What are the main types of Temporomandibular Disorders. How are TMDs diagnosed and treated. What causes TMD and who is most affected by this condition. What are the common symptoms of TMD and when should you seek medical help. How can TMD be managed at home with simple lifestyle changes.

What Are Temporomandibular Disorders (TMDs)?

Temporomandibular disorders (TMDs) encompass a group of over 30 conditions affecting the jaw joint and muscles controlling jaw movement. The term “TMJ” specifically refers to the temporomandibular joint itself, while “TMDs” denote the broader spectrum of disorders associated with this joint.

TMDs are classified into three main categories:

• Disorders of the joints, including disc disorders
• Disorders of the masticatory muscles (used for chewing)
• TMD-associated headaches

Each category comprises several specific disorders, creating a complex landscape of potential diagnoses. It’s important to note that an individual may experience one or more of these conditions simultaneously.

The Prevalence and Impact of TMDs

Recent studies have shed light on the widespread nature of TMDs in the United States. Approximately 11-12 million adults report experiencing pain in the temporomandibular joint region. Interestingly, TMDs exhibit a gender disparity, affecting women twice as frequently as men. This discrepancy is particularly pronounced among women aged 35 to 44.

While many TMDs are short-lived and resolve independently, some cases can become chronic, significantly impacting an individual’s quality of life. TMDs may occur in isolation or coincide with other medical conditions such as headaches, back pain, sleep disorders, fibromyalgia, and irritable bowel syndrome.

What Causes Temporomandibular Disorders?

The etiology of TMDs is often multifaceted and not always clear-cut. While injury to the jaw or temporomandibular joint can trigger some TMDs, many cases seem to develop without an apparent cause. Recent research points to a complex interplay of factors:

• Genetic predisposition
• Psychological stressors
• Individual pain perception
• Life stressors

These elements may collectively influence both the onset and chronicity of TMDs. Researchers are also exploring the potential role of structural and mechanical differences in the TMJ between males and females, given the higher prevalence among women.

Contrary to popular belief, research does not support the notion that malocclusion (a “bad bite”) or orthodontic treatment causes TMDs.

Recognizing the Symptoms of TMD

Identifying TMDs can be challenging due to the variety of symptoms and their overlap with other conditions. However, certain signs may indicate the presence of a temporomandibular disorder:

• Pain in the chewing muscles and/or jaw joint (the most common symptom)
• Pain radiating to the face or neck
• Jaw stiffness
• Limited jaw movement or locking
• Painful clicking, popping, or grating in the jaw joint during mouth movements
• Tinnitus, hearing loss, or dizziness
• Changes in dental occlusion (how upper and lower teeth fit together)

It’s crucial to differentiate between normal joint sounds and those indicative of a problem. Clicking or popping sounds without associated pain are common, considered normal, and typically don’t require treatment.

How Are TMDs Diagnosed?

Diagnosing TMDs presents a unique challenge due to the lack of a standardized, universally accepted diagnostic test. The process often involves a comprehensive approach:

1. Detailed medical history: Your healthcare provider will inquire about your symptoms, their location, timing, exacerbating and alleviating factors, and any pattern of spread.
2. Assessment of other pain conditions: Information about concurrent issues like headaches or back pain is crucial.
3. Physical examination: The practitioner will examine your head, neck, face, and jaw for tenderness, abnormal sounds, or movement difficulties.
4. Imaging studies: X-rays, MRI, or CT scans may be recommended to visualize the joint structures.

Given the overlap of symptoms with other conditions, your doctor may need to rule out alternative diagnoses before confirming a TMD.

Treatment Approaches for TMDs

When considering treatment for TMDs, it’s essential to understand several key points:

• Many TMD symptoms resolve spontaneously without intervention.
• Joint sounds without pain are normal and don’t necessitate treatment.
• Due to limited evidence supporting most TMD treatments, experts advise against interventions that permanently alter jaw joints, teeth, or bite, as well as surgical procedures.

Initial treatment often focuses on conservative, nonsurgical approaches:

1. Dietary modifications: Consuming softer foods to reduce jaw strain.
2. Application of ice or heat: To alleviate pain and promote healing.
3. Over-the-counter pain relievers: Such as ibuprofen or acetaminophen.
4. Gentle jaw exercises: To improve mobility and reduce stiffness.
5. Stress reduction techniques: Including relaxation exercises or counseling.

