Temporomandibular disorder (TMD) is a term that refers to dysfunction and symptoms affecting the temporomandibular joint (TMJ). Like any other joint in the body, TMJ is prone to injuries and damage that induce various symptoms whose severity varies from one person to another. This post focuses on TMDs, their causes, symptoms, and management options. The aim of today’s article is to teach you everything that is there to know about the common temporomandibular disorders and hopefully, it will succeed its goal.
What does TMJ do?
The temporomandibular joint is a hinge that connects temporal bones of the skull in front of each ear and jaw bone. Acting like a sliding joint, the temporomandibular joint makes sure that our jaws and skull are well connected at all times. You have two TMJs, one on each side of your jawbone. Each temporomandibular joint consists of blood vessels, nerves, muscles, and bones. Each time you open your mouth, TMJ makes two distinct motions: rotation and translation i.e. the joint allows you to move the jaw up and down and side to side[i]. Thanks to the temporomandibular joint we are able to open our mouth in order to satisfy our daily physiological needs.
The joint allows you to sustain functions of life such as chewing, sucking, kissing, speaking, yawning, and others. The TMJ is subjected to the same afflictions as other joints and an extensive mismanagement. Unlike other joints, the presence of teeth and the tooth relationship play a major role in its function, management, and the likelihood of dysfunctions[ii].
What is a TMD?
TMJ disorders also referred to as a temporomandibular joint syndrome, are conditions that affect this joint specifically. Problems with nerves, muscles in your face and jawbone are very common but they are usually referred to as TMJ syndrome. The TMD can cause pain and impair range of motion in your jaw, thus affecting your quality of life. Once you start suffering from a temporomandibular joint disorder, you will start with your ability to eat, drink, speak, kiss, chew properly. Statistics show that 35 million people or 12% of the US population are affected by TMD at any given time[iii].
We can classify these conditions into three categories:
- Internal derangement of the joint that involves displaced disk, injury, dislocated the jaw
- Arthritis affecting TMJ
- Myofascial pain and discomfort in the muscles that regulate jaw function
You can have more than one TMD at the same time[iv].
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Causes of TMD
Although millions of people have TMJ disorders the exact cause is largely unknown. In many cases, the reason why a patient developed problems with this joint is difficult to determine. More research on this subject is necessary to elucidate underlying causes that lead to TMD. Multiple factors can contribute to muscle tightness and dysfunction that are characteristic for this disorder. A person can experience pain and discomfort in their jaw if the disk erodes or moves out of its alignment, the joint is damaged due to injury, or the cartilage is damaged due to arthritis. Stress is also found to be a common cause for a temporomandibular joint disorder, thinking how many people are prone to grinding or clenching their teeth and muscles whenever they are under a lot of stress.
Who is at risk?
Everyone can develop TMD, but some people are at a higher risk than others. Most patients who seek treatment for TMD are women of childbearing age i.e. between 18 and 44 years old. For men between the ages of 18 and 44 has not been noticed any great risk. Other factors[v] that can increase the risk of TMD and contribute to this disorder are:
- Arthritis and other inflammatory musculoskeletal disorders, especially rheumatoid arthritis and osteoarthritis which are considered to be the most common types of Arthritis
- Jaw injury
- Clenching or grinding your teeth for long-term
- Poor posture in the neck and upper back, which can very easily cause abnormalities or loss of the jaw muscle function
- Excessive gum chewing
- Orthodontic braces
- Anxiety and stress
- Autoimmune conditions
- Insertion of breathing tube prior to surgery
- Dental procedures and prolonged mouth opening
- Jaw trauma
- Poorly positioned teeth
- Genetic predisposition to pain sensitivity
- Chronic pain conditions such as chronic daily headache and/or back pain
Symptoms of TMD
The condition can affect one side of the face only or both. Severity and duration of symptoms vary from one person to another. Although TMJ is located at the point where your jaw meets the skull, the disorder can affect eyes, forehead, neck, ear, and your entire face. In most cases, affected individuals experience the following symptoms[vi]:
- Headaches or migraines
- Neck ache or a backache
- Earache or pain around the ear that spreads to the cheeks
- Tinnitus or ringing in the ears
- Pain, tenderness, and discomfort while moving the jaw, located in the face area, the jaw joint itself, neck, shoulders, and even your eyes, full mouth and around and/or in the ear.
