More Than Jaw Pain | NIH News in Health

September 2020

Print this issue

TMJ Disorders Explained

En españolSend us your comments

Your jaw works hard every day so you can laugh, talk, smile, and eat. When it’s working properly, you may not give it much thought. But if your jaw starts to hurt, it can take the joy out of simple, everyday things.

The jaw joint is one of the most complex joints in the human body. For most people, it moves effortlessly up and down, side to side, and in and out, transitioning from one movement to the next seamlessly. But, more than 10 million people in the U.S. live with jaw pain and dysfunction.

Doctors call these conditions temporo-mandibular disorders. They’re more commonly called temporomandibular joint (TMJ) disorders.

“Temporomandibular disorders—and how people respond to them—vary widely,” explains Dr. Dena Fischer, a dental health expert at NIH. “For example, some experience discomfort, others tension, and still others severe pain.”

Some people get symptoms in the muscles that move the jaw. For others, it’s in a disc within the jaw joint that’s damaged. You can also develop arthritis, or joint inflammationHeat, swelling, and redness caused by the body’s protective response to injury or infection.. You can even have more than one kind of disorder at the same time.

TMJ disorders sometimes start after an injury. But for most people, there’s no obvious cause. In addition to pain, other symptoms can include stiffness, limited jaw movement, painful clicking or popping in the joint, or changes in the way the teeth fit together.

If you have any of these symptoms, talk with your health care provider. To diagnose a TMJ disorder, they’ll ask you questions about your symptoms and examine your head, neck, face, and jaw. They’ll also check your dental and medical history. They may use imaging tests, like X-rays, too.

Experts recommend starting with simple, self-care practices for jaw pain (see the Wise Choices box for tips). “For a lot of people, the pain will resolve over time,” Fischer explains. “Your doctor may also recommend trying a bite guard. These are plastic splints that fit over the teeth.”

Sometimes, TMJ disorders can become chronic—causing pain or discomfort that lasts more than three months. Aggressive treatments include surgery, splints that change the bite, and even adjusting or removing teeth. But whether these treatments help hasn’t been scientifically studied, explains Fischer.

For some people, they may make things worse. “And once you have surgery, you can’t put things back the way they were before,” she says.

If you have symptoms that last more than three months, your dentist or health care provider may refer you to a specialist. Doctors who specialize in muscles and bones, arthritis, pain, and the nervous system may be able to help.

But better treatments are needed. NIH-funded researchers have been studying the role that genesStretches of DNA you inherit from your parents that define features, like your risk for certain diseases. play in who develops a TMJ disorder and how long it lasts. In a large study, researchers identified several genes that are more common in people who have severe jaw pain. They’re now testing whether early treatment can help people with certain genes lower their risk of developing a chronic disorder.

“We hope that having a better understanding of why temporomandibular disorders develop will ultimately help us prevent them and find new treatments,” Fischer says.

Note: The title of this article was changed after publication.

NIH Office of Communications and Public Liaison
Building 31, Room 5B52
Bethesda, MD 20892-2094
[email protected]
Tel: 301-451-8224

Editor: Harrison Wein, Ph.D.
Managing Editor: Tianna Hicklin, Ph.D.
Illustrator: Alan Defibaugh

Attention Editors: Reprint our articles and illustrations in your own publication. Our material is not copyrighted. Please acknowledge NIH News in Health as the source and send us a copy.

For more consumer health news and information, visit health.nih.gov.

For wellness toolkits, visit www.nih.gov/wellnesstoolkits.

How Long Does TMD Last?

Restorative Dentistry |3 min read

published August 10, 2021Last updated January 28, 2022

We know that jaw pain or TMJ-related issues are very uncomfortable.

It impacts your quality of life.

Any disorders of the joints, jaw muscles, and nerves, are known as TMJ disorder (or TMD).

If you’re dealing with that right now, you’re likely wondering:

How long does TMD last?!

We’ll answer that very question and give you a run-through of how it can be treated.

How long does TMD last?

It depends on the severity of the underlying condition.

TMJ symptoms last anywhere from a couple of days to a few weeks.

Some TMJ disorders can last months or years… This text opens a new tab to the WebMD website…, such as those caused by teeth grinding and arthritis.

