What does the medical term tmj mean: TMJ disorders – Symptoms and causes

30.09.202310.07.2023 by alexxlab

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

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:

Disorders of the joints, including disc disorders.
Disorders of the muscles used for chewing (masticatory muscles).
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.

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.

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.

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.

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.

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.

TMJ disorders: MedlinePlus Medical Encyclopedia

Temporomandibular joint and muscle disorders (TMJ disorders) are problems that affect the chewing muscles and joints that connect your lower jaw to your skull.

There are 2 matching temporomandibular joints on each side of your head. They are located just in front of your ears. The abbreviation “TMJ” refers to the name of the joint, but it is often used to mean any disorders or symptoms of this region.

Many TMJ-related symptoms are caused by the effects of physical stress on the structures around the joint. These structures include:

Cartilage disk at the joint
Muscles of the jaw, face, and neck
Nearby ligaments, blood vessels, and nerves
Teeth

For many people with temporomandibular joint disorders, the cause is unknown. Some causes given for this condition are not well-proven. They include:

A bad bite or orthodontic braces.
Stress and tooth grinding. Many people with TMJ problems do not grind their teeth, and many who have been grinding their teeth for a long time do not have problems with their temporomandibular joint. For some people, the stress associated with this disorder may be caused by the pain, as opposed to being the cause of the problem.

Poor posture can also be an important factor in TMJ symptoms. For example, holding your head forward while looking at a computer all day strains the muscles of your face and neck.

Other factors that may make TMJ symptoms worse include poor diet and lack of sleep.

Many people end up having “trigger points.” These are contracted muscles in your jaw, head, and neck. Trigger points can refer pain to other areas, causing a headache, earache, or toothache.

Other possible causes of TMJ-related symptoms include arthritis, fractures, dislocations, and structural problems present since birth.

Symptoms associated with TMJ disorders may be:

Biting or chewing difficulty or discomfort
Clicking, popping, or grating sound when opening or closing the mouth
Dull, aching pain in the face
Earache
Headache
Jaw pain or tenderness of the jaw
Locking of the jaw
Difficulty opening or closing the mouth

You may need to see more than one medical specialist for your TMJ pain and symptoms. This may include a health care provider, a dentist, or an ear, nose, and throat (ENT) doctor, depending on your symptoms.

You will need a thorough exam that involves:

A dental exam to show if you have poor bite alignment
Feeling the joint and muscles for tenderness
Pressing around the head to locate areas that are sensitive or painful
Sliding the teeth from side to side
Watching, feeling, and listening to the jaw open and shut
X-rays, CT scan, MRI, Doppler test of the TMJ

Sometimes, the results of the physical exam may appear normal.

Your provider will also need to consider other conditions, such as infections, nerve-related problems, and headaches that may be causing your symptoms.

Simple, gentle therapies are recommended first.

Soft diet to calm the joint inflammation.
Learn how to gently stretch, relax, or massage the muscles around your jaw. Your provider, dentist, or physical therapist can help you with these.
Avoid actions that cause your symptoms, such as yawning, singing, and chewing gum.
Try moist heat or cold packs on your face.
Learn stress-reducing techniques.
Exercise several times each week to help you increase your ability to handle pain.
Bite analysis.

Read as much as you can on how to treat TMJ disorders, as opinion varies widely. Get the opinions of several providers. The good news is that most people eventually find something that helps.

Ask your provider or dentist about medicines you can use. These might include:

Short-term use of acetaminophen or ibuprofen, naproxen (or other nonsteroidal anti-inflammatory drugs)
Muscle relaxant medicines or antidepressants
Muscle relaxant injections like toxin botulinum
Rarely, corticosteroid shots in the TMJ to treat inflammation

Mouth or bite guards, also called splints or appliances, have long been used to treat teeth grinding, clenching, and TMJ disorders. They may or may not help.

While many people have found them to be useful, the benefits vary widely. The guard may lose its effectiveness over time, or when you stop wearing it. Other people may feel worse pain when they wear one.
There are different types of splints. Some fit over the top teeth, while others fit over the bottom teeth.
Permanent use of these items may not be recommended. You should also stop if they cause any changes in your bite.

If conservative treatments do not work, it does not automatically mean you need more aggressive treatment. Use caution when considering treatment methods that cannot be reversed, such as orthodontics or surgery that permanently changes your bite.

Reconstructive surgery of the jaw, or joint replacement, is rarely required. In fact, the results are often worse than before surgery.

You can get more information and find support groups through the TMJ Syndrome Association at tmj.org/.

For many people, symptoms occur only sometimes and do not last long. They tend to go away in time with little or no treatment. Most cases can be successfully treated.

Some cases of pain go away on their own without treatment. TMJ-related pain may return again in the future. If the cause is nighttime clenching, treatment can be very tricky because it is a sleeping behavior that is hard to control.

