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