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Joint in mouth: TMJ disorders – Symptoms and causes

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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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Temporomandibular Joint Disorders (TMJ & TMD): Overview

Written by WebMD Editorial Contributors

Medically Reviewed by Evan Frisbee, DMD on October 31, 2021

  • What Causes TMD?
  • What Are the Symptoms?
  • How Is TMD Diagnosed?
  • Home Treatments for TMD
  • Traditional Treatments
  • Other Treatments
  • Surgery for TMD
  • More

Your temporomandibular joint is a hinge that connects your jaw to the temporal bones of your skull, which are in front of each ear. It lets you move your jaw up and down and side to side, so you can talk, chew, and yawn.

 

Problems with your jaw and the muscles in your face that control it are known as temporomandibular disorders (TMD). But you may hear it wrongly called TMJ, after the joint.

We don’t know what causes TMD. Dentists believe symptoms arise from problems with the muscles of your jaw or with the parts of the joint itself.

Injury to your jaw, the joint, or the muscles of your head and neck — like from a heavy blow or whiplash — can lead to TMD. Other causes include:

  • Grinding or clenching your teeth, which puts a lot of pressure on the joint
  • Movement of the soft cushion or disc between the ball and socket of the joint
  • Arthritis in the joint
  • Stress, which can cause you to tighten facial and jaw muscles or clench the teeth

TMD often causes severe pain and discomfort. It can be temporary or last many years. It might affect one or both sides of your face. More women than men have it, and it’s most common among people between the ages of 20 and 40.

 

Common symptoms include:

 

  • Pain or tenderness in your face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide
  • Problems when you try to open your mouth wide
  • Jaws that get “stuck” or “lock” in the open- or closed-mouth position
  • Clicking, popping, or grating sounds in the jaw joint when you open or close your mouth or chew. This may or may not be painful.
  • A tired feeling in your face
  • Trouble chewing or a sudden uncomfortable bite — as if the upper and lower teeth are not fitting together properly. Learn more about the pros and cons of teeth alignment surgery.
  • Swelling on the side of your face

 

You may also have toothaches, headaches, neck aches, dizziness, earaches, hearing problems, upper shoulder pain, and ringing in the ears (tinnitus).

 

Many other conditions cause similar symptoms — like tooth decay, sinus problems, arthritis, or gum disease. To figure out what’s causing yours, the dentist will ask about your health history and conduct a physical exam.

 

They’ll check your jaw joints for pain or tenderness and listen for clicks, pops, or grating sounds when you move them. They’ll also make sure your jaw works like it should and doesn’t lock when you open or close your mouth. Plus they’ll test your bite and check for problems with your facial muscles.

 

Your dentist may take full face X-rays so they can view your jaws, temporomandibular joints, and teeth to rule out other problems. They may need to do other tests, like Magnetic resonance imaging (MRI) or computer tomography (CT). The MRI can show if the TMJ disc is in the proper position as your jaw moves. A CT scan shows the bony detail of the joint.

 

You may get referred to an oral surgeon (also called an oral and maxillofacial surgeon) for further care and treatment. This doctor specializes in surgery in and around the entire face, mouth, and jaw area. You may also see an orthodontist to ensure your teeth, muscles, and joints work like they should.

There are things you can do on your own to help relieve TMD symptoms. Your doctor may suggest you try some of these remedies together.

Take over-the-counter medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), like naproxen or ibuprofen, can relieve muscle pain and swelling.

Use moist heat or cold packs. Apply an ice pack to the side of your face and temple area for about 10 minutes. Do a few simple jaw stretches (if your dentist or physical therapist OKs them). When you’re done, hold a warm towel or washcloth to the side of your face for about 5 minutes. Perform this routine a few times each day.

Eat soft foods. Add yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans, and grains to your menu. Cut foods into small pieces so you chew less. Skip hard, crunchy foods (like pretzels and raw carrots), chewy foods (like caramels and taffy), and thick or large bites that require you to open wide.

Avoid extreme jaw movements. Keep yawning and chewing (especially gum or ice) to a minimum and don’t yell, sing, or do anything that forces you to open wide.

