Temporomandibular Joint Disorder (TMJ Disorder)

What is temporomandibular joint disorder?

Temporomandibular joint disorder (TMJ disorder) is a condition that causes frequent pain in the jaw joint. The pain occurs where the jaw meets the skull, just in front of the ear on each side of the face. Another term for this disorder is myofascial pain dysfunction of the jaw.

TMJ disorder is more common in women than men.

How does it occur?

The cause of TMJ disorder is usually not known, but causes can include:

• Frequent clenching of the jaw or grinding of the teeth (the most common cause). You may clench your jaws or grind your teeth when you are feeling stressed or when you are sleeping. If you do it mainly when you are sleeping, you may not even know you are doing it.
• Ill-fitting dentures.
• Frequent chewing of gum or ice.
• Physical or dental abnormalities, such as problems of teeth alignment.
• Injury from, for example, prolonged or repeated opening of the jaw or a direct blow to the joint. Pain from the injury may seem to go away after just a short time, but months to years later painful traumatic arthritis may develop in the joint.
• Other forms of arthritis in the jaw, such as rheumatoid arthritis or osteoarthritis.

What are the symptoms?

The most common symptom is pain in the jaw joint. The pain is usually dull but sometimes sharp. In most cases the pain is worse when you move your jaw, especially when you are chewing. If you are grinding your teeth at night, the pain may also be worse first thing in the morning.

Other possible symptoms are:

• clicking, popping, or grating sounds when you move your jaw
• trouble completely opening your jaw or an uncomfortable bite
• headache
• ear pain or earache.

The painful symptoms of TMJ disorder can be similar to the symptoms of other conditions, such as ear problems. For this reason, you should see your healthcare provider about the pain.

How is it diagnosed?

Your healthcare provider will want to know when your jaw hurts and how long it has been hurting. He or she will ask if your jaw has been injured or if you have had dental work recently.

Your healthcare provider will examine your jaw for tenderness and check how it moves. An X-ray may be taken.

How is it treated?

To help relieve your symptoms:

• Avoid overusing your jaw. Rest your jaw by eating only soft food. Do not chew gum or ice.
• Try not to clench your jaw or grind your teeth. Your healthcare provider may recommend a bite block (also called a night guard), which is a plastic mouthpiece that stops the teeth from grinding together. Bite blocks are usually worn only at night.
• Your dentist may make a hard splint for you to wear during the day to keep your jaw from closing completely.
• Put a warm, moist washcloth on your jaw for 20 minutes, 4 to 8 times a day.
• Massage the joint by pressing gently with your fingertips and moving them in a circular direction.
• Put a cloth-covered ice pack on your jaw for 20 minutes 4 to 8 times a day.
• Ask your healthcare provider about taking an anti-inflammatory medicine, such as ibuprofen, to help the joint become less irritated. Nonsteroidal anti-inflammatory medicines (NSAIDs) may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days for any reason.
• In some cases your provider may recommend a shot of steroid or cortisone in the joint to treat the inflammation.

Other treatments may include taking muscle relaxants for a few days, using relaxation techniques, and learning ways to have less stress. Your healthcare provider may refer you to a physical therapist for treatment, such as massage and exercises that gently stretch the muscles and help with relaxation. If your pain is clearly related to stress, counseling and medicine can help.

If there is a problem with the way your teeth fit together when you bite, you may need to see a dentist.

Surgery is rarely necessary. Before you have jaw surgery, get a second opinion, preferably from a healthcare provider or dentist who has a lot of experience with this problem.

How can I help prevent TMJ disorder?

Because the cause of TMJ disorder is not known, healthcare providers do not know how to prevent it. But the following may help:

• Avoid overusing your jaw (for example, avoid chewing gum or ice).
• Try not to grind your teeth.
• See your dentist for treatment of teeth that are not aligned well.