Temporomandibular Joint (TMJ) Syndrome

Temporomandibular Joint Syndrome is a painful condition involving the joint that opens and closes the mouth. The disorder may affect the jaw joint or the muscles surrounding it. The jaw, or temporomandibular, joint is located just in front of either ear.

Causes

The exact cause of TMJ syndrome is often unclear. Possible causes include:
  • Excess tension in the jaw muscles
  • Faulty alignment between the upper and lower teeth and jaws
  • Disturbed movement of the jaw joint
  • Displacement or abnormal position of the jaw joint or cartilage disc inside the jaw joint
  • Inflammation of the joint
  • Excess or limited motion of the joint
  • Injury of the jaw or face

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Sex: female
  • Age: 30-50 years old
  • Clenching or grinding of teeth
  • Poorly fitting dentures
  • Fibromyalgia
  • Stress
  • Arthritis

Symptoms

Symptoms include:
  • Jaw pain that is often not localized
  • Pain that is worse with chewing, yawning, or opening the mouth
  • Locking or catching of the jaw joint
  • Limited ability to open the mouth
  • A bite that feels "off," uncomfortable, or as if it is frequently changing
  • Deviation of the jaw to one side
  • Headaches or pain in the shoulder, back, or neck
  • Clicking, popping, or grating sounds with movement of the jaw
  • Swelling in the affected side of the face or mouth
  • Dizziness
  • Visual changes
  • Earache
  • Ringing in the ears
  • Diminished hearing
  • Depression

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. The physical exam may include:
  • Range of motion tests
  • Listening for sounds in the joints
  • Examining your teeth, jaw joints, and muscles of your face and head
  • Palpation of the jaw joints and the muscles of the face and head
Other tests may include:

X-rays – plain x-rays or panoramic dental x-rays of the jaw and jaw joint. They show the bony structures well but not soft tissues.
Arthrogram – x-rays taken after dye is injected into the jaw joint.Sometimes the movements of the jaw are videotaped.
Tomogram – can show x-ray "slices" through the joint
CT Scan – a type of x-ray that uses a computer to make pictures of the inside of the jaw joint
MRI Scan – a test that uses magnetic waves to make pictures of the inside of the jaw joint

Treatment

Treatment may include:
Pain Relief
A soft diet may be recommended to reduce pain while chewing. Pain can be treated with warm or cold packs, restriction of jaw movement, or medications. The most commonly used medicines are acetaminophen, nonsteroidal anti-inflammatory drugs, muscle relaxants, and antidepressants. In some cases the jaw joint may be injected with pain relieving medicine such as cortisone or lidocaine.
Physical Therapy
Gentle massage or stretching exercises, transcutaneous electrical nerve stimulation (TENS), and biofeedback may reduce pain and help muscles to relax.
Stress Reduction
Counseling to learn stress management and relaxation techniques may help some patients with TMJ.
Dental Procedures
A splint or mouth guard can be made that you wear in your mouth to relax your jaw muscles and prevent clenching and grinding of your teeth. Correction of bite abnormalities by a dentist or orthodontist is sometimes recommended.
Surgical Procedures
Surgical correction may be a last resort if other treatments have not succeeded and the pain becomes unbearable. Many of the available procedures have not been scientifically proven to treat TMJ syndrome. Types of surgery include:
Arthroplasty – procedures that involve operating on the jaw joint
Condylotomy – surgical removal of part of the jaw bone

Prevention

There are no guidelines for preventing TMJ. If you have TMJ, the following may help prevent symptoms:
  • Have a night guard made, to prevent grinding your teeth at night.
  • Don't use a pillow for sleeping.
  • Try to limit jaw movements and learn to relax your jaw. Block a yawn by putting your fist under your chin.
  • Avoid yelling or loud singing.
  • Don't chew gum.
  • Learn relaxation techniques and better ways to cope with stress.