In some cases, your healthcare provider may recommend additional interventions:

• Physical therapy
• Prescription medications (e.g., muscle relaxants, anti-inflammatory drugs)
• Oral appliances or splints
• Cognitive behavioral therapy

Self-Care Strategies for Managing TMDs

Individuals experiencing TMD symptoms can implement several self-care measures to alleviate discomfort and promote healing:

• Practice good posture, especially when using electronic devices
• Avoid excessive jaw movements (e.g., wide yawning, gum chewing)
• Use proper technique when biting into large foods
• Hold a warm, moist towel against the affected area
• Engage in stress-reduction activities like meditation or yoga
• Maintain a balanced diet rich in anti-inflammatory foods

These strategies can complement professional treatment and may provide significant relief for many individuals with TMDs.

When to Seek Professional Help for TMD Symptoms

While many cases of TMD resolve on their own, certain situations warrant professional evaluation:

• Persistent pain lasting more than a few weeks
• Inability to open or close your mouth fully
• Difficulty eating or speaking due to jaw problems
• Jaw pain accompanied by other concerning symptoms (e.g., fever, swelling)

Early intervention can prevent the progression of TMDs and improve outcomes. Your dentist or primary care physician can provide an initial assessment and refer you to a specialist if necessary.

The Role of Interdisciplinary Care in TMD Management

Given the complex nature of TMDs, an interdisciplinary approach to care often yields the best results. This may involve collaboration between:

• Dentists specializing in orofacial pain
• Physical therapists
• Pain management specialists
• Psychologists or psychiatrists
• Otolaryngologists (ear, nose, and throat doctors)

This comprehensive approach ensures that all aspects of the disorder are addressed, from physical symptoms to psychological factors influencing pain perception and coping mechanisms.

Emerging Research and Future Directions in TMD Treatment

The field of TMD research is dynamic, with ongoing studies exploring new avenues for diagnosis and treatment:

• Genetic markers: Identifying genetic factors that may predispose individuals to TMDs
• Biomarkers: Developing tests to objectively measure TMD presence and severity
• Personalized medicine: Tailoring treatments based on individual genetic and physiological profiles
• Novel pain management techniques: Exploring alternatives to traditional medications

These advancements hold promise for more accurate diagnoses and targeted therapies in the future, potentially improving outcomes for those affected by TMDs.

Living with TMD: Long-Term Management and Quality of Life

For individuals with chronic TMDs, long-term management strategies are crucial:

• Regular follow-ups with healthcare providers to monitor symptoms and adjust treatment plans
• Incorporating stress management techniques into daily routines
• Maintaining a support network of family, friends, and healthcare professionals
• Staying informed about new developments in TMD research and treatment options

With proper management and a proactive approach to care, many individuals with TMDs can maintain a good quality of life and effectively control their symptoms.

The Economic Impact of TMDs

Temporomandibular disorders not only affect individual health but also have broader economic implications:

• Healthcare costs: Including diagnostic procedures, treatments, and follow-up care
• Lost productivity: Due to work absences or reduced efficiency caused by pain and discomfort
• Indirect costs: Such as transportation to medical appointments and caregiver expenses

Understanding these economic factors underscores the importance of effective prevention strategies and timely intervention for TMDs.

TMDs in Special Populations

While TMDs can affect anyone, certain populations may require special consideration:

• Adolescents: Early intervention and education about jaw health are crucial
• Elderly individuals: TMD symptoms may be complicated by other age-related conditions
• Pregnant women: Hormonal changes may influence TMD symptoms and treatment options
• Athletes: Particularly those in contact sports, who may be at higher risk of jaw injuries

Tailored approaches to diagnosis and treatment are essential for these groups to ensure optimal outcomes.

The Psychological Dimension of TMDs

The relationship between TMDs and psychological well-being is bidirectional:

• Chronic pain from TMDs can lead to anxiety and depression
• Stress and emotional distress may exacerbate TMD symptoms
• Cognitive-behavioral interventions can be effective in managing both psychological and physical aspects of TMDs

Addressing the psychological components of TMDs is crucial for comprehensive care and improved quality of life for affected individuals.

Preventive Strategies for TMDs

While not all TMDs are preventable, certain measures may reduce the risk or severity of these disorders:

• Maintaining good posture, especially during computer use or smartphone interactions
• Practicing stress-reduction techniques regularly
• Avoiding excessive gum chewing or nail biting
• Using proper form during strength training exercises that involve jaw clenching
• Wearing appropriate protective gear during high-impact sports

Incorporating these habits into daily life may contribute to overall jaw health and potentially reduce the incidence of TMDs.