But:

Treatment and proper care may relieve you of your symptoms.

How is TMD treated?

There are various types of treatment for TMD.

Your dentist will recommend one based on the cause of the disorder as well as your dental and personal needs.

If clenching or teeth grinding is the cause of the problem, you may be advised to use a custom-made appliance.

A dental appliance or nightguard will ease muscle pressure and protect your teeth at night.

If you have missing teeth, they could be the culprit behind your jaw pain or misalignment. Your dentist may create a custom restoration – an implant or bridge – to restore the proper balance.

Can TMD go away on its own?

For many people, TMD symptoms eventually subside on their own.

Unfortunately, that’s not always the case.

We recommend visiting your dentist if you’re experiencing:

• Persistent pain or tenderness in your jaw
• Clicking or popping in the jaw joint
• Migraines
• Locked jaw (you can’t open or close your jaw completely)
• Aching pain in or around your ear(s)
• Difficulty or pain while chewing
• Aching facial pain
• Dizziness
• Unevenly worn teeth

All of the above symptoms are common signs of TMJ disorder.

TMD can be serious and grow into a long-lasting issue if left untreated.

What happens if TMD goes untreated?

The chronic form of TMD may cause damage to your:

• Tendons
• Muscles
• Cartilage
• Temporal bone

And:

That damage can lead to health problems such as:

• Arthritis
• Nerve damage
• Permanent dislocation
• Worn teeth
• Vertigo
• Anxiety
• Depression
• Insomnia
• And more

So it’s best to seek TMD treatment to keep your flare-ups under control.

Are there home remedies for TMD?

There are ways that you can manage your TMD symptoms at home, but they likely won’t fully treat your condition.

Applying ice or warm, moist heat to the side of your face may help soothe your pain.

Taking over-the-counter pain medication like Ibuprofen may also help provide some relief.

Avoid slouching or having a forward head posture to avoid overworking or straining your temporomandibular joint (TMJ).

Also, practicing self-care may reduce your TMD symptoms. Try taking a daily walk to de-stress and brighten your mood.

Are you seeking TMD treatment?

Your Woburn dentists would love to help you!

At Dental Health Care of Woburn, we’ll provide you with world-class dentistry and ensure that all your needs are met.

We’ll do whatever it takes to make your visits relaxing and enjoyable.

Contact us to schedule a TMD treatment consultation.

Book Your Appointment

Or contact us by:

• Phone: 781-935-8810
• Email: reception@dentalhealthcareofwoburn. com
• Send us a message online

Dental Health Care of Woburn serves patients from Woburn, Winchester, Burlington, Stoneham, Reading, Tewksbury, Wilmington, Lexington, Wakefield, and surrounding communities.

Temporomandibular Joint Dysfunction: A Case Study | Lyashev I.N., Ekusheva E.V.

The article presents a clinical observation of a patient with pain dysfunction of the temporomandibular joint. The issues of diagnostics and further treatment of comorbid diseases and conditions in patients with orofacial pain are considered.

