What are temporomandibular disorders. How are TMDs diagnosed. What are the most effective treatments for jaw pain and dysfunction. Can TMD be prevented. How do TMDs impact quality of life. What is the connection between TMD and other chronic pain conditions.

Understanding Temporomandibular Disorders (TMDs)

Temporomandibular disorders (TMDs) encompass a group of over 30 conditions affecting the jaw joint and muscles controlling jaw movement. The term “TMD” refers to the disorders themselves, while “TMJ” specifically denotes the temporomandibular joint. These joints are located on each side of the jaw and can be felt by placing fingers in front of the ears while opening the mouth.

TMDs are classified into three main categories:

• Disorders of the joints, including disc disorders
• Disorders of the masticatory (chewing) muscles
• Headaches associated with TMD

Within each category, there are several specific disorders. It’s important to note that an individual may experience one or more of these conditions simultaneously.

Prevalence and Demographics

Recent studies indicate that approximately 11-12 million adults in the United States experience pain in the temporomandibular joint region. Interestingly, TMDs are twice as common in women as in men, with a particularly high prevalence among women aged 35-44.

Causes and Risk Factors of TMDs

The exact cause of TMDs is often unclear, with symptoms frequently appearing without an obvious trigger. However, research suggests that a combination of factors may contribute to the development and persistence of these disorders:

• Genetic predisposition
• Psychological stressors
• Individual pain perception
• Injury to the jaw or temporomandibular joint

Contrary to popular belief, research does not support the notion that a bad bite or orthodontic braces cause TMDs. However, the higher prevalence in women has led researchers to investigate potential structural and mechanical differences in the TMJ between males and females.

Recognizing TMD Symptoms

While certain sounds like clicking or popping in the TMJs without pain are common and considered normal, several symptoms may indicate the presence of a TMD:

• Pain in the chewing muscles and/or jaw joint (most common symptom)
• Pain spreading 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
• Changes in the way upper and lower teeth fit together

When to Seek Medical Attention

If you experience persistent jaw pain, difficulty opening or closing your mouth, or any of the symptoms mentioned above, it’s advisable to consult a healthcare professional. Early intervention can help prevent the condition from worsening and improve overall quality of life.

Diagnosing Temporomandibular Disorders

Diagnosing TMDs can be challenging due to the lack of a standardized, widely accepted test. The process typically involves a comprehensive approach:

1. Detailed medical history
2. Physical examination of the head, neck, face, and jaw
3. Evaluation of pain patterns and triggers
4. Assessment of jaw movement and function
5. Possible imaging studies (X-ray, MRI, or CT scan)

Healthcare providers may need to rule out other conditions before confirming a TMD diagnosis, as pain in the mouth, jaw, or face can be attributed to various factors.

Differential Diagnosis

Differentiating TMDs from other conditions is crucial for appropriate treatment. Some conditions that may present similar symptoms include:

• Dental problems (e.g., tooth decay, gum disease)
• Trigeminal neuralgia
• Sinus infections
• Ear infections
• Facial neuralgias

Treatment Approaches for TMDs

Before embarking on any treatment plan, it’s essential to understand that:

• Many TMD signs and symptoms resolve without intervention
• Sounds without pain in the temporomandibular joints are normal and don’t require treatment
• Experts advise against treatments causing permanent changes to the jaw joints, teeth, or bite, as well as surgical interventions, due to limited evidence supporting their efficacy

Conservative Treatment Options

For many individuals with TMDs, conservative treatments can provide significant relief:

1. Soft food diet
2. Application of ice or heat packs
3. Over-the-counter pain relievers
4. Jaw exercises and stretches
5. Stress reduction techniques
6. Avoiding extreme jaw movements

Advanced Treatment Modalities

In cases where conservative measures prove insufficient, healthcare providers may recommend:

• Physical therapy
• Prescription medications (e.g., muscle relaxants, antidepressants)
• Oral appliances or splints
• Cognitive behavioral therapy
• Trigger point injections
• Botulinum toxin injections

It’s crucial to work closely with a healthcare professional to develop a tailored treatment plan based on individual symptoms and needs.

Living with TMD: Coping Strategies and Lifestyle Modifications

Managing TMD often involves adopting certain lifestyle changes and coping strategies to minimize pain and improve function:

• Practice good posture
• Avoid clenching or grinding teeth
• Use relaxation techniques to reduce stress
• Maintain a balanced diet rich in anti-inflammatory foods
• Get adequate sleep
• Engage in regular, low-impact exercise

Self-Care Techniques

Implementing self-care techniques can significantly alleviate TMD symptoms:

1. Gentle jaw stretches and exercises
2. Massage of the jaw and temple areas
3. Application of warm compresses
4. Practicing proper jaw alignment during daily activities
5. Avoiding excessive gum chewing or nail biting

The Impact of TMDs on Quality of Life

Temporomandibular disorders can significantly affect an individual’s quality of life, impacting various aspects of daily functioning:

• Difficulty eating and speaking
• Sleep disturbances
• Reduced social interactions due to pain or embarrassment
• Emotional distress and anxiety
• Decreased work productivity

Psychological Aspects of TMD

The relationship between TMD and mental health is bidirectional. Chronic pain associated with TMD can lead to depression and anxiety, while psychological stress can exacerbate TMD symptoms. Addressing both physical and emotional aspects is crucial for comprehensive management.