The Role of Diet in TMD Management

Dietary choices can play a significant role in managing TMD symptoms:

• Soft foods: Reducing jaw strain during acute flare-ups
• Anti-inflammatory foods: Such as omega-3 rich fish, berries, and leafy greens
• Adequate hydration: Supporting overall joint health
• Avoiding excessive caffeine: Which can increase muscle tension

A balanced, TMD-friendly diet can complement other treatment approaches and contribute to overall jaw health.

TMDs and Sleep Disorders

The relationship between TMDs and sleep disturbances is complex:

• Sleep bruxism (teeth grinding) can exacerbate TMD symptoms
• TMD pain may disrupt sleep patterns
• Sleep apnea and TMDs may coexist, complicating diagnosis and treatment

Addressing sleep-related issues is often an integral part of comprehensive TMD management.

The Impact of Technology on TMDs

Modern technology usage patterns may influence TMD prevalence and symptoms:

• “Text neck” posture from prolonged smartphone use can affect jaw alignment
• Increased screen time may lead to more frequent clenching or grinding
• Telemedicine offers new opportunities for TMD diagnosis and management

Awareness of these technological factors can inform both prevention strategies and treatment approaches for TMDs.

TMD (Temporomandibular Disorders) | National Institute of Dental and Craniofacial Research

On this page

1. Overview
2. Causes
3. Symptoms
4. Diagnosis
5. Treatment
6. Helpful Tips
7. Additional Resources

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Overview

Healthy temporomandibular joint during mouth opening & closing.

Temporomandibular disorders (TMDs) are a group of more than 30 conditions that cause pain and dysfunction in the jaw joint and muscles that control jaw movement. “TMDs” refers to the disorders, and “TMJ” refers only to the temporomandibular joint itself. People have two TMJs; one on each side of the jaw. You can feel them by placing your fingers in front of your ears and opening your mouth.

There are three main classes of TMDs:

1. Disorders of the joints, including disc disorders.
2. Disorders of the muscles used for chewing (masticatory muscles).
3. Headaches associated with a TMD.

There are several disorders within each class. See diagram below for some examples.

Classification of Temporomandibular Disorders (TMDs) with Examples

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*A person may have one or more of these conditions at the same time.

Many TMDs last only a short time and go away on their own. However, in some cases they can become chronic, or long lasting. In addition, TMDs can occur alone or at the same time as other medical conditions such as headaches, back pain, sleep problems, fibromyalgia, and irritable bowel syndrome.

A recent study found that about 11-12 million adults in the United States had pain in the region of the temporomandibular joint.

Temporomandibular disorders are twice as common in women than in men, especially in women between 35 and 44 years old.

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Causes

Injury to the jaw or temporomandibular joint can lead to some TMDs, but in most cases, the exact cause is not clear. For many people, symptoms seem to start without obvious reason. Recent research suggests a combination of genes, psychological and life stressors, and how someone perceives pain, may play a part in why a TMD starts and whether it will be long lasting.

Because TMDs are more common in women than in men, researchers are exploring whether the differences in TMJ structure and mechanics between females and males may play a role.

Research does not support the belief that a bad bite or orthodontic braces cause TMDs.

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Symptoms

It is important to know that sounds (such as clicking or popping) without pain in the TMJs are common, are considered normal, and don’t need treatment.

However, the following symptoms may signal a TMD:

• Pain in the chewing muscles and/or jaw joint (most common symptom).
• Pain that spreads to the face or neck.
• Jaw stiffness.
• Limited movement or locking of the jaw.
• Painful clicking, popping, or grating in the jaw joint when opening or closing the mouth.
• Ringing in the ears, hearing loss, or dizziness.
• A change in the way the upper and lower teeth fit together.

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Diagnosis

There is no widely accepted, standard test available to diagnose TMDs. Because the exact causes and symptoms are not clear, identifying these disorders can be difficult.

Your doctor or dentist will note your symptoms and take a detailed medical history. He or she will ask questions about your pain, including its location, when it occurs, what makes it better or worse, and if it stays in one area or spreads to other parts of your body. The doctor or dentist will also ask if you have other pain conditions such as headache or back pain.

He or she also will examine your head, neck, face, and jaw for tenderness; jaw clicking or popping; or difficulty with movement. The doctor or dentist might also suggest imaging studies such as an x-ray, magnetic resonance imaging (MRI), or computed tomography (CT).

Pain in the mouth, jaw, or face may or may not be related to TMDs. Your doctor or dentist may have to rule out other conditions before diagnosing a TMD.

