What Is Temporomandibular Joint Disorder?

Temporomandibular joint disorder, commonly referred to as TMJ disorder, is a condition that affects the temporomandibular joint, which connects the jawbone to the skull. This disorder is characterized by dysfunction, pain, and discomfort in the muscles and joints responsible for jaw movement. The main causes of TMJ disorder include jaw injuries, arthritis, misalignment of the teeth or jaw, teeth grinding, stress, and poor posture. Symptoms can manifest as jaw pain, clicking or popping sounds when opening or closing the mouth, difficulty chewing or talking, facial pain, and headaches.

Overview

The two joints that attach your lower jaw to your skull are called the temporomandibular joints (TMJ). The mandible, or lower jaw, and the temporal bone, or side and base of the skull, make up these joints, which slide and rotate in front of each ear. The joint performs the function of speaking, chewing, and yawning movements. 

The dysfunction of the temporomandibular joint is referred to as temporomandibular joint disorder or TMJ disorder. A variety of symptoms and effects on daily activities might result from the muscles, ligaments, and bones surrounding the joint experiencing malfunction or pain. Each person will experience TMJ condition differently, and it can be either acute or chronic .¹

Based on the National Institute of Dental and Craniofacial Research, temporomandibular disorder (TMD) can be classified as:

• Myofascial tissue pain: TMD most frequently manifests in this way. It causes discomfort or soreness in the muscles that operate the jaw, neck, and shoulder as well as in the fascia, the connective tissue that covers the muscles.

• Joint internal derangement: Specifically, this refers to a dislocated jaw, displaced disc (the cartilage cushion between the jaw bone's head and the skull), or damage to the condyle (bony projections fitting into the skull depression).
• Joint degeneration: The TMJ can be affected by degenerative conditions such as rheumatoid arthritis or osteoarthritis. 

Each of these circumstances can be had concurrently.¹

Causes of TMJ disorder

TMJ disorder can have multiple causes, and often, it is a combination of factors that contribute to its development. Some common causes include:

• Jaw injuries: Trauma or injury to the jaw can result in TMJ disorder.
• Arthritis: Conditions such as osteoarthritis and rheumatoid arthritis can affect the temporomandibular joint.
• Misalignment of the teeth or jaw: Irregularities in dental occlusion or improper alignment of the jaw can contribute to TMJ disorder.
• Teeth grinding (bruxism): Habitual grinding or clenching of the teeth can place excessive strain on the temporomandibular joint.
• Stress: Emotional or psychological stress can lead to jaw clenching and muscle tension, exacerbating TMJ disorder.
• Poor posture: Slouching or maintaining poor posture can strain the muscles and joints involved in jaw movement .²

Signs and symptoms of TMJ disorder

The signs and symptoms of TMJ disorder can vary widely among individuals. Some common indicators include:

• Jaw pain or tenderness: Discomfort or pain in the jaw joint or surrounding muscles is a common symptom.
• Clicking, popping, or grating sounds: These sounds may occur when opening or closing the mouth and can be accompanied by pain.
• Limited jaw movement: Difficulty in fully opening or closing the mouth can be experienced.
• Facial pain: TMJ disorder can cause pain in the face, particularly around the jaw joint, temples, or ears.
• Headaches or migraines: Some individuals may experience frequent headaches, including migraines and dizziness due to TMJ disorder.
• Ear-related symptoms: TMJ disorder can be associated with ear pain, ringing in the ears (tinnitus), or a feeling of fullness in the ears.
• Difficulty chewing or biting: TMJ disorder can make it challenging to chew or bite food properly.^3,4

Management and treatment for TMJ disorder

The management and treatment of TMJ disorder focus on relieving pain, improving jaw function, and addressing the underlying causes. The approach to treatment may vary depending on the severity of symptoms, individual needs, and the underlying factors contributing to TMJ disorder. Here are some common management strategies:

1. Lifestyle modifications: Making simple changes in daily habits can have a positive impact on TMJ disorder. These modifications may include:
   • Practising stress management techniques
   • Maintaining good posture
   • Avoiding hard or chewy foods

• Self-care measures: Several self-care measures can be implemented to alleviate TMJ disorder symptoms. These may include:
  •  Applying heat or cold packs
  • Jaw exercises: Your healthcare provider or physical therapist can guide you on appropriate exercises.
  • Avoiding excessive jaw movements

