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Treatment Temporomandibular Joint and Muscle Disorders

Temporomandibular joint and muscle disorders, commonly called "TMJ," are a group of conditions that cause pain and dysfunction in the jaw joint and the muscles that control jaw movement. We don’t know for certain how many people have TMJ disorders, but some estimates suggest that over 10 million Americans are affected. The condition appears to be more common in women than men.

What is the temporomandibular joint?

The temporomandibular joint connects the lower jaw, called the mandible, to the bone at the side of the head—the temporal bone. If you place your fingers just in front of your ears and open your mouth, you can feel the joints. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. Muscles attached to and surrounding the jaw joint control its position and movement.

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When we open our mouths, the rounded ends of the lower jaw, called condyles, glide along the joint socket of the temporal bone. The condyles slide back to their original position when we close our mouths. To keep this motion smooth, a soft disc lies between the condyle and the temporal bone. This disc absorbs shocks to the jaw joint from chewing and other movements.

The temporomandibular joint is different from the body’s other joints. The combination of hinge and sliding motions makes this joint among the most complicated in the body. Also, the tissues that make up the temporomandibular joint differ from other load-bearing joints, like the knee or hip. Because of its complex movement and unique makeup, the jaw joint and its controlling muscles can pose a tremendous challenge to both patients and health care providers when problems arise.

What are TMJ disorders?

Disorders of the jaw joint and chewing muscles—and how people respond to them—vary widely. Researchers generally agree that the conditions fall into three main categories:

  1. Myofascial pain, the most common temporomandibular disorder, involves discomfort or pain in the muscles that control jaw function.
  2. Internal derangement of the joint involves a displaced disc, dislocated jaw, or injury to the condyle.
  3. Arthritis refers to a group of degenerative/inflammatory joint disorders that can affect the temporomandibular joint.

A person may have one or more of these conditions at the same time. Some people have other health problems that co-exist with TMJ disorders, such as chronic fatigue syndrome, sleep disturbances or fibromyalgia, a painful condition that affects muscles and other soft tissues throughout the body. It is not known whether these disorders share a common cause.

People who have a rheumatic disease, such as rheumatoid arthritis, may develop TMJ disease as a secondary condition. Rheumatic diseases refer to a large group of disorders that cause pain, inflammation, and stiffness in the joints, muscles, and bone. Both rheumatoid arthritis and some TMJ disorders involve inflammation of the tissues that line the joints. The exact relationship between these conditions is not known.

How jaw joint and muscle disorders progress is not clear. Symptoms worsen and ease over time, but what causes these changes is not known. Most people have relatively mild forms of the disorder. Their symptoms improve significantly, or disappear spontaneously, within weeks or months. For others, the condition causes long-term, persistent and debilitating pain.

Symptoms

A variety of symptoms may be linked to TMJ disorders. Pain, particularly in the chewing muscles and/or jaw joint, is the most common symptom. Other likely symptoms include:

  • radiating pain in the face, jaw, or neck,
  • jaw muscle stiffness,
  • limited movement or locking of the jaw,
  • painful clicking, popping or grating in the jaw joint when opening or closing the mouth,
  • a change in the way the upper and lower teeth fit together.

Diagnosis

There is no widely accepted, standard test now available to correctly diagnose TMJ disorders. Because the exact causes and symptoms are not clear, identifying these disorders can be difficult and confusing. Currently, health care providers note the patient’s description of symptoms, take a detailed medical and dental history, and examine problem areas, including the head, neck, face, and jaw. Imaging studies may also be recommended.

You may want to consult your doctor to rule out known causes of pain. Facial pain can be a symptom of many other conditions, such as sinus or ear infections, various types of headaches, and facial neuralgias (nerve-related facial pain). Ruling out these problems first helps in identifying TMJ disorders.

Causes

Trauma to the jaw or temporomandibular joint plays a role in some TMJ disorders. But for most jaw joint and muscle problems, scientists don’t know the causes. For many people, symptoms seem to start without obvious reason. Research disputes the popular belief that a bad bite or orthodontic braces can trigger TMJ disorders. Because the condition is more common in women than in men, scientists are exploring a possible link between female hormones and TMJ disorders.

There is no scientific proof that clicking sounds in the jaw joint lead to serious problems. In fact, jaw clicking is common in the general population. Jaw noises alone, without pain or limited jaw movement, do not indicate a TMJ disorder and do not warrant treatment.

The roles of stress and tooth grinding as major causes of TMJ disorders are also unclear. Many people with these disorders do not grind their teeth, and many long-time tooth grinders do not have painful joint symptoms. Scientists note that people with sore, tender chewing muscles are less likely than others to grind their teeth because it causes pain. Researchers also found that stress seen in many persons with jaw joint and muscle disorders is more likely the result of dealing with chronic jaw pain or dysfunction than the cause of the condition.

 

Reference:

National Institute of Dental and Craniofacial Research, USA.