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Treatment

Before receiving treatment for TMDs, you should know:

• Sounds without pain in the temporomandibular joints are normal, happen frequently, and do not need treatment.
• Signs and symptoms of TMD go away in many people without treatment.
• Because evidence is lacking for the majority of TMD treatments, experts strongly recommend staying away from treatments that cause permanent changes to the jaw joints, teeth, or bite; or that involve surgery.

Nonsurgical Treatments

Because many jaw joint and muscle problems are temporary and do not get worse, simple treatment may be all that is necessary.

When you first feel discomfort in your jaw joints or muscles, your doctor or dentist may have you:

• Eat soft foods.
• Apply heat or cold to the face in combination with exercises to gently stretch and strengthen the jaw muscles.
• Take over-the-counter medications, for example nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen.
• Reduce habits such as jaw clenching, gum chewing, or nail biting.

If these steps do not help, or if in the process of trying them your doctor/dentist diagnoses a specific type of TMD, one or more of the following treatments may be recommended.

Physical Therapy

The goal of physical therapy is to maintain, improve, or bring back movement and physical function. There are several types of physical therapy. One type is manual therapy, in which a therapist uses his/her hands to stretch the soft tissues and muscles around the joint. Manual therapy has been shown to help improve function and relieve pain.

Self-management and Behavioral Health Approaches

Self-management refers to activities you can do yourself and include:

• Learn all you can about your specific type(s) of TMD.
• Learn meditation & relaxation techniques.
• Set specific goals related to managing your condition.
• Stay involved in activities that are meaningful to you.

Certain behavioral health approaches, usually offered by a psychologist, have been shown to help manage TMDs. These include cognitive behavioral therapy and biofeedback.

Cognitive behavioral therapy seeks to identify negative thoughts or thought patterns and change them, as well as provide coping skills.

Biofeedback involves using sensors that monitor breathing, heart rate, muscle contraction, and temperature. For example, a sensor on your jaw can detect when you tighten your jaw muscles. With the help of a therapist, you can learn to notice the unwanted behavior and relax.

Medications

Your doctor or dentist may recommend medication(s) to treat your symptoms.

These include:

• Over-the-counter medications such as:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), used to treat pain.
• Prescription medications such as:
  • Antianxiety medications.
  • Antidepressants.
  • Antiseizure medications.
  • Opioids.

Some of these medications can lead to addiction or have other serious side effects. If you are prescribed any of these medications, make sure your doctor or dentist explains how to take them and for how long.

Intraoral Appliances

Intraoral appliances are devices that fit over the teeth. They do not change the teeth or bite. They are also known as nightguards, splints, stabilization appliances, occlusal splints, interocclusal splints, or bruxism splints.

There is not a lot of evidence they improve TMD pain. If a dentist or doctor suggests you use one:

• Make sure it is not designed to permanently change your bite.
• Stop using it and consult your dentist/doctor if it causes pain.

Complementary Treatments

A complementary treatment is a non-mainstream practice used together with conventional medicine. Acupuncture and transcutaneous electrical nerve stimulation (TENS) are two complementary treatments that have been studied for TMDs.

Acupuncture is a technique in which practitioners stimulate specific points on the body—most often by inserting thin needles through the skin. There is limited evidence that it helps TMDs.

TENS is a battery-powered device that uses electrodes placed on the skin. The device creates electrical impulses that may change how pain is perceived. Although some studies have shown that TENS may help relieve pain in TMDs and improve the ability to open the mouth, the studies were small with short-duration TENS treatments.

Surgery and Other Medical & Dental Procedures

The treatments discussed in this section are more complex, involve going into the chewing muscles or the temporomandibular joints (with a needle or other instrument), or changing your bite and teeth. More importantly, some of them – like occlusal treatments (see below)— don’t work and may make the problem worse. Before having any of these procedures:

• Ask about simpler treatments and try those first.
• Ask the doctor or dentist to explain the procedure—in detail—in a way you can understand.
• Ask how the procedure will help improve your specific TMD.
• Ask about the risks.
• Get second opinions from qualified medical or dental specialists.

Occlusal Treatments

Occlusion refers to how teeth fit together. For years it was thought that misaligned teeth (malocclusion) were a cause of TMDs; however, there is no evidence to support this belief. Occlusal treatments modify the teeth and bite. Examples include:

• Placing crowns on the teeth.
• Grinding down the teeth.
• Using orthodontic treatment(s) to change the position of some or all teeth.

