when you open and close your mouth and checking to see what range of motion you have in the joint. The doctor will ask whether you have felt a clicking, popping or rough crackling sound when the lower jaw moves.

The doctor will press on areas of your jaw and face to locate the pain or discomfort. They may also ask about whether you are feeling stress and how you cope with such feelings. You will be asked about habits such as clenching your teeth, chewing gum, etc.

The doctor will check your bite. They will look for lost teeth, unusual placement of teeth, signs of chronic teeth grinding. It may be necessary to follow up with X-rays of the teeth.

In some cases, a computed tomography scan may be done to check the bones of the joint. A magnetic resonance imaging scan may be done to reveal problems with the disk in the joint.

How is temporomandibular joint disorder treated?

Treatment of TMJD varies, depending on what is causing the symptoms. Treatment may include:

  • Arthocentisis, a procedure that flushes debris and the byproducts of inflammation out of the joint.
  • Correcting poor habits such as grinding the teeth or chewing gum. Sometimes a device (a night guard) inserted in the mouth can help control grinding of the teeth.
  • Corrective dental treatment.
  • Drugs to relieve pain and reduce swelling and inflammation.
  • Splints that reposition the jaw, ligaments and muscles into better alignment.
  • Surgery to correct abnormalities of the jaw.
  • Stress management such as meditation, deep breathing and progressive muscle relaxation.
  • Stretching or massaging the jaw muscles.
  • Applying heat or cold to the muscles to relieve inflammation and pain.

Key points

  • Temporomandibular joint disorder happens when there is inflammation or pain in the joints that make is possible for the jawbone to rotate and slide.
  • The disorder can happen due to wear and tear on the cartilage, arthritis, injuries, dislocations, structural problems in the joint, dental problems infections or tumors.
  • Treatment options run from stretching and massaging to surgery.
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