Don’t rest your chin on your hand. Don’t hold the phone between your shoulder and ear. Practice good posture to reduce neck and facial pain.

Keep your teeth slightly apart as often as you can. This will relieve pressure on your jaw. Put your tongue between your teeth to control clenching or grinding during the day.

Learn relaxation techniques to help loosen up your jaw. Ask your dentist if you need physical therapy or massage. Consider stress reduction therapy as well as biofeedback.

Talk to your dentist about these tried-and-true treatments for TMD:

 

Medications. Your dentist can prescribe higher doses of NSAIDs if you need them for pain and swelling. They might suggest a muscle relaxer to relax your jaw if you grind or clench your teeth. Or an anti-anxiety medication to relieve stress, which may bring on TMD. In low doses they can also help reduce or control pain. Muscle relaxants, anti-anxiety drugs, and antidepressants are available by prescription only.

 

A splint or night guard. These plastic mouthpieces fit over your upper and lower teeth so they don’t touch. They lessen the effects of clenching or grinding and correct your bite by putting your teeth in a more correct position. What’s the difference between them? You wear night guards while you sleep. You use a splint all the time. Your dentist will tell you which type you need.

 

Dental work. Your dentist can replace missing teeth and use crowns, bridges, or braces to balance the biting surfaces of your teeth or to correct a bite problem. Learn more about what causes an overbite, as well as when an overbite is considered normal.

If the treatments listed above don’t help, your dentist may suggest one or more of the following:

Transcutaneous electrical nerve stimulation (TENS). This therapy uses low-level electrical currents to provide pain relief by relaxing your jaw joint and facial muscles. It can be done at the dentist’s office or at home.

Ultrasound. Deep heat applied to the joint can relieve soreness or improve mobility.

Trigger-point injections. Pain medication or anesthesia is injected into tender facial muscles called “trigger points” to give relief.

Radio wave therapy. Radio waves stimulate the joint, which increases blood flow and eases pain.

Low-level laser therapy. This lowers pain and inflammation and helps you move your neck more freely and open your mouth wider.

If other treatments can’t help you, surgery is an option. Once it’s done, it can’t be undone, so get a second or even third opinion from other dentists.

 

There are three types of surgery for TMD. The type you need depends on the problem.

 

Arthrocentesis is used if you have no major history of TMJ but your jaws are locked. It’s a minor procedure that your dentist can do in their office. They’ll give you general anesthesia, then insert needles into the joint and wash it out. They may use a special tool to get rid of damaged tissue or dislodge a disc stuck in the joint, or to unstick the joint itself.

 

Arthroscopyis surgery done with an arthroscope. This special tool has a lens and a light on it. It lets your doctor see inside your joint. You’ll get general anesthesia, then the doctor will make a small cut in front of your ear and insert the tool. It’ll be hooked up to a video screen, so they can examine your joint and the area around it. They may remove inflamed tissue or realign the disc or joint. This type of surgery, known as minimally invasive, leaves a smaller scar, has fewer complications, and requires a shorter recovery time than a major operation.

 

Open-joint surgery. Depending on the cause of the TMD, arthroscopy may not be possible. You may need this type of surgery if:

 

  • The bony structures in your jaw joint are wearing down
  • You have tumors in or around the joint
  • Your joint is scarred or full of bone chips

 

You’ll get general anesthesia, then the doctor will open up the entire area around the joint so they can get a full view and better access. You’ll need longer to heal after open-joint surgery, and there is a greater chance of scarring and nerve injury.

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        Why underestimating the evil microbes in the mouth is deadly › Articles and news › DoctorPeter.ru

        “I decided to write a short memo on how to treat your teeth and survive. The memo is for… everyone. Written in FAQ mode, or frequently asked questions.

        1. Is it really possible to die from a spreading infection after tooth extraction/treatment?

        Yes, alas. The cases are, of course, isolated. According to my conservative estimates, about 50 people a month die from teeth in Moscow. As a rule, these are young adequate people, often quite wealthy. There are several problems here. The microbes that live in our mouths are very vicious. So much so that sometimes they can eat through our tissues from the tongue to the pelvis in a couple of days. Eating into black dust! It’s true, I’ve seen it myself. At the opening. Our national “it will pass by itself”, “didn’t attach importance to it”, etc. also plays a role. Well, the incompetence of doctors is sometimes present too. In general, underestimating the problem is deadly.