There is no evidence these occlusal treatments work, and they could make the problem worse.

Botulinum Toxin

Botulinum toxin Type A works by relaxing muscles. It is FDA-approved for some medical conditions (like migraines) but not for TMDs. Studies have looked at injecting botulinum toxin Type A into the chewing muscles to reduce muscle spasm and pain. However, the information from these studies is limited and it is not clear whether this medication works to relieve TMD symptoms.

Prolotherapy

Prolotherapy involves injecting a solution into the TMJ area that causes irritation, with the goal of triggering the body to respond by repairing the joint. Prolotherapy has shown promise specifically for TMDs in which the joint is out of its normal position (dislocation) or when the joint goes beyond its normal range of movement (hypermobility). However, there have been only a few small studies on this treatment for TMDs.

Arthrocentesis

In this procedure a needle is used to push liquid into the TMJ. The pressure caused by the liquid removes scar-like tissue (adhesions). In addition, when the liquid is flushed out of the joint, it removes substances that cause inflammation. Arthrocentesis has been shown to help with pain relief and improve mouth opening in people whose temporomandibular disc is out of place; however, these effects do not last long.

Arthroscopy

During arthroscopy the doctor inserts an instrument with a tiny video camera into the jaw joint. The doctor can see the joint, which can help in diagnosis. He or she can also remove adhesions or reposition the joint’s disc. This procedure works moderately well in helping improve pain and function.

Surgery

Open surgery gives access to the temporomandibular joint through a cut (incision) next to the ear. It’s important to know that surgery makes permanent changes to your joint. There are no long-term research studies on the safety of open surgery for TMDs or on how well it works to relieve symptoms.

Surgery should only be considered if:

• There is destruction of the joint that cannot be fixed with other procedures.
• There are severe symptoms (pain and/or difficulty opening the mouth), despite trying other treatments.

If your healthcare provider suggests surgery, be sure to ask:

• Why are you suggesting surgery?
• Are there other options besides surgery?
• How will it help me?
• What are the risks?

TMJ Implants

Implants are artificial devices that are used to replace part of the jaw joint or the entire joint. There are currently three TMJ implants approved by the FDA.

Implants might be considered when:

• There is an injury to the joint.
• There is a condition you’re born with (congenital condition) that needs to be repaired.
• The joint is frozen (ankylosis), commonly caused by injury or infection.
• There’s severe damage to the joint.
• There’s ongoing pain.
• All simpler treatments have been tried and have failed.

Some studies suggest that, when used in very specific cases, TMJ implants can improve function and quality of life. As with any surgery, proceed with caution.

Implants used many years ago (and since taken off the market), did not help patients and left them with severe complications, including permanent damage to the jaw joint(s). Because of this, researchers have called for long-term studies to look at the safety and efficacy of the newer TMJ implants.

Remember: Before any surgery, including implant surgery, it is extremely important to get opinions from more than one doctor and to completely understand the risks. If possible, seek an opinion from a surgeon who specializes in treating TMDs.

Summary of Treatments for Temporomandibular Disorders (TMDs)

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Helpful Tips

If you think you have a TMD or are diagnosed with one:

• Start with simple treatments first; remember that TMD symptoms often go away on their own, without treatment.
• Consult a dentist or doctor.
• Learn all you can about the TMD you have.
• Avoid (when possible) treatments that involve going into or permanently changing the jaw joints, especially surgery or TMJ implants.
• Understand all the risks when considering surgery or other medical or dental procedures that result in permanent change and seek an opinion from an orofacial pain clinic at a medical or dental school, if possible.

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Additional Resources

• MedlinePlus: Temporomandibular Joint Dysfunction
  The NIH National Library of Medicine’s collection of links to government, professional, and non-profit/voluntary organizations with information on temporomandibular disorders.
• The TMJ Association
  The TMJ Association is a non-profit, patient advocacy organization whose mission is to improve the quality of health care and the lives of everyone affected by temporomandibular disorders.
• American Chronic Pain Association
  The ACPA offers peer support and education in pain management skills to people with pain, their family and friends, and health care professionals.

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Cherubism: MedlinePlus Genetics

Description

Cherubism is a disorder characterized by abnormal bone tissue in the jaw. Beginning in early childhood, both the lower jaw (the mandible) and the upper jaw (the maxilla) become enlarged as bone is replaced with painless, cyst-like growths. These growths give the cheeks a swollen, rounded appearance and often interfere with normal tooth development. In some people the condition is so mild that it may not be noticeable, while other cases are severe enough to cause problems with vision, breathing, speech, and swallowing. Enlargement of the jaw usually continues throughout childhood and stabilizes during puberty. The abnormal growths are gradually replaced with normal bone in early adulthood. As a result, many affected adults have a normal facial appearance.