Mouth splints are a common treatment approach for teeth grinding. While some splints may silence the grinding by providing a flat, even surface, they may not be as effective at reducing pain or stopping clenching. Splints may work well in the short-term, but could become less effective over time. Some splints can also cause bite changes if they are not fitted properly. This may cause a new problem.

TMJ may cause:

Chronic face pain
Chronic headaches

See your provider right away if you are having trouble eating or opening your mouth. Keep in mind that many conditions can cause TMJ symptoms, from arthritis to whiplash injuries. Experts who are specially trained in facial pain can help diagnose and treat TMJ.

Many of the home-care steps to treat TMJ problems can also help prevent the condition. These steps include:

Avoid eating hard foods and chewing gum.
Learn relaxation techniques to reduce overall stress and muscle tension.
Maintain good posture, especially if you work all day at a computer. Pause often to change position, rest your hands and arms, and relieve stressed muscles.
Use safety measures to reduce the risk for fractures and dislocations.

TMD; Temporomandibular joint disorders; Temporomandibular muscle disorders; Costen’s syndrome; Craniomandibular disorder; Temporomandibular disorder

Indresano AT, Park CM. Nonsurgical management of temporomandibular joint disorders. In: Fonseca RJ, ed. Oral and Maxillofacial Surgery. 3rd ed. St Louis, MO: Elsevier; 2018:chap 39.

Lee E, Crowder HR, Tummala N, Goodman JF, Abbott J, Zapanta PE. Temporomandibular disorder treatment algorithm for otolaryngologists. Am J Otolaryngol. 2021;42(6):103155. PMID: 34214714. pubmed.ncbi.nlm.nih.gov/34214714/.

Okeson JP. Temporomandibular disorders. In: Kellerman RD, Rakel DP, eds. Conn’s Current Therapy 2022. Philadelphia, PA: Elsevier; 2022:522-525.

Pedigo RA, Amsterdam JT. Oral medicine. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 60.

Updated by: Michael Kapner, DDS, General Dentistry, Norwalk Medical Center, Norwalk CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Jaw – TMJ disorder | Treatment at the Champel Dental Center

Temporomandibular joint dysfunction or algodysfunctional syndrome of the mandibular apparatus (ADMAS) is a complex of symptoms that can manifest itself very variably, associated with one or more of the following manifestations

Painful manifestations (ear pain, headache pain in the temples, pain in the jaw).
Articular manifestations: articular noises (clicks when opening the mouth, creaking), painful or non-painful restriction of mouth opening, discomfort when chewing and eating, feeling of joint instability, blocking when the mouth is closed or, conversely, blocking when the mouth is wide open.
Other manifestations such as ringing in the ears (tinnitus) or neck pain.

The various mechanisms that cause TMJ dysfunction are complex, but various risk factors, often interrelated, are known to cause this dysfunction.

Anomalies dental articulation (way of articulation of the upper and lower jaws with each other).
Injuries and fractures of the face (especially jaw), skull or neck. They can lead to damage to the temporomandibular joint.
Stressful life events and high levels of anxiety seem to aggravate symptoms.
Parafunction is unconscious or unconscious hyperactivity of the jaw muscles, sometimes associated with tooth wear and night grinding (this is a case of bruxism). They are often associated with the stress of everyday life and abnormalities in dental articulation.
Hyperlaxia is due to the presence of too loose, too stretched ligaments. Often found in young women. This results in too much maximum mouth opening. This favors blockage when the mouth is wide open (dislocation of the jaw).
Rheumatic diseases may occur in the jaw joint.

What is the origin of pain and its treatment?

There are two types of pain:

Most often they have muscular origin and occur in the initial stages of the disease. They are associated with muscle spasms and contractures.
They become articular as the disease progresses and joint damage appears. In fact, at this stage they are most often intertwined (muscular and articular).

It is the difference between these two types of pain that determines the success and delivery of the treatment.

At the initial stage, the doctor often cannot determine whether the pain is mainly due to muscle spasms or to diseases of the joints, unless you have a completely normal examination of the joints (purely muscular stage) or, on the contrary, the problem with the joints is obvious, for example, in case of severe osteoarthritis.

Therefore, we usually start (except in special cases) treatment with occlusal devices. This treatment is able to relieve pain of muscular origin and regulate minor and still reversible articular disorders.
This treatment, which should last at least 2-3 months, allows us to distinguish between two origins of pain (muscular or joint).

Nine times out of ten, an occlusal treatment is effective and solves your problem, as the pain is usually associated with muscle spasms and minor joint disturbances after muscle spasms. Even if after treatment and after the pain has disappeared, a clicking sound remains, indicating a violation of the small joints, this is acceptable, since this is clearly not the cause of your pain.

The result obtained can be stabilized by treating anomalies of the dental articulation in order to place the joint and lower jaw in the most stable and least traumatic position.