TMJ disorders are a subset of problems assigned to the larger category known as temporomandibular dysfunction (TMD). This is a family of problems related to the jaw joints (temporomandibular joints), the upper and lower jaws, associated muscles and ligaments, and the teeth.

Symptoms of TMD can be subtle or profound and may include mild temporal headaches, pain in front of the ears, stiffness of the jaw muscles and pain associated with jaw movement such as with chewing or wide opening. Some people will notice intermittent clicking or popping sounds coming from the jaw joint area with jaw movement. This usually represents a disorder involving the TMJ disc. The disc is a cushion inside the jaw joint, which can become displaced. When the disc is out of position it will effect the smooth movement of the jaw resulting in clicking and possible pain coming from the joint area during jaw use. More advanced cases may include difficulty with mouth opening (locking) which can last for a few moments, hours, days or may be permanent. The most severe conditions generally are associated with greater levels of discomfort. The end stage of advanced TMJ dysfunction may be arthritis, which consists of bony degeneration of the TMJ leading to chronic pain, limited jaw mobility and scraping or irregular sounds emanating from the joint area during function. TMD may develop for many reasons. It is common to find more than one factor contributing to the onset of the condition.

Treatment

It is important to properly diagnose the condition prior to prescribing treatment. A general dentist is usually the first to recognize the signs and symptoms of TMD and may direct treatment. More advanced cases or patients who do not respond to initial treatment may be referred to a specialist for further evaluation. Evaluation may include a review of the patient’s history, condition, physical exam and radiographs. Other tests such as CT or MRI scans may be used for more in depth study of the joint area. Once a diagnosis of TMD has been made, a variety of measures may be implemented for treatment. The measures are aimed at eliminating as many of the factors that may have contributed to the onset of the TMD. Most of the treatment can be considered self-care.

The following is a list of some common self-care treatments:

• Jaw rest
• Avoiding wide opening
• Keep teeth apart while not eating (avoid clenching)
• Eating soft foods
• Applying ice and heat to affected area
• Avoiding gum chewing
• Jaw exercises
• Stress reduction

Beyond self-care, treatment may involve the use of a bite splint (night guard) to reduce clenching activity thereby reducing muscle, joint and dental injury. Muscle relaxants, anti-inflammatory agents and physical therapy can reduce pain, clenching activity and improve jaw mobility. Occlusal adjustment (bite adjustment), restorative dentistry and orthodontics may be used to correct significant problems with the alignment of teeth. Problems with jaw alignment due to growth, trauma, or degenerative joint disease can be managed with corrective jaw surgery. Surgery on the temporomandibular joint is usually confined to those patients who have painful clicking, locking or an inability to open their mouth. Surgery is only considered when non-surgical treatments have been unsuccessful or are not indicated. Approximately 80% of TMD sufferers improve with conservative management (non-surgical). Treatment may take months or years, depending on the severity and causes of the condition.

 

 

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