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 of the TMJ / Jaw Joint & some of the main chewing muscles
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 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 April 2020
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

Am Fam Physician 2007.  Temporomandibular Joint Disorders

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 Dent Ed 2008.  TMJ Disorders - Future Innovations in Diagnostics & Therapeutics

NEJM 2008.  Temporomandibular Disorders

AGRI 2009.  Etiology of temporomandibular disorder pain

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 Manual Manip Ther 2009.  Management & Treatment of Temporomandibular Disorders - A Clinical Perspective

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

Int J Oral Maxillofac Implants 2013.  Temporomandibular Joint Disorders - A Review of Etiology, Clinical Management &
Tissue Engineering Strategies

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

BJOMS 2014.  Temporomandibular joint multidisciplinary team clinic

Am Fam Physician 2015.  Diagnosis & Treatment of Temporomandibular Disorders

BMJ 2015.  Clinical Review.  Temporomandibular Disorders

Dental Press J Orthod. 2015.  TMD & Chronic Pain - A Current View

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

Dent Update 2016.  Pain Part 6. Temporomandibular Disorders

BJOMS 2017.  Current Thinking about the Management of Dysfunction of the Temporomandibular Joint - A Review

Austral Dent J 2018.  Management of Temporomandibular Joint Disorders - A Surgeon’s Perspective

Intech 2018.  Nonsurgical Strategies for the Treatment of Temporomandibular Joint Disorders

Intech 2018.  Osteoarthritis of the TMJ - Clinical & Imagenological Diagnosis, Pathogenic Role of the Immuno-
Inflammatory Response & Immunotherapeutic Strategies

J Appl Oral Sci 2019.  Temporomandibular Joint Disc Displacement with Reduction - A Review of Mechanisms & Clinical
Presentation

J Pain Res 2019.  Management of Pain in Patients with Temporomandibular Disorder (TMD) - Challenges & Solutions
Treatment Algorithm for TMJ Dysfunction & Myo-Fascial Pain Syndrome
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.

The ætiology of jaw joint problems is multi-factorial and includes biological, environmental, social, emotional and cognitive
triggers.

Factors consistently associated with jaw joint problems include other pain conditions (e.g., chronic headaches),
fibromyalgia, autoimmune disorders, sleep apnœa and psychiatric illness (e.g. depression & anxiety).

Smoking is associated with an increased risk of jaw joint problems in females younger than 30 years.


Classification of Jaw Joint Problems

Jaw joint problems are classified as either as intra-articular (within the joint) or extra-articular (involving the surrounding
musculature).

Musculoskeletal conditions are the most common cause of jaw joint problems, accounting for at least 50% of cases.

Articular disk displacement involving the condyle–disk relationship is the most common intra-articular cause of jaw joint
problems.
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.