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Temporomandibular Joint Disorders

Overview

Temporomandibular joint (TMJ) disorders are a result of the inflammation of the TMJ, a hinge-like joint that connects the lower jaw to the skull, resulting in severe jaw and neck pain and headaches.

The combination of a hinge-like action and sliding motions is responsible for the movement-related functions performed by the TMJ. The parts of the bones that interact within the TMJ are protected by cartilage; the articular disk, a shock-absorbing disk, which ensures smooth movement, is present between these parts. TMJ disorders, which are often quite painful, can occur due to the following causes: 

  • Erosion of the articular disk or its displacement and misalignment
  • Arthritis-induced damage to the cartilage in the TMJ
  • Damage to the joint caused by a blow or other accidents
  • Bruxism

The symptoms of TMJ disorders include the following:

  • Soreness or stiffness in the jaw muscle
  • Frequent headaches, neck pain, and migraines
  • Clicking or popping of the jaw
  • Trismus (lockjaw)
  • Pain when eating or yawning
  • A misaligned bite
  • Pain and swelling around the jaw joint
  • Tenderness of the jaw muscles

Usually, TMJ disorders are diagnosed on the basis of an oral examination. Dentists will examine the jaw when the mouth is opened and closed to check for clicking sounds and assess the range of motion of the jaw; further, they will gently press some areas in the jaw to locate any sites of pain. If any problem is suspected based on the findings of the aforementioned tests, the following procedures may be needed:

  • Dental X-ray: to examine the jaw and/or teeth and identify any bone-related problems.
  • CT scan: for a detailed analysis of the bones involved in the functioning of the TMJ.
  • MRI: to detect problems in the articular disk or surrounding soft tissues.
  • TMJ arthroscopy: insertion of a small thin tube (cannula) into the joint space and visualisation of the joint region using a small camera (arthroscope); this technique is sometimes used to diagnose TMJ disorders.

While symptoms sometimes disappear without treatment, TMJ disorders may case persistent symptoms, in which case one or more of the following treatment options (often performed simultaneously) are recommended:

  • Medications: The following medications may help alleviate TMJ disorder-induced pain (when administered along with other nonsurgical treatments):
    • Pain killers and anti-inflammatories.
    • Tricyclic antidepressants for controlling bruxism and sleeplessness and relief from pain.
    • Muscle relaxants, such as antispasmodics, may be used for a few days or weeks: these provide relief from the pain attributed to muscle spasms.
  • Nondrug therapies: TMJ disorders may also be treated using nondrug therapies:
    • Application of mouth guards or splints: These occlusal devices, which may be soft or firm depending on the nature of use, are often beneficial for people with jaw pain when inserted over the teeth. However, the mechanisms by which they provide pain relief remain unclear.
    • Physical therapy: To maintain the flexibility and strength of the jaw muscles, dentists often recommend exercises along with the administration of ice, moist heat, and ultrasound therapies.
    • Counselling: Awareness, education, and counselling can help patients identify problematic habits, i.e., those that may exacerbate pain, such as leaning on the chin, tooth clenching/grinding, or onychophagia (biting fingernails). Accordingly, patients may be trained to avoid such habits via corrective psychotherapy.
  • Surgeries and other related procedures: If other conservative approaches fail to provide relief from symptoms, surgical procedures to correct the jaw and the TMJ may be recommended.
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