Exodontia.Info
Jaw Joint Problems
The temporomandibular joint (TMJ / jaw joint) is located in front of the ear where the skull and the lower
jaw meet.  The joint allows the lower jaw (
mandible) to move and function for eating, talking etc.  The joint
itself is made up of two bones that are separated by a disc of cartilage (a tough tissue).  Ligaments and
muscles surround the joint.
Diagram Showing the Position & Anatomy of the TMJ / Jaw Joint
Problems with the jaw joint are very common but typically only last a few months before getting better.  In some instances, only the
muscles are affected (known as
myofacial pain dysfunction), whereas in others, the cartilage and ligaments may also be a
problem (known as
internal derangement of temporomandibular joint).

The most common symptoms are:

  • Joint noise - such as clicking, cracking, crunching, grating or popping.
  • Pain - usually a dull ache in and around the ear.  The pain may radiate, i.e. move forwards along the cheekbone or
    downwards into the neck.
  • Headache.
  • Trismus - inability to open your mouth fully.

Most jaw joint problems are made worse by chewing and are aggravated at times of stress.


What causes jaw joint problems?

Pain is caused by the muscles in and around the jaw joint tightening up.  Joint noise occurs if the disc of cartilage moves out of its
normal position between the bones of the jaw joint.  Most commonly, the disc slips forward and a noise is made when it returns to
its normal position in between the bones.  The noise sounds louder to some patients than others because the joint is just in front of
the ear.  The ligaments and muscles surrounding the joint can in turn go into spasm, producing pain and a difficulty in opening the
mouth properly.


Why have I got jaw joint problems?

The cartilage in the jaw joint is thought to slip forwards because of over-use of the muscles surrounding the jaw.  The over-use
commonly produces tightening of the muscles and may occur as a result of chewing habits, such as grinding or clenching the teeth
when under stress (usually when asleep).  Nail biting or holding things between the teeth can also cause jaw joint problems.  Less
commonly, missing back teeth, an uneven bite or an injury to the jaw can lead to the problem.  Often, no obvious cause is found.


Are my problems anything to worry about?

Jaw joint problems are usually not serious and do not lead on to other problems,
e.g. arthritis of the jaw joint.  However, they are a nuisance.  Fortunately, jaw joint problems usually respond well to simple
treatments.
What are the Treatments?

Treatments vary depending on whether you are suffering from myofacial pain dysfunction, internal derangement of the
temporomandibular joint
or a combination of both.  On the whole, treatment is aimed at trying to reduce the workload of the
muscles, so allowing the disc of cartilage to return to a normal position in the joint.

This includes such
advice as:

  • Eat a soft diet that requires little chewing - allowing the over-worked muscles to rest.

  • Take painkillers - anti-inflammatory medication (e.g. Ibuprofen) is good and can be taken as either tablets or applied as a gel
    (such as Ibuprofen gel or Voltarol Gel / Emugel) on the outside of the joint.

  • Use heat - e.g. wrap a hot water bottle filled with warm water in a towel and apply it to the side of your face.

  • Identify and stop any bad habits, such as clenching or grinding.  Although, this may be difficult as they are often 'subconscious',
    i.e. you may not be aware you are doing them.

  • Use relaxation therapy and learn techniques to control tension and stress.

  • Jaw joint exercises - your doctor will advise you on the best kind of exercises for your problems.  Please remember to follow
    them as instructed.

  • Rest the joint as much as possible, e.g. avoid yawning.

  • Wear a clear plastic splint that fits over the teeth and is worn mainly at night (a Bite Raising Appliance).  This helps support
    the joint and surrounding muscles.

  • Follow a physiotherapy programme.

  • Replace missing teeth to balance the bite (if appropriate).


What happens if these methods do not help?

Surgery is only carried out in a small number of cases.  This can involve manipulation of the joint whilst you are asleep, or more
rarely, surgery carried out with a mini telescope.  In extreme cases, it may be necessary to open the joint and operate on the
bones, cartilage and ligaments.


Can jaw joint problems develop into anything worse?

It is important to realise that jaw joint problems, although a nuisance, are not sinister and usually respond well to relatively simple
measures over a period of time.

Patients can manage most of the treatments themselves.