• Medications: Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, may help alleviate pain and reduce inflammation associated with TMJ disorder. Muscle relaxants or low-dose tricyclic antidepressants may be prescribed in some cases to manage muscle spasms or associated chronic pain.
• Oral splints or mouthguards: These devices are custom-made by dental professionals and can help align the jaw and reduce teeth grinding or clenching. Oral splints can be worn during sleep or throughout the day, depending on the individual's needs. They provide a cushioning effect, protect the teeth, and relieve strain on the jaw joint.
• Physical therapy: Physical therapy techniques can be beneficial in managing TMJ disorder. Therapeutic exercises, ultrasound therapy, electrical stimulation, and manual techniques can improve jaw mobility, reduce pain, and increase muscle strength. A physical therapist experienced in TMJ disorders can design an individualized treatment plan.
• Dental treatments: In some cases, dental treatments may be necessary to address bite abnormalities or misalignments that contribute to TMJ disorder. Orthodontic treatments, dental crowns, or tooth realignment procedures can help improve dental occlusion and reduce stress on the jaw joint.
• Injections: In severe cases of TMJ disorder, injections may be considered for pain relief. Corticosteroid injections into the joint or local anaesthetic injections into the muscles can provide temporary relief from severe pain and inflammation.
• Surgery: Surgery is typically reserved for cases of TMJ disorder that do not respond to conservative treatments. Surgical interventions may involve joint replacements, joint repositioning, or arthroscopy to repair or remove damaged tissues within the joint. Surgery is considered a last resort and is only recommended when other treatment options have been exhausted.^3,5

Diagnosis

Diagnosing TMJ disorder involves a comprehensive evaluation of the patient's medical history, a physical examination of the jaw joint and surrounding structures, and, if necessary, additional diagnostic tests. Here are the steps involved in the diagnosis of TMJ disorder:

1. Medical history: The healthcare provider will begin by taking a detailed medical history, including asking about the patient's symptoms, the duration and frequency of the symptoms, any previous injuries or trauma to the jaw, and any other relevant medical conditions.
2. Physical examination: A physical examination will be performed to assess the jaw joint and surrounding structures. This may include:
   • Palpation: The healthcare provider will gently feel the jaw joint and muscles for any tenderness, swelling, or abnormalities.
   • Range of motion assessment: The patient will be asked to open and close their mouth, move their jaw from side to side, and perform other movements to evaluate the range of motion and identify any limitations or difficulties.
   • Bite evaluation: The dentist or healthcare provider may assess the alignment of the teeth and how the upper and lower jaws fit together when biting or chewing.
3. Additional diagnostic tests: In some cases, additional tests may be required to confirm the diagnosis and rule out other possible causes of the symptoms. These may include:
   • Dental X-rays: X-rays can help evaluate the teeth, jawbone, and temporomandibular joint. They can identify any abnormalities, such as fractures, dislocations, or degenerative changes.
   • Magnetic resonance imaging (MRI): An MRI scan provides detailed images of the jaw joint and surrounding structures. It can help visualize the disc within the joint, detect any structural abnormalities, and assess the extent of damage or inflammation.
   • Computed tomography (CT) scan: A CT scan can provide cross-sectional images of the jaw joint, revealing detailed information about the bony structures and joint abnormalities.
   • Electromyography (EMG): EMG measures the electrical activity of the jaw muscles. It can help identify muscle imbalances, tension, or spasms associated with TMJ disorder.
4. Referral to specialists: In complex cases or when the diagnosis is uncertain, the healthcare provider may refer the patient to a specialist, such as a dentist specializing in orofacial pain or a maxillofacial surgeon. These specialists have advanced training and expertise in diagnosing and treating TMJ disorders. It is important to remember that the diagnosis of TMJ disorder may require the involvement of multiple healthcare professionals, including dentists, oral and maxillofacial surgeons, and physical therapists. A comprehensive evaluation and accurate diagnosis are essential to develop an effective treatment plan tailored to the individual's specific needs.⁵ 

FAQs

Can TMJ disorder be prevented?

While it may not be possible to prevent TMJ disorder entirely, adopting healthy habits such as maintaining good posture, practising stress management techniques, and avoiding excessive teeth grinding or clenching can reduce the risk of this condition.

How common is TMJ disorder?

TMJ affects between 10 and 35 million people in the United States at any given moment, according to estimates. It can affect individuals of any age, but it is more commonly seen in people of childbearing age.⁶

Who is at risk of TMJ disorder?

Several factors can increase the risk of developing TMJ disorder, including a history of jaw injuries, certain dental conditions, hormonal influences (more prevalent in people assigned female at birth (AFAB), and individuals who frequently clench or grind their teeth.⁶

When should I see a doctor?

If you experience persistent jaw pain, difficulty in opening or closing your mouth, or any other symptoms associated with TMJ disorder that significantly impact your daily life, it is advised to speak with a healthcare professional for a precise diagnosis and the best course of treatment.

Summary

Temporomandibular joint disorder (TMJ disorder) is a condition that affects the temporomandibular joint, causing pain and dysfunction in the jaw muscles and joints. It can arise from various causes, including jaw injuries, misalignment, teeth grinding, and stress. The symptoms of TMJ disorder can range from jaw pain and limited movement to facial pain, headaches, and ear-related symptoms. Treatment options include lifestyle modifications, self-care measures, medications, dental treatments, physical therapy, and in some cases, surgery. If you suspect TMJ disorder, it is advisable to seek medical attention for proper diagnosis and appropriate management.