Temporomandibular joint disorders

Your temporomandibular joint (also referred to as TMJ) is the joint just in front of each ear, where your jaw bone connects to your skull. Problems with the TMJ and the muscles that control jaw movement are known as temporomandibular joint disorders, temporomandibular disorders (TMD) or TMJ syndrome.

TMJ disorders are common and can result in a painful, clicking or locking jaw. They tend to affect women more often than men.

Many people with TMJ disorders find that their symptoms improve with time, and only a small proportion develop ongoing problems. There are various treatments available to help control symptoms, including physiotherapy, medicines and dental treatments.

Symptoms

The most common symptom associated with TMJ disorders is dull, aching pain, which varies in strength from mild to severe. The pain is usually felt in the jaw, but can also be felt in the surrounding areas, including the face, ear and teeth. The pain may also radiate to the scalp, neck or shoulders, and some people get headaches.

The pain is usually worse when chewing (especially chewy or hard foods). It may also be exacerbated by yawning or talking for a long time.

Other signs and symptoms associated with TMJ disorders include:

  • jaw muscle tenderness;
  • noise in the joint - often a grating sensation or jaw clicking when chewing;
  • difficulty opening or closing the mouth completely; and
  • jaw locking, where the jaw temporarily locks into place when opening or closing the mouth.

What causes TMJ disorders?

There isn’t always an obvious cause for TMJ disorders. They may be caused by combination of problems with the joint and its surrounding structures.

The 3 most common types of temporomandibular disorders are:

  • pain and movement problems related to the muscles of the jaw, such as tension and spasm - this is known as myofascial pain and dysfunction;
  • internal derangement of the temporomandibular joint (where the disc that normally sits in the TMJ becomes misaligned); and
  • osteoarthritis of the TMJ.

TMJ syndrome can also be associated with:

  • other types of arthritis;
  • injury; and
  • joint hypermobility (looseness of the jaw).

Jaw clenching and teeth grinding (also known as bruxism) can put significant stress on jaw muscles and contribute to TMJ syndrome. Tooth grinding often happens during sleep, and is often related to stress and anxiety. Sleep disorders may also contribute.

Poor posture (e.g. holding the head forward while looking at your computer screen) may also strain the muscles of the jaw, face and neck.

How are TMJ disorders diagnosed?

If you have jaw pain or problems chewing, you should see your GP (general practitioner).

Your doctor will ask about your symptoms and whether anything makes the jaw pain or discomfort better or worse. They’ll want to examine your jaw and the surrounding muscles, and will ask you to open and close your mouth several times as part of the examination. They may also want to look at the inside of your mouth and your teeth.

Your doctor will be looking for the 4 main signs of TMJ syndrome - pain, noise coming from the joint, tenderness of the muscles used for chewing and problems moving the jaw.

Your doctor may also check for problems in other parts of your body, such as arthritis, and for other possible causes of facial pain such as sinusitis, ear infection, headache or nerve-related pain (trigeminal neuralgia).

Tests and referrals

Your doctor may recommend tests, such as an X-ray, ultrasound or MRI scan to look for problems with the temporomandibular joint. However, imaging tests such as these are not usually needed.

Your doctor may recommend you see your dentist, a dentist specialising in jaw disorders or a physiotherapist for specialised treatment.

People with severe symptoms or symptoms that are not improving may need to see a specialist doctor, such as a pain specialist or an oral and maxillofacial surgeon.

Treating TMJ disorders and pain

There are many different treatments available to relieve the symptoms of TMJ disorders. Depending on the cause of your problem, your doctor will be able to advise you of the treatments that are most suitable for you.

If you have jaw clicking, popping or other sounds when you chew, but no other symptoms, treatment is not usually recommended.

Self-care

Many people find that their symptoms get better with time, even without treatment. In the meantime, the pain and discomfort can be improved by simple things you can do yourself.