Occasionally,
jaw joint problems may return after several years.  It is very rare for jaw joint problems to progress to anything
serious, like arthritis.
Last Updated 13th July 2016
Useful Websites:

Newcastle Dental School

NHS Evidence Clinical Knowledge Summaries

American Academy of Oro-Facial Pain

National Institute of Dental and Craniofacial Research

Dental Health Information Center (Temperomandibular [TMJ] Disorders)

American Society of Temperomandibular Joint Surgeons

Quality Dentistry (TMJ)

TMJ Association (TMJ Archive)

American Academy of Otolaryngologists - Head & Neck Surgery

Mayo Clinic

Emedicine.com

Practical Pain Management

Orofacialpain.org.uk



Useful Articles:

Am Soc TMJ Surgeons 2001.  Guidelines for Diagnosis & Management of Disorders Involving the TMJ & Related Musculoskeletal
Structures

McKinley Health Center, University of Illinois 2002.  Temporomandibular Joint Disorders

BAOMS 2003. Jaw Joint Problems

BDJ 2004.  Treatment of TMJ disorders by stabilising splints in general dental practice - results after initial treatment

RadioGraphics 2006.  Neurologic Head & Neck Imaging.  MR Imaging of TMJ Dysfunction - A Pictorial Review

TMJ Disorders (2006) - US Department of Health & Human Services, National Institutes of Health.

BAOS Information Sheet (2006).  Temporomandibular (Jaw) Joint Problems

European Academy of Craniomandibular Disorders 2007.  Recommendations for Examination, Diagnosis, Management of Patients
with Temporomandibular Disorders & Oro-Facial Pain by the GDP

ENT News 2008 - Assessment & Initial Management of TMJ Disorders

J Oral Maxillofac Surg 2009.  Temporomandibular Disorders in Surgical Practice. Does Science Support Treatment Decisions.

BJOMS 2009.  Leading article.  Current Thinking in Temporomandibular Joint Management.

Cochrane Database Syst Rev 2009.  Stabilisation Splint Therapy for Temporomandibular Pain Dysfunction Syndrome (Review)

J Oral Maxillofac Surg 2010.  Oral & Maxillofacial Surgery & Chronic Painful Temporomandibular Disorders — A Systematic
Review.

BJOMS 2010.  Review article - Oral Surgery and TMJ-related papers published in BJOMS in 2008 and 2009.

International Dentistry SA 2010.  Etiology of temporomandibular disorders - the journey so far

BDJ 2010.  Risk management in clinical practice. Part 8.  Temporomandibular disorders

Dental Update 2011.  Differential Diagnosis for Orofacial Pain, Including Sinusitis, TMD, Trigeminal Neuralgia

British Journal of Pain 2011.  Recent Advancements in Temporomandibular Disorders (TMDs)

J Dent 2011.  Limited evidence that acupuncture is effective for treating temporomandibular disorders

British J Pain 2011.  Recent Advances in Temporomanidular Disorders (TMDs)

Evidence-Based Dentistry 2012.  Some Evidence for the Management Temporomandibular Joint Disorders

Evidence-Based Dentistry 2012.  Ultrasonography has an acceptable diagnostic efficacy for temporomandibular disc displacement

BDJ 2012.  Letter to Editor.  TMJ Dysfunction

BJOMS 2012.  Oral Presentations.  The TMJ MDT clinic — the King’s experience

BDA February 2013 - TMJ - What Should I Do, Who Should I Turn To?

BDJ 2013.  Oral Surgery - Part 3.  Temporomandibular Disorders

European Pain Federation 2013.  Temporomandibular Disorders.  Patient Leaflet

Dent Update 2013. Conservative Temporomandibular Disorder Management.  What DO I do - FAQ

Eastman Dental Hospital 2013.  Temporomandibular Disorder (Primary Care)

Eastman Dental Hospital 2013.  Temporomandibular Disorder (Complex)

Int J OMF 2013.  A New Surgical Classification for TMJ Disorders

J Lasers in Med Sci 2011.  Immediate Relief of TMJ Clicking Following Low Level Laser Therapy after Orthodontic Treatment.  A
Case Report

RCS Eng 2013.  Temporomanidbular Disorders (TMDs) - An Update & Management Guideline for Primary Care from UK Specialist
Interest Group in Orofacial Pain & TMDs

US Dept Health & Human Services, Nat Institute of Health 2013.  TMJ Disorders

American Academy of Orofacial Pain 2014.  Temporo-Mandibular Joint Disorders

BDJ 2014.  Temporomandibular disorders, trismus & malignancy - development of a checklist to improve patient safety

BMJ 2015.  Clinical Review.  Temporomandibular Disorders

Dent Update 2015.  Pain-Related Temporomandibular Disorder − Current Perspectives & Evidence-Based Management

Dent Update 2016.  Pain Part 6. Temporomandibular Disorders
Treatment Algorithm for TMJ Dysfunction & Myo-Fascial Pain Syndrome