Temporomandibular joint pathology and orofacial pain

To date, there is a certain reassessment of the role of diseases associated with the pathology of the dentoalveolar system in the occurrence of orofacial pain. One example of this approach is temporomandibular joint pain dysfunction (TMJD) as the most common cause of chronic pain in the face and oral cavity in clinical practice, not associated with dental diseases.
Many issues of the pathology of the temporomandibular joint (TMJ) remain relevant, since there is still no consensus on the etiology, pathogenesis and methods of rational and effective treatment of TMD. There is no single classification that would take into account the various pathological processes that develop in the bone, cartilage components and adjacent muscle and ligamentous structures of this complex anatomical and functional formation. Numerous discussions on these issues, both in academic circles and among practitioners, have not yet been able to lead to the formation of a single point of view. At the same time, the vast majority of patients with painful TMD are at the primary appointment with the dentist – up to 76% [1], less often – with the maxillofacial surgeon [2]. At the same time, signs of TMD of varying severity are determined in 16–59% of the adult population [3], while in 70–89% of cases there is no inflammatory changes in the TMJ area [4].
The most likely reasons for this situation are the lack of interdisciplinary communication between specialists who are treated by patients with orofacial pain, and the specific perception of the clinical picture by highly specialized doctors treating these patients. In part, it is necessary to recognize a certain imperfection of modern medical science in terms of the formation of such a focused approach to solving most clinical situations. As clinicians accumulate experience and knowledge in specialized areas of medicine, a certain worldview is formed that allows them to adapt and apply the acquired knowledge in practice. This often leads to a certain fixation of the specialist on his own methods of treatment, and in case of failure of the latter, to the denial of the erroneous approach and a negative attitude towards the patient and his problem. Conversely, specialists of a narrow profile are in a hurry to refer the patient to numerous instrumental examinations, without paying due attention to the nature of complaints and careful history taking, or redirect to colleagues, in particular to neurologists or psychiatrists, without fully evaluating the patient’s clinical picture from the point of view of their specialties.
The concept of a multidisciplinary approach in the analysis of a particular clinical situation and the search for optimal therapeutic algorithms is the most advantageous, although not without drawbacks. In particular, it remarkably realizes itself in the treatment of comorbid conditions that negatively affect the course of any disease, which, according to our clinical observations, are often observed in patients with orofacial pain. Painful TMDJ in recent years has been given great importance as a comorbid disorder in headache, since a high prevalence of this pathology is shown in patients with various types of primary cephalgia (up to 67.1%) [5, 6], especially in patients with episodic and chronic migraine – in 86.8% and 91.3% of cases, respectively [7]. The presence of painful TMD leads to an increase in headache attacks, significantly impairs the ability to work and further reduces the quality of life of patients with migraine; there is also an inverse clinical relationship between these two diseases [8].
The implementation of a multidisciplinary approach in the management of a patient with orofacial pain after the initial appointment ideally requires, as necessary, further periodic consultations in the format of a consultation by clinicians of different profiles. In practice, in the vast majority of cases, even with simultaneous observation by several specialists, the patient can be treated under conditions of quite understandable inconsistency in therapeutic measures between them. This, of course, is due to the initial lack of a unified algorithm for diagnosing and treating patients with orofacial pain, generally accepted and approved by doctors of various specialties.
In connection with the current situation, the responsibility of each of the specialists involved in the process of treating a patient with pain syndrome increases significantly. On the one hand, it is necessary to be able to correctly differentiate the pathology that falls within the competence of this clinician, and on the other hand, to be able to correctly correlate the complaints made with the patient’s clinical picture and the results of the data obtained during the examination to identify or exclude comorbidity, as well as clearly present the goals and tasks in referring the patient to other specialists.
As an example illustrating the diagnostic search for a probable cause of the disease and an interdisciplinary approach to managing a patient with pain in the face, we present a case of pain TMD. It should be noted that a certain contribution to the development and further maintenance of the pathological process in painful TMDJ is made by a violation of the anatomical relationships in the TMJ, including dislocation of the intraarticular disc and compression of the richly innervated and vascularized bilaminar zone of the joint, which is important to consider when managing these
patients.

Clinical observation

Patient A ., 28 years old, turned to the maxillofacial surgeon with complaints of paroxysmal pains of a bursting, aching nature in the region of the upper jaw on the right, accompanied by burning, numbness and a feeling of crawling on the face and in the oral cavity and spreading to the area temple, ear and angle of the lower jaw; to discomfort and sound phenomena (clicks, crunches) in the TMJ area that occur when the mouth is opened wide and when chewing hard and solid food, as well as to recurrent intense headaches in the parietal-temporal areas, accompanied by nausea, intolerance to light and loud sounds, and lasting for a day or more.
From the anamnesis: headache attacks first appeared at school, in connection with them she always took analgesics and tried to lie down and sleep; they come up several times a year. My mother and grandmother had similar headaches, which disappeared over time. A few years ago, she was consulted by a neurologist, magnetic resonance imaging (MRI) of the brain did not reveal any pathology. A diagnosis of “migraine without aura” was made, drugs from the triptan group were recommended for pain relief. Currently, attacks of intense cephalalgia occur once a week, and the previously prescribed drugs have become worse. Clicks and a slight crunch in the TMJ area, not accompanied by pain, were noted in her youth. In the last few months, I began to notice discomfort in the TMJ area, more on the right; 2 months ago, after severe hypothermia, burning pains appeared in the region of the upper jaw, which did not disappear after taking analgesic drugs (nimesulide, ibuprofen). After contacting a neurologist, carbamazepine was prescribed, which had only a partial analgesic effect, more pronounced in the 1st month. treatment (600 mg/day), a further increase in the dose of the drug (up to 800 mg/day) did not bring the desired effect and was very poorly tolerated by the patient. Pain in the region of the upper jaw on the right became constant.