Most people with cherubism have few, if any, signs and symptoms affecting other parts of the body. Rarely, however, this condition occurs as part of another genetic disorder. For example, abnormal jaw growth, like that in cherubism, can occur in Ramon syndrome, which also involves short stature, intellectual disability, and overgrowth of the gums (gingival fibrosis). Additionally, cherubism-like growths have been reported in rare cases of Noonan syndrome (a developmental disorder characterized by unusual facial characteristics, short stature, and heart defects), fragile X syndrome (a condition primarily affecting males that causes learning disabilities and cognitive impairment), and neurofibromatosis type 1 (a condition primarily characterized by multiple skin tumors).

Frequency

The incidence of cherubism is unknown. Nearly 350 cases have been reported worldwide.

Causes

Mutations in the Sh4BP2 gene have been identified in about 80 percent of people with cherubism. In most of the remaining cases, the genetic cause of the condition is unknown.

The Sh4BP2 gene provides instructions for making a protein that plays a role in relaying chemical signals within cells. the Sh4BP2 protein is particularly important for the function of cells involved in the replacement of old bone tissue with new bone (bone remodeling) and certain immune system cells.

Mutations in the Sh4BP2 gene lead to production of an abnormal protein that does not get broken down when it is no longer needed. Too much Sh4BP2 protein likely increases signaling in certain cells, causing an immune reaction (inflammation) in the jaw bones and also triggering the production of osteoclasts, which are cells that break down bone tissue during bone remodeling. An excess of these bone-destroying cells contributes to the destruction of bone in the upper and lower jaws. A combination of bone loss and inflammation likely underlies the cyst-like growths characteristic of cherubism.

When cyst-like growths in the jaw, like those in cherubism, occur as a feature of a genetic syndrome, they are caused by the genetic alteration involved in the syndrome rather than by an Sh4BP2 alteration.

Inheritance

This condition is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder.

Other Names for This Condition

• Familial benign giant-cell tumor of the jaw
• Familial fibrous dysplasia of jaw
• Familial multilocular cystic disease of the jaws

Additional Information & Resources

Genetic Testing Information

• Genetic Testing Registry: Fibrous dysplasia of jaw

Genetic and Rare Diseases Information Center

• Cherubism

Patient Support and Advocacy Resources

• Disease InfoSearch
• National Organization for Rare Disorders (NORD)

Research Studies from ClinicalTrials.gov

• ClinicalTrials.gov

Catalog of Genes and Diseases from OMIM

• CHERUBISM

Scientific Articles on PubMed

• PubMed

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Treatment of TMJ dysfunction – diagnostics, methods and prices in Moscow

TMJ dysfunction – disruption of the temporomandibular joint, partial or complete loss of its functions. Accompanied by pain, restriction of movement of the jaws when opening the mouth, chewing, talking. It is difficult to treat due to the variety of symptoms and causes. In our Center, this complex problem is successfully solved by candidates of medical sciences , doctors with specialized training in gnatology and practical experience of 11 years.

TMJ dysfunction syndrome – what is it?

The temporomandibular joint (TMJ) connects the movable lower jaw and the fixed temporal bone of the upper jaw. There are two such joints – located on both sides of the skull in front of the ears. Each consists of a temporal fossa above and an articular head (mandible) below. Between them is the articular disc, which softens the friction of the articular surfaces during the movement of the lower jaw.

The main assistants of the joints are chewing muscles, which help to move the lower jaw relative to the upper one, as well as to keep it in the correct anatomical position, while easing the load on the joint.

Joints are quite mobile, work synchronously, provide:

• jaw movements, typical for conversation;
• movement of the jaw during chewing;
• maximum mouth opening, e.g. when yawning.

Normally, all elements of the system provide an easy, smooth, silent movement. But if there are changes in the articular surfaces and (or) the muscles that are attached to the joints, the whole system fails. There is a violation of the mobility of the joint or its dysfunction (one or two at once).

