What Is the TMJ?

The temporomandibular joint connects the jaw to the skull by means of the temporal bones, which are located in front of the ears. It’s the joint that acts like a hinge when the jaw opens and closes, moves up and down, or moves side to side as you are chewing, talking, and yawning. When a patient has issues with the jaw and the related facial muscles that go with it, they are said to have a temporomandibular disorder (TMD). Some people erroneously refer to these problems as TMJ, though, because of the name of the joint.

What Are the Causes of TMD?

There are many theories about what causes TMD, but there is no definitive answer to this question. Most dentists think that the issues are related to the jaw muscles or to some defective parts of the temporomandibular joint itself. Other reasons a patient may develop TMD include:

  • Grinding or clenching the teeth
  • Stress, which can make people tighten their jaw and facial muscles and/or clench their teeth
  • An injury to the TMJ, the jaw, or the head and neck muscles – for example, whiplash or a heavy blow to the head or neck
  • Arthritis in the temporomandibular joint
  • Movement of the soft cushion or disc between the ball and the socket in the TMJ

How Do I Know If I Have TMD?

Most people have no difficulty realizing that they have TMD because of the terrible pain and discomfort that usually accompanies it. This pain can last for a short time or for years at a time. Typically, TMD affects people between the ages of 20 and 40, and more women than men experience it. TMD can occur in just one side of the face, or on both sides.
Many of our patients complain of the following symptoms associated with TMD:

  • Pain or tenderness in the face, neck, shoulders, jaw joint, and/or in or around the ear when talking, chewing, or opening the mouth wide
  • Grating, popping, or clicking sounds coming from the jaw when opening or closing one’s mouth – these sounds may be accompanied by pain but they do not have to be
  • Trouble opening the mouth widely
  • The facial muscles feeling “tired”
  • The jaw getting “locked” or “stuck” in a certain position, whether the mouth is open or closed
  • Facial swelling, particularly on the side of the face
  • Difficulty chewing or a feeling that the top and bottom teeth are not fitting together the way they should when biting
  • Toothaches
  • Hearing problems
  • Ringing in the ears (aka tinnitus)
  • Pain in the upper shoulders
  • Dizziness
  • Headaches
  • Neck aches

How Can TMD Be Treated?

For some patients, TMD symptoms eventually subside without requiring treatment. But for those whose symptoms continue, your doctor may suggest one or more of the following treatment options:

  • Physical therapy – this could involve exercises to strengthen and stretch the jaw muscles, ice, ultrasound, and/or moist heat.
  • Counseling –for those patients whose symptoms are caused and/or exacerbated by stress, counseling may help them understand the factors that provoke the painful responses like teeth grinding, teeth clenching, biting one’s fingernails, or leaning on one’s chin.
  • Bite guards/oral splints – these devices, which can be firm or soft, are worn over the teeth and provide some patients with relief from their jaw pain. The exact reasons why these devices help are not known, but this is a safe, noninvasive option that many people find effective.

Medications – these are often combined with other nonsurgical treatments to provide pain relief for TMD sufferers. There are several varieties of medications that are used for this purpose, such as:

  • Pain relievers – if over-the-counter pain medications are ineffective for relieving a patient’s TMD symptoms, stronger pain relievers may be prescribed.
  • Sedatives – if the patient is prone to nighttime teeth clenching that is making the pain worse, a doctor may prescribe a sedative like clonazepam (Klonopin) to keep the patient from clenching or grinding in their sleep.
  • Muscle relaxers – these types of medication are used temporarily, whether for a few days or a few weeks, to alleviate pain experienced by TMD sufferers.
  • Tricyclic antidepressants – although these are most commonly used to treat depression, some of them, such as amitriptyline, can also provide pain relief.

Medical procedures – these are usually the last resort, but if the above strategies do not help, your doctor may recommend one of the following:

  • Injections –similarly to other types of joint pain, TMD pain sometimes responds to corticosteroid injections. In some cases, a doctor may choose to inject botulinum toxin (aka Botox and similar drugs) into the jaw muscles to help with pain while chewing.
  • Arthrocentesis – in this procedure, the doctor carefully inserts needles into the temporomandibular joint in order to use fluid to irrigate the area, getting rid of debris and inflammatory materials.
  • Surgery – for those patients who cannot find relief from their jaw pain via more conservative methods due to the fact that the problem seems to originate within the temporomandibular joint itself, a doctor or dentist may recommend surgery to either replace or repair the joint. This approach is somewhat controversial, however; the National Institute of Dental and Craniofacial Research strongly advises against performing these types of surgeries unless all other options have been exhausted.

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