On examination: asymmetric facial deformity; hypermobility when moving in the area of ​​both TMJ, slight crepitus on auscultation. In the oral cavity – dento-alveolar deformity of class II1 Angle. On the right, in the projection of the innervation of the II branch of the trigeminal nerve, hyperesthesia with areas of allodynia is noted. There are no motor, coordinating and other neurological disorders.
MRI of the TMJ was performed, which determined the complete ventral dislocation of both TMJ discs without reposition, and cone beam computed tomography (CBCT) of the facial skeleton, which revealed the presence of asymmetric skeletal deformity due to a decrease in the posterior facial height and size of both condylar processes. In order to determine further management tactics for the patient and conduct a comprehensive treatment of existing chronic pain syndrome and deformation of the facial skeleton, she was consulted jointly by a maxillofacial surgeon, an orthodontist and a neurologist, and subsequently, after the detection of high titers of the human herpes virus type 6 (HHV-6) in blood and saliva, directed to a dermatovenereologist at the Herpetic Center. Dysfunction of the TMJ, asymmetric deformation of the facial skeleton with a tendency to a vertical type of growth, migraine without aura, postherpetic neuropathy of the II branch of the right trigeminal nerve (HHV-6) were diagnosed.
Long-term antiviral, immunomodulating and analgesic therapy was recommended , including drugs from the triptan group to relieve headache attacks, β-blockers and anticonvulsants (gabapentin) for the prophylactic treatment of migraine without aura and the treatment of postherpetic neuropathy of the II branch of the right trigeminal nerve. To normalize the dental status, a complex orthosurgical treatment of the existing pathology of the TMJ and skeletal deformity was recommended in a planned manner.
After the normalization of the immune status indicators (including in the absence of HHV-6 in the blood and saliva), a dental distraction preoperative plate was made for patient A. to create decompression in the region of both TMJs, surgical reposition and fixation in the physiological position of the intraarticular discs of both TMJ. The control MRI of the TMJ showed a stable position of the repositioned discs of both joints. In the postoperative period, the necessary correction of the plate was carried out to create the stability of the lower jaw, the wearing of which was recommended to the patient for the next 3 months. The patient noted a significant decrease in various pain manifestations in the region of the upper jaw and a decrease in the frequency of migraine attacks up to two times a month.
After orthodontic preparation of the dentition, the second stage of surgical treatment was performed: orthognathic surgery to eliminate the existing skeletal deformity. Adequate occlusal support for both TMJs was created in the patient, optimal anatomical relationships on the part of the facial skeleton were restored. Patient A. completes treatment under the supervision of an orthodontist and the dynamic supervision of a neurologist with correction of the therapy taken as necessary. There is a complete regression of pain in the face and oral cavity, headache attacks occur no more than once a month and are successfully stopped by taking triptan-containing drugs.

Statement

Pain syndrome in the face and oral cavity, as a rule, is characterized by a polymorphic clinical picture, characterized by polyetiology, multifactoriality and the objective complexity of determining the various causes of its occurrence. The presented complex approach of the maxillofacial surgeon, orthodontist, dermatovenereologist and neurologist to the management of a patient with TMD who has migraine without aura and postherpetic neuropathy of the II branch of the trigeminal nerve was the key to a successful outcome of her treatment, the contribution to which was made by each of the specialists who complemented each other until a stable result is achieved. Thus, the diagnosis and further treatment of comorbid diseases and conditions in patients with orofacial pain is extremely important, since it allows them to help these patients more effectively, while the presence of a comorbid pathology supports their chronic and sometimes intractable pain
syndrome.