Causes of dysfunction of the temporomandibular joint

The main causes of TMJ dysfunction can be divided into several categories:

Dental

Lead to dysfunction of the joint due to physiologically incorrect closure of the jaws (occlusion) and their interaction in general:

• Injuries of the lower jaw
• Malocclusion
• Inadequate prosthetics
• Partial or total absence of teeth

Myogenic

Lead to increased stress on the joint and development of TMJ dysfunction in the jaw muscles (muscle dysfunction):

• Prolonged mechanical tension of facial muscles
• Hypertonicity of masticatory muscles due to bruxism
• Excessive muscle tension due to entrapment of the facial nerve

Diseases of the joint

Progressive pathologies affect the TMJ and impair its functions:

• Osteoarthritis
• Rheumatoid arthritis
• Inflammatory processes of the articular surface of infectious etiology

Anatomical factors

Increase the likelihood of TMJ dysfunction:

• Congenital anomalies of the structure of the lower jaw, pathologically low alveolar processes
• Anatomical discrepancy between the temporal fossa and the articular head, incorrect position of the disc at their articulation

Characteristic symptoms and signs

TMJ destruction is characterized by:

Pain tends to increase during speech, eating or yawning, when the range of motion of the lower jaw increases.

Symptoms characteristic of the manifestation of the destructive process in the joint may be pronounced or blurred. This is typical for a protracted chronic process. There are also likely periods of remission, followed by exacerbations – the symptoms can appear sharply against the background of emotional experiences.

The general condition also deteriorates, :

Less typical symptoms should also be treated with caution :

Treatment of TMJ dysfunction must be immediate !

Due to the variety of symptoms and lack of understanding which doctor to contact, a person comes to a competent specialist with an advanced chronic form that accompanies him for many years and reduces the quality of life with debilitating manifestations. And without timely therapeutic measures, the onset of complete or partial ankylosis (immobilization of the jaw), which is difficult to treat, is possible.

Levin Dmitry Valerievich

Chief Physician and Founder of the Doctor Levin Medical Center

Who treats TMJ pain dysfunction and how?

The complexity of the situation is the lack of competent specialists in this field. Disappointed patients often turn to our Center after a long walk through various clinics from one doctor to another, who already have a huge number of pictures and tests on their hands, but have not received the long-awaited relief.

Few people know that degenerative processes in the joint of the lower jaw are treated by a gnathologist. Orthopedic dentists or orthodontists who have undergone special gnathological training can also be treated.

For help! Gnathology is a branch of medicine that studies the relationship of all elements of the dental system (jaw bones, ligaments, muscles, joints) and the treatment of pathologies that violate this physiologically correct interaction.

After diagnosing, the doctor will determine the causes of failures, suggest the most optimal ways to ensure a balanced operation of the entire system. Having outlined the methods of correction, he will also control the course of treatment.

Also, to ensure maximum effectiveness of therapeutic measures, consultation or direct participation of doctors may be required:

• Traumatologist – in case of displacement of the temporomandibular joint due to injury
• Neurologist – in case of infringement of the facial nerve or involvement in the process of nerve endings of nearby tissues and organs.
• Psychologist – if the destruction in the joint was formed due to prolonged tension of the muscles of the face due to psychological trauma or stress.

Diagnosis of the joint of the lower jaw

Diagnostics of the pathology of the joint, volumetric and multi-stage. Includes a set of examinations:

Primary history taking and examination

• Finding out the characteristics of the patient’s life – the specifics of work, the presence of chronic diseases, psycho-emotional background
• Questioning the patient about the probable cause of pathological changes in the jaw – trauma, inflammatory processes in the oral cavity, past dental history, the presence of neurological pathologies
• Visual inspection of the external surface of the projection of the joint and oral cavity, if possible
• Palpation examination of the joints, which helps to detect muscle tension, swelling and displacement
• Listening to sounds when opening the mouth, which may be clicks or pops
• Determining the amplitude of jaw mobility, identifying the range of possible movements
• External bite test
• The doctor also draws up a photo protocol – takes a photo of the face and intraoral photographs.

The gnatologist also performs a general posture assessment, as TMJ disorders are directly related to skeletal changes in general.

Functional and computer diagnostics

Impressions are taken, diagnostic models are made to analyze the relationship between the upper and lower dentitions when they are closed, to establish contacts of teeth on opposite rows.

The most informative diagnostic methods for suspected TMJ dysfunction are:

• 3D computed tomography (CT) . Allows you to explore the bone structures of the joint and jaws.
• Magnetic resonance imaging (MRI) . It is carried out to study the soft elements of the joint (cartilage, capsule, bone marrow).

The results of a comprehensive study help to determine the severity of the pathology, draw up a plan and sequence of treatment, and the need to involve narrow specialists.