Research and Future Directions in TMD Management

Ongoing research in the field of temporomandibular disorders aims to improve understanding, diagnosis, and treatment options:

• Genetic studies to identify potential risk factors
• Development of more accurate diagnostic tools
• Investigation of novel treatment approaches, including regenerative medicine
• Exploration of the relationship between TMDs and other chronic pain conditions
• Assessment of long-term outcomes of various treatment modalities

Emerging Therapies

Several promising therapies are currently under investigation for TMD management:

1. Platelet-rich plasma (PRP) injections
2. Stem cell therapy
3. Targeted drug delivery systems
4. Neurofeedback and biofeedback techniques
5. Advanced imaging for personalized treatment planning

As research progresses, these innovative approaches may offer new hope for individuals struggling with persistent TMD symptoms.

Preventing TMDs: Proactive Measures for Jaw Health

While not all cases of TMD can be prevented, certain measures may help reduce the risk of developing these disorders:

• Maintain good posture, especially when using electronic devices
• Practice stress management techniques
• Avoid excessive jaw movements, such as wide yawning or aggressive gum chewing
• Use proper form when exercising, particularly during activities that may strain the neck and jaw
• Seek early treatment for dental issues
• Be mindful of jaw clenching or teeth grinding, especially during sleep

Ergonomic Considerations

Ergonomic adjustments in daily life can play a significant role in preventing TMD:

1. Adjust computer screens to eye level to prevent neck strain
2. Use a headset for prolonged phone conversations
3. Ensure proper sleeping posture with supportive pillows
4. Take regular breaks during activities that require prolonged jaw use, such as singing or public speaking

By implementing these preventive strategies, individuals can promote overall jaw health and potentially reduce their risk of developing TMDs.

The Connection Between TMDs and Other Chronic Pain Conditions

Temporomandibular disorders often coexist with other chronic pain conditions, suggesting potential shared underlying mechanisms or risk factors. Some conditions frequently associated with TMDs include:

• Fibromyalgia
• Chronic fatigue syndrome
• Irritable bowel syndrome
• Headaches and migraines
• Neck and back pain

Implications for Treatment

The overlap between TMDs and other chronic pain conditions has important implications for treatment approaches:

1. Comprehensive pain management strategies
2. Multidisciplinary care involving various healthcare specialists
3. Consideration of systemic factors in treatment planning
4. Addressing psychosocial aspects of chronic pain
5. Exploring potential common pathways for pain modulation

Understanding these connections can lead to more holistic and effective treatment strategies for individuals experiencing multiple chronic pain conditions.

TMDs in Special Populations: Considerations and Challenges

Certain populations may require specific considerations when it comes to TMD diagnosis and management:

TMDs in Children and Adolescents

While less common than in adults, TMDs can affect younger individuals. Factors to consider include:

• Growth and development of the jaw and facial structures
• Impact on school performance and social interactions
• Potential influence of orthodontic treatments
• Importance of early intervention and education

TMDs in Older Adults

Aging can bring unique challenges in TMD management:

• Increased likelihood of coexisting health conditions
• Potential interactions with medications
• Age-related changes in jaw structure and function
• Considerations for denture wearers

TMDs in Pregnant Women

Pregnancy can influence TMD symptoms and treatment options:

• Hormonal changes affecting joint laxity
• Limitations on certain medications and imaging studies
• Potential exacerbation of symptoms due to stress and physical changes
• Importance of safe, pregnancy-compatible treatment approaches

Tailoring TMD management strategies to these specific populations ensures more effective and appropriate care.

The Role of Interdisciplinary Care in TMD Management

Given the complex nature of temporomandibular disorders, an interdisciplinary approach to care can offer significant benefits:

Key Healthcare Professionals in TMD Management

• Dentists specializing in orofacial pain
• Oral and maxillofacial surgeons
• Physical therapists
• Pain management specialists
• Psychologists or psychiatrists
• Neurologists
• Rheumatologists

Benefits of Collaborative Care

An interdisciplinary approach offers several advantages:

1. Comprehensive assessment of all contributing factors
2. Coordinated treatment plans addressing multiple aspects of TMD
3. Improved patient outcomes through combined expertise
4. Enhanced ability to manage complex or refractory cases
5. Opportunity for patient education and empowerment

By leveraging the expertise of various healthcare professionals, patients with TMDs can receive more holistic and effective care, potentially leading to better long-term outcomes and improved quality of life.

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.