TMJ treatment (joint dysfunction)

Description Symptoms Methods of treatment Prices Answers to questions

We have already helped more than 300 patients

We restore the function of the joint and improve the quality of life

Treatment terms from 1 month

TMJ dysfunction is a fairly common pathology today, since it is largely caused by stress factors. Here it can be difficult to understand what is primary, what is secondary, because people with joint dysfunction come, as a rule, with bite pathology, pathology of the musculoskeletal system (curvature of the spine, neck). Therefore, joint treatment is a complex story. It happens that the primary pathology is the pathology of the joint, it happens that the musculoskeletal system.

Causes of TMJ dysfunction

The orthodontist should find out what was primary – bite, misalignment of teeth or missing teeth, possibly not very successful orthodontic treatment in anamnesis, early treatment when they were children or adolescents and subsequent treatment could serve reason. It is important to correctly diagnose.

Comprehensive treatment of the TMJ

When the doctor has determined the cause of the joint pathology, or causes, he determines the patient’s readiness for a comprehensive treatment plan. In addition to the orthodontist, an osteopath or a chiropractor, or even an orthopedist, can be involved if a more complex correction of the musculoskeletal system is needed.

The patient should be aware that it is possible to align the jaw with a splint or splint, but it will not solve the problem of malocclusion. Orthodontic treatment is required to correct the bite. If you have already had orthodontic treatment before, then it is more difficult to decide on a second treatment.

Therefore, first the problem with the joint is solved by means of a splint or joint splint, then the bite is corrected, and, if necessary, prosthetics. In parallel, work is underway with an osteopath to restore the muscular corset of the back and neck.

It happens that a patient refuses treatment with braces after resolving a problem with a joint. In this case, we warn him about the need to wear an articular splint constantly in order to avoid the appearance of old problems with the TMJ. After all, a relapse can happen against a background of stress quite quickly.

What are the symptoms of TMJ dysfunction?

• Soreness or pain in one or both TMJs at rest or when opening the mouth.

• Crackling, clicking, crepitus and other noises in the area of ​​one or both TMJs when opening the mouth.

• History of TMJ injuries (previously), incl. dislocation, subluxation, chronic subluxation.

• Restrictions in the mobility of the TMJ, restriction in opening the mouth.

• Excessive masticatory muscle tone, bruxism (“grinding” of teeth during sleep, at rest).

• Asymmetry of chin, lips, frenulum of lips, asymmetry of mouth opening, S-shaped opening.

• Suspicion of the presence of a forced position of the lower jaw.>

The presence of one or more of the above may indicate TMJ dysfunction.

Conventional orthodontic treatment does not address TMJ dysfunction. In the process of orthodontic treatment, the severity of dysfunction may not change, decrease or increase. At the moment, in the world scientific orthodontic literature there is no convincing data on the relationship between orthodontic treatment and the state of the TMJ. Deterioration of the joint after treatment may not be related to this treatment.

Please note! Even in the absence of visible clinical manifestations of joint dysfunction, there may be hidden disorders that require special diagnostics to identify them.

If there is a forced incorrect position of the lower jaw, its position may change during treatment with a change and complication of the treatment plan (the need to extract individual teeth, an increase in the duration of treatment). A reliably forced position cannot be diagnosed by traditional orthodontic methods; to check its presence, as a rule, a special analysis is required (manual functional analysis, determination of the central ratio of the jaws), the use of a special articular splint for a period of several months, which, however, does not give 100 % guarantees.

For detailed joint diagnostics, clarification of the specifics of your case, further production of the joint splint, you can make an appointment with a dentist-orthodontist who deals with the issue of TMJ dysfunction.

TMJ dysfunction is a chronic condition that can be managed but not cured (i.e. it is possible to eliminate the symptoms, however, the pathological changes in the joints, if they have already occurred, are likely to persist).

What happens if TMJ dysfunction is not treated?

If the dysfunction is not treated, the compensatory capabilities of the body may be exhausted sooner or later, the symptoms will worsen, the pathology will begin to progress, causing more discomfort (sometimes for several years), thereby affecting the deterioration of the function of the dentoalveolar system.

In order to try to prevent this and treat the individual temporomandibular joint structure and function, patients are usually offered the following approach.

