Jaw Joint Problems – Exodontia

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.

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.

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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.

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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.