- Unusual popping, clicking or grinding noise while eating, talking, or when you open your mouth
- Restricted movement i.e. locking of the joint that prevents you opening your mouth or chewing easily
- Aching facial pain
- Feelings of tiredness in your face
- Blurred vision
- Muscle spasms in the jaw
- Pain at the base of the tongue
- Shoulder pain
- Swelling of the face, most commonly on the affected side of the face
Diagnosis and treatment
Based on the described symptoms, a doctor already assumes TMD is the culprit. In order to diagnose the problem, the physician observes the range of jaw motion, feels and listens to the jaw while you open and close mouth, and creates pressure by pressing areas around the joint to identify the sites where pain occurs. So the first step is always taking an anamnesis and performing a physical exam. To rule out other conditions, patients may need dental X-rays, CT scan, or MRI. Ultrasound is also quite commonly used to detect any abnormalities which might be the reason why such symptoms develop, especially inside the joint itself. Usually, the physical exam, the X-rays and the ultrasound alone are enough to make a clear diagnosis, if not, the doctor will perform the CT scan and the MRI just to make sure. All of these diagnostic techniques are safe, non-invasive and accurate. In some cases, the doctor performs TMJ arthroscopy by inserting a cannula (thin tube) in the joint space. The tube carries a camera arthroscope which gives doctors a clear view of the area and makes diagnosis easier.
The disorder doesn’t always require a treatment, it can go away on its own. What the doctor will probably recommend is for you to rely on a healthy diet, take some over-the-counter painkillers, reduce your stress levels and avoid any hard foods, chewing gums and any activities that require you to open your mouth wide. Warm compressions over the temporomandibular joint can also help with the pain and stiffness. In instances when symptoms don’t go away, doctors may recommend different approaches such as medications (NSAIDs, antidepressants, and muscle relaxants), physical therapy, corticosteroid injections, surgery, and wearing mouth guards[vii]. Recently, the use of Botox has spread far more than the simple use of Botox to make your wrinkles and fine lines less visible. Nowadays, doctors recommend their patients trying Botox to treat their temporomandibular joint syndrome symptoms and it seems to be working! According to a study published [viii]in the Journal of Dentistry, the use of Botox is an effective treatment that is able to reduce the clicking sounds, the pain, hyperactivity and dysfunction of the temporomandibular joint.
Prevention of TMD
The temporomandibular joint syndrome can be prevented by using some quite effective techniques. There is no need to mention that we are talking about safe, non-invasive, inexpensive techniques that are sure worth giving them a try, especially if you have had a history involving a TMD before.
- Avoid chewing gums
- Avoid chewing your fingernails, pens, and pencils
- Avoid eating hard candy
- Massage your jaw and the temporomandibular joint regularly
- Avoid grinding and clenching your teeth
- Use a good neck support while sleeping by adopting a good sleep posture
Disorders affecting TMJ are common and although their underlying cause is unknown, different factors and diseases play a role. Bearing in mind TMD induces a number of symptoms it is important to see your doctor who will diagnose the problem and recommend adequate treatment approach if the condition doesn’t go away on its own. It is important to remember at least the most common symptoms of TMD so that you would be able to notice the symptoms while in their early stage and report them to your doctor right away so that he/she can diagnose your condition and start an early treatment. Combination of different treatment options works best.
[i] TMJ anatomy and function, University of Washington http://www.uwmsk.org/tmj/anatomy.html
[ii] Helland MM. Anatomy and function of the temporomandibular joint. Journal of Orthopedic and Sports Physical Therapy 1980;1(3):145-52. https://www.jospt.org/doi/pdf/10.2519/jospt.19184.108.40.206
[iii] TMD basics: the basics of jaw joint, TMJA http://www.tmj.org/Page/34/17
[iv] TMJ (temporomandibular joint and muscle disorders), National Institute of Dental and Craniofacial Research https://www.nidcr.nih.gov/health-info/tmj
[v] Temporomandibular joint syndrome (TMJ), MedicineNet https://www.medicinenet.com/temporomandibular_joint_syndrome_tmj/article.htm#what_causes_tmj_syndrome
[vi] TMJ disorders: causes, symptoms, and relief, MedicalNewsToday https://www.medicalnewstoday.com/articles/317706.php
[vii] TMJ disorders, Mayo Clinic https://www.mayoclinic.org/diseases-conditions/tmj/diagnosis-treatment/drc-20350945
[viii] Ataran R, Bahramian A, Jamali Z, Pishahang V, Barzegani HS, Sarbakhsh P, Yazdani J, The role of Botulinum Toxin A in treatment of temporomandibular joint disorders: a review, Journal of Dentistry 18(3): 157–164