Structure of the TMJ

TMJ dysfunction treatment method

1. Diagnosis of TMJ dysfunction.

• During the diagnosis of the joint in the clinic, a number of measurements and tests are carried out, all sensations in the joint area are recorded (discomfort, clicks, pain, jaw deviation when opening and closing), the difference in sensations in the right and left joints.

• The orthodontist also takes casts of the jaws and takes photographs of the face and intraoral photographs, as well as a three-dimensional computed tomography of the face (3D CT), if necessary, the doctor can give a referral for an additional study – magnetic resonance imaging of the TMJ (MRI).

• Often, an orthodontist, in addition to manual functional analysis, conducts a visual assessment: posture, symmetry of the shoulder girdle, shoulder blades, hip bone structures, etc. , performs the necessary tests, photographs. According to the results, it is possible to appoint an appointment for a consultation with an osteopath or a chiropractor for joint management of the patient. Allied specialists (orthopedist, surgeon, periodontist) can also be involved in the preparation of the treatment plan.

What exercises are prescribed to patients to normalize the work and relax the masticatory muscles?

Exercise No. 1

Draw a vertical line on the mirror with a marker, stand opposite, so that the line divides the face into right and left halves, place your fingers on the area of ​​the articular heads, lift your tongue up and back, open and close your mouth along the line (maybe it will not work right away), 2-3 times / day for 30 repetitions. You do not need to open your mouth wide (comfortable width), the main thing is symmetrically (so that the jaw does not “move out” in any direction). If there is a click, open until it clicks.

Exercise No. 2 (cycle)

Do it when possible, for example, in front of the TV, at the computer, in a traffic jam while driving. Open – close your mouth without closing your teeth for 30 seconds, then reach your tongue alternately to the right, then to the left cheeks for 30 seconds. Open again – close your mouth, then for 30 seconds move your tongue in a circle inside the vestibule (behind the lips), first in one direction, then in the other direction (clockwise – counterclockwise), open again – close your mouth, etc. During this half-hour cycle, the teeth should not touch, the lips should be closed. If you want to close your mouth or take a sip, put your tongue between your teeth. Repeat the cycle for 20-30 minutes 2-3 times/day

2. Occlusal therapy for TMJ dysfunction

After the diagnosis, the patient is booked to the orthodontist for an appointment to determine the central ratio of the jaws (“true” position of the lower jaw, the position in which your joint and masticatory muscles will be most comfortable).

In order to more precisely establish and fix this position, an occlusal splint (splint) will be individually made for the patient from a special plastic that is erased as it is worn. The tire must be worn constantly (sleep, talk, eat in it if possible) – this is the meaning of occlusive therapy, which will help the joint and masticatory muscles to reorganize into the most comfortable functional state.

Cleaning and caring for the tire is very simple – after eating (as well as while brushing your teeth) clean with a soft brush with toothpaste or soap.

3. Installation of a bracket system for a patient with TMJ dysfunction

Installation of a bracket system on the upper jaw is performed after an average of 3 months of occlusive therapy. The splint is adjusted once every 1-2 weeks, or at the discretion of the doctor, until the main complaints from the TMJ are eliminated (in parallel with the alignment of the teeth in the upper jaw), then the bracket system is installed on the lower jaw with a partial reduction (grinding) of the interfering parts of the occlusal tires, or complete removal. Here the patient needs to be patient – the process can take several months.

At the same time, the new position of the lower jaw is monitored: repeated manual functional analysis, photometry, bite registration is possible, computed tomography of the face during treatment, continuation of orthodontic treatment on a bracket system.

Upon completion of orthodontic treatment, the final control of the position of the lower jaw follows (manual functional analysis, photometry, bite registration, 3D CT of the face upon completion (after) treatment).

Splint

Joint splint with braces

TMJ dysfunction treatment result

Treatment results in a satisfactory aesthetic result, achievement of full occlusion with multiple even fissure-tubercle contacts and elimination or reduction of TMJ dysfunction. Mandatory, if indicated, is a full-fledged rational prosthetics or functional and aesthetic restoration of teeth, as the final stage of treatment – at this stage, a detailed consultation of an orthopedic dentist is necessary.