Treatment of diseases of the temporomandibular joint

Methods of therapeutic measures are selected depending on the degree of the pathological process and the causes of its occurrence. But the basic principle and sequence of treatment of TMJ dysfunction is as follows:

Elimination of soreness and removal of muscle hypertonicity

Comprehensive treatment using the above methods and means, in most cases, gives a positive effect and long-term remission.

Recommended for the duration of treatment:

1. Complete exclusion of solid food, which will make it possible to maintain conditional rest for the joint
2. Maximum restriction of mobility – you can not yawn widely, open your mouth
3. Alternating warm and cold compresses
4. Performing myogymnastics, a set of exercises is selected by a doctor

Occlusion correction

Necessary for jaw occlusion disorders that have affected TMJ dysfunction. Correction is performed using braces or aligners, which are installed only after the condition improves, the pain syndrome is eliminated and muscle tone is reduced.

After a course of orthodontic treatment, the jaws take a physiologically correct position, their exact closing and contact of the teeth of the opposite row is achieved.

Restoration of missing teeth

In the absence of teeth, their restoration is mandatory. These can be bridges or implants. The second option is preferable because it solves the problem once and for all. The implant completely replaces the lost tooth – both the root and the crown part. This provides a uniform load on the jawbone, prevents its atrophy. In addition, unlike bridge prosthetics, it is not necessary to grind adjacent teeth to fix the structure.

Frequently Asked Questions from Patients

How can I distinguish symptoms of TMJ dysfunction from other diseases?

Symptoms of pathological processes in the joint are similar to manifestations of other processes:

• myocardial infarction is characterized by pain radiating to the neck, lower jaw and shoulders;
• otitis – accompanied by severe pain in the ears, hearing loss;
• violation of cerebral circulation – proceeds with the presence of dizziness, flickering flies and nausea;
• cervical and thoracic osteochondrosis – similar in localization of pain;
• infringement of the facial nerve – also due to unilateral facial muscle tension and swelling;
• complicated diseases of the gums and teeth – accompanied by inflammation and immobility of the lower jaw.

Therefore, in order to avoid making an incorrect diagnosis, our doctor carefully studies the patient’s life and illness history, conducts a visual and palpation examination, and prescribes the necessary functional and instrumental studies.

Levin Dmitry Valerievich
Oral and maxillofacial surgeon, chief physician of the Center

What if the treatment does not work?

Conservative treatment does not help in cases where changes in the joint are serious. In this case, one of the types of surgical operations is performed:

• puncture of the cavity and arthroscopy of the joint;
• a small incision to eliminate pathological tissue, adjust the location of the cartilaginous disc and condyle;
• intra-articular intervention in the presence of a tumor process, bone fragments and destruction of bone tissue.

The type of surgical intervention is determined by a council of doctors after all the necessary studies confirming its expediency.

Dmitry Levin
Oral and maxillofacial surgeon, chief physician of the Center

Levin Dmitry Valerievich

Author of the article. Oral and maxillofacial surgeon, chief physician of the Center

What is it?

As you know, the lower jaw is connected to the upper, forming the temporomandibular joint, thanks to which we can speak, chew, yawn. Temporomandibular syndrome (TMJ) is a whole symptom complex, the main features of which are soreness of the masticatory muscles, crunching or crackling when chewing, opening the mouth, and limiting the mobility of the lower jaw.

TMJ can be caused by osteoarthritis, bruxism (teeth grinding), malocclusion, and some other factors. Both one and both temporomandibular joints can be affected.

TMJ symptoms range from mild (moderate pain when chewing) to severe, manifested by inability to open the mouth or headache. Sometimes it is not possible to determine the exact cause of TMJ.

Most temporomandibular joint inflammation is mild and resolves on its own within a few weeks with limited stress on the joint, but occasionally TMJ symptoms may recur.

What to expect

TMJ pain can be on one or both sides, worse when chewing. In severe cases, the pain spreads to the muscles of the face, neck, chronic headaches, nocturnal bruxism, difficulty opening or closing the mouth appear. TMJ may also be accompanied by blurred vision, dizziness, or muscle stiffness.

Prevalence

It is believed that TMJ occurs in every fourth person at least once in a lifetime.

Treatment

Treatment may include:

• muscle relaxation exercises,
• joint stress relief,
• warm compresses,
• pain relievers or anti-inflammatory drugs (acetaminophen, ibuprofen, sen),
• bite correction at the dentist ,
• wearing special night guards to prevent bruxism,
• intra-articular injections.