        2. How to recognize that something went wrong after treatment/removal?

        If after a tooth fell ill / you treated or removed it, after a couple of days there is pain when swallowing, difficulty opening the mouth, reddening of the skin in this area, the temperature rises to 38C – it is necessary to see a doctor within 3 hours. Maybe it’s a false alarm, maybe not. It is worth contacting a maxillofacial surgeon or a dental surgeon.

        3. I squeezed a pimple on my face – swelling appeared

        Never squeeze anything on your face! The most important rule. Also – piercing, warming and applying ointments. Into the fire! Half of the infection is driven deep and the tissues are impregnated with it. The result of such pressures can be meningitis and abscesses in the brain. In addition to multiple scars on the face from the operation. You should wipe the pimple with alcohol or vodka and see a doctor as soon as possible. The same rule of 3 hours. It may be possible to prick the pimple with an antibiotic and do without surgery.

        4. At night I went to the kitchen to drink water and hit my jaw on the door frame

        Most often, this story is told by people who at 3 am went to drink water that was not at all and not at all to the kitchen. And it wasn’t a joint that hit them in the jaw. Doesn’t matter. If, after an injury, the teeth are unusual, there is numbness of the lips or tongue, pressure on the chin is painful and it is difficult to open the mouth – a visit to the doctor (rule of three hours). Perhaps the jaw is broken. Complete rest is needed – do not talk, eat only liquid food (kefir, broth), rinse with at least water every hour. If the injury is fresh, it will be possible to carefully fasten the fragments without surgery.

        5. I was shaving, my hand trembled – a bleeding wound appeared on my face. The face is richly supplied with blood, so the blood can go quite strongly. First, don’t panic. Sterile bandages or wipes and hydrogen peroxide are taken from the first aid kit. Press the peroxide-soaked cloth firmly into the wound, as hard as possible. Remove any item from the freezer (chicken leg or ice) and press firmly over the napkin. You can tightly bandage these napkins with a bandage or scarf. Well, the three-hour rule. Remember that the wound is sutured in the first few hours. Then you can’t do it. And so she will heal, as it turns out.

        6. There are “stumps” from the teeth in the mouth, they do not hurt. Is it really nothing to worry about?

        Half of all those who died from dental infections began their story with this phrase. Like, nothing hurt, and the tooth fell apart 10 years ago. Run – to the dental surgeon to uproot these sources of infection! The consequences can be – from a broken jaw after a crust of bread to severe heart defects. I already talked about the freezer at the beginning.

        7. Smoking and oncology

        Much has been said about the dangers of smoking. I will tell from myself. All patients with oral and facial cancer are smokers. 100%! 95 percent are users of Golden Java. And they all said, shedding tears, that what kind of *** they were that they smoked! That they would give everything to go back and not even start. If you saw these terrible disfiguring tumors, if you smelled the decay of cancer, I think you would immediately throw the pack away. I want to bring my smoking friends on a tour and show how it happens.

        Let’s just summarize:

        1. Go to the dentist for a check-up and get a clear picture of your dental treatment. Make a treatment plan – what needs to be done now, what is tolerable. It is clear that the dentist should be like a father – proven, experienced and defending your interests.
        2. Be alert after treatment – check for the symptoms I have mentioned. If there is at least a couple – the rule of three hours. The phone number and address of the doctor should be in front of your eyes.
        3. There are departments of the ChLH in the 1st Gradskaya and in the 36th City Clinical Hospital, this is an extreme case (in St. Petersburg – in the 15th and Alexander hospitals, the First Medical University – Note ed.)
        hurts! Pimples, “fluxes”, injuries. This is a 100% guarantee of complications.
        5. Do not know what to do – rinse your mouth with a solution of soda (1 teaspoon in a glass of cool water). Keep in mouth for 5 minutes, every 2 hours. It will not be worse.
        6. Antibiotics are prescribed by a doctor, and only he! But if you are in the taiga, and there are no doctors and are not expected yet, have amoxiclav or augmentin on hand, dosage 1000 mg.