Self-care measures for TMJ disorders include:

  • resting the jaw by eating soft foods and avoiding hard and chewy foods, chewing gum, nail biting and excessive talking;
  • gentle muscle stretching and relaxing exercises; and
  • using heat packs or warm compresses several times per day for pain relief.

Stress relief

Managing stress and anxiety is important if this is causing or contributing to the pain. There are various ways to help relieve stress, including doing yoga, deep breathing exercises or meditation. Practising progressive muscle relaxation and doing regular exercise, such as swimming or walking, can also help.

Cognitive behavioural therapy has been studied as a possible to treatment for TMJ disorders to help reduce stress and anxiety, relieve TMJ pain and improve coping skills.

Medicines

If self-care measures and stress relief are not helping, your doctor may recommend medicines.

  • Pain relievers can help ease the pain of some types of TMJ disorders in the short term. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are usually recommended.
  • Muscle relaxants such as benzodiazepines (e.g. diazepam) can relieve symptoms of ongoing muscle pain. These medicines are only prescribed for a short period of time - usually about 10 days.
  • Certain types of antidepressant medicines, including tricyclic antidepressants, have been shown to relieve pain in people with TMJ disorders.
  • Injections of botulinum toxin type A into the muscles involved in jaw movement may be helpful in people with TMJ disorders caused by muscular problems.

Your doctor will talk to you about the common side effects of these medicines and the risks and benefits of taking them.

Physiotherapy

Treatment with a physiotherapist can help reduce the pain and movement problems associated with TMJ disorders. Therapies used include:

  • massage;
  • ultrasound treatment;
  • specific jaw muscle exercises;
  • transcutaneous electrical nerve stimulation (TENS), which uses mild electrical currents from electrodes that are taped to the skin to treat pain; and
  • electromyographic feedback (biofeedback), which is a treatment used to help you to learn to relax your jaw muscles.

Dental treatments

If you have been grinding your teeth at night, it may help to wear a special mouthguard (also known as a mouth splint or night guard appliance) while you sleep. By helping prevent jaw clenching and teeth grinding, a mouthguard can ease the tension in your jaw muscles.

Oral splints can also be worn during the day to relax your jaw muscles and prevent damage to your teeth from grinding. Day splints are usually only used on a short-term basis.

Surgery for TMJ disorders

Arthroscopic or open-joint surgery may be suggested for some people with severe and persistent TMJ disorders with structural problems in the joint. However, surgery is usually only recommended for those who have not responded to other treatments.

Your doctor will discuss the pros and cons of the different procedures and whether they would be appropriate in your case.

Alternative therapies

Acupuncture may help relieve pain in people with TMJ disorders, but more studies are needed to prove its effectiveness.

Low-level laser therapy and injections of hyaluronic acid have also been studied for symptom relief in TMJ syndrome. More studies are needed to prove that these therapies are safe and effective.

Support groups

There are support groups in Australia for people with TMJ disorders. Search for a support group online or ask your doctor if there are any local groups that would be suitable. Support groups can be very helpful in connecting people with similar problems who can give each other practical advice and emotional support.

References

1. Orofacial pain: Temporomandibular disorders (published March 2012). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2018 Jul. https://tgldcdp.tg.org.au/ (accessed Nov 2018).
2. BMJ Best Practice. Temporomandibular joint syndrome (updated March 2018; reviewed October 2018). https://bestpractice.bmj.com/ (accessed Nov 2018).
3. Lomas J, Gurgenci T, Jackson C, Campbell D. Temporomandibular dysfunction. AJGP 2018;47(4). https://www1.racgp.org.au/AJGP/2018/April/Temporomandibular-dysfunction (accessed Nov 2018).
4. National Institute of Dental and Craniofacial Research, National Institutes of Health (US). TMJ (temporomandibular joint and muscle disorders) (reviewed Jul 2018). https://www.nidcr.nih.gov/health-info/tmj/more-info (accessed Nov 2018).
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