TMJ Dysfunction Disorder
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What is TMJ dysfunction disorder?
The temporomandibular joint (TMJ) connects your jaw to your skull. The jaw joint, in front of your ears, helps your mouth open and close when talking and chewing.
Problems with the jaw and its muscles are called temporomandibular joint dysfunction disorder. It’s also known as temporomandibular disorder (TMD). People often refer to TMD as TMJ.
TMD causes pain and discomfort in your jaw, face, or neck. It can also cause your jaw to click, pop, or feel stiff. TMD can be constant or come and go.
Often, TMD gets better with treatments like pain medications, jaw exercises, and a nighttime mouthguard. If these don’t work, you might need injections to reduce pain and tension or go to a physical therapist. Sometimes, surgery is recommended.
Ask your doctor if your TMJ disorder could be part of a larger multisystem disorder. Although your symptoms may be an isolated jaw joint disorder, there is new evidence that it might be part of a larger problem. Given inflammation is one of the primary causes of symptoms, you may not realize inflammation in other joints (back, knees, etc) are connected. —Dr. Chandra Manuelpillai
The most common symptoms of TMD include facial pain (in front of the ears and by the temple), and jaw and neck pain. You may have trouble moving your jaw and opening it wide. You may hear clicking or popping when opening and closing your jaw. In severe cases, it may become lockjaw—your jaw is locked in the open or shut position.
- Face, jaw, or neck pain, especially when the jaw is moving
- Trouble moving your jaw when talking, chewing
- Difficulty opening your mouth wide (yawning or biting into a sandwich)
- Clicking or popping sounds from your jaw
- Jaw stiffness
- Change in the way the upper and lower teeth come together when you bite down, making chewing and talking difficult
- Earache or irritation
- Lockjaw—when the jaw freezes in place
What is the main cause of TMJ?
There are three main causes of TMJ disorders.
- Muscular: Some people with TMD have sensitive jaw muscles or hold a lot of tension in their jaw. Tension, exhaustion, or muscle spasms can trigger pain. The pain can spread to the rest of the face, jaw, and neck.
- Mechanical: Sometimes, the temporomandibular joint has been damaged. This can be from:
- Grinding teeth while sleeping.
- Clenching jaw during the day.
- Trauma (from an accident or injury) that causes the bones, muscles, or disks of the TMJ to slip out of place.
- Inflammatory or degenerative: Inflammation or irritation of the joint can cause TMD. So can the joint breaking down over time. This can occur because of normal aging, or grinding teeth. Arthritis can also cause the joint to become irritated and stiff.
Women are more likely to develop temporomandibular joint disorders. If you smoke tobacco, you’re even more likely to get it.
People with chronic pain conditions, like chronic headaches or fibromyalgia, are more likely to have TMD. So are people who have an autoimmune disorder, sleep apnea, or a psychiatric disorder like anxiety or depression.
Treatment for TMJ disorders
Allow conservative measures such as heat/ice, rest, and physical therapy time to work. It may take several weeks to see results. Although you may feel like you are willing to try almost anything to stop your symptoms and improve your quality of life, more extensive interventions such as surgery should be a last resort. It’s not a guaranteed cure. —Dr. Manuelpillai
- Prescription or over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can relieve pain from inflammation.
- Muscle relaxants prescribed by a doctor can help with tension and muscle spasms.
- Steroids prescribed by a doctor can reduce inflammation.
- Certain antidepressants are effective in reducing nerve pain. These include tricyclic antidepressants (amitriptyline, doxepin).
- Topical pain relievers to rub on the skin. They may contain NSAIDs, numbing medications, or steroids.
These can help prevent flare-ups.
- Avoid eating hard foods (raw fruits and vegetables, chips, pretzels, hard candy).
- Avoid eating chewy foods (tough meats, dried meats, dried fruit, caramel, taffy).
- Place a hot or cold pack on the joint—right below the ear.
- Reduce stress, which may be creating muscle tension or causing you to clench or grind your jaw. You can use relaxation techniques, such as deep breathing or meditation.
- Wear a mouthpiece at night. These are fitted by your dentist to keep your jaw in place at night and keep you from grinding your teeth.
- Quit smoking.
You may be referred to a physical therapist who specializes in TMD. You will be shown exercises that strengthen certain muscles and improve your TMJ range of motion better.
If the other treatments do not work, your doctor might try steroid injections to reduce inflammation and pain.
Botox injections prevent muscles from contracting to prevent clenching and spasms. It also helps with healing and stops teeth grinding.
Most cases of TMD do not need surgery. Surgery is usually only recommended when the joint is not in the correct place—whether it was always that way or because of an injury.
Can TMJ go away on its own?
TMJ disorder should be treated to help reduce the symptoms. Often a combination of medication, lifestyle changes, and physical therapy are recommended.
Diagnosing TMD can be hard. A doctor or dentist can help rule out other conditions with similar symptoms, including neuralgia (caused by damaged nerves), sinusitis, migraines, ear infection, or a dental issue.
TMJ disorders may be a lifelong challenge. The pain can interfere with life including difficulty eating and/or sleeping. Those with chronic pain can suffer from depression and/or irritability. If other measures are still not effective, it is best to have a multidisciplinary approach including discussing with your primary care doctor, dentist, psychiatrist, pain specialist, and physical therapist. —Dr. Manuelpillai
Generally, TMD is not a sign of anything serious. But if you notice symptoms, call your primary care doctor or dentist. They may refer you to an oral surgeon or an ear, nose, and throat specialist (otolaryngologist).
TMD often gets better with lifestyle changes. If there isn’t any improvement after a few weeks, talk to your doctor or dentist. They may give you a prescription for medication or physical therapy.
Dr. Maina graduated from Princeton University (BA, 2013) with a degree in psychology and received her medical degree from the University of Pennsylvania Perelman School of Medicine. She is currently a resident physician in Otolaryngology at the University of Pennsylvania affiliated hospitals. After graduating from Princeton, she spent a year researching embryonic gene expression with the Center for Research on Reproduction and Women's Health at UPenn. She also received a grant from the National Institutes of Health to study abnormal innate immune responses and taste-related genes in chronic sinus infections. In her free time, she enjoys cooking, reading, listening to podcasts, and finding new DIY décor projects.