Five years ago, Stephen, a 40-year-old business manager, started having occasional pain in his jaw and the muscles of his face and neck. Sometimes he would have trouble moving his jaw and would hear clicking sounds while he was chewing. His doctor and dentist told him to reduce the stress in his life and make sure he was not clenching his teeth. Despite his best efforts, the symptoms got so bad that his work performance suffered. Another doctor suggested he see a dentist who had experience treating orofacial pain. This dentist diagnosed Steve's problem as a temporomandibular disorder (TMD) and recommended a combination of treatments that finally relieved his pain and chewing difficulties.

What Is in a Name?

There has been a great deal of controversy among clinicians and researchers about the name, definition, symptoms, causes, and treatment of temporomandibular disorders. As a result, many people with TMD have gone to several medical and dental providers before getting a correct diagnosis and treatment.

The temporomandibular joint (TMJ) is the jaw joint. Temporomandibular disorders (TMD) refers to a group of conditions that affect the temporomandibular joint, as well as the muscles that control chewing. Although the terms TMJ and TMJ disorder are used to describe disorders associated with this joint, TMD is also an accepted term.

Because many people do not seek treatment for their jaw pain or other associated problems, it is hard to tell how many are actually affected by TMD. For most people, the discomfort is temporary and fluctuates over time. Only a small percentage develop serious, long-term problems. TMD appears to affect women more than men.

Details of the Temporomandibular Joint

The temporomandibular joint connects your lower jaw (mandible) to the temporal bone on the side of your head. You can feel it on each side of your head by placing your fingers just in front of your ears and opening your mouth or moving your jaw from side to side.

The TMJ is made up of 2 sections separated by a disc, which absorbs shock to the joint from chewing and other movements. This system, along with the muscles attached to and surrounding the joint, allows the jaw to move up and down, forward and back, and sideways. This movement enables you to talk, chew, and swallow. Anything that prevents the joints and muscles from working together properly may contribute to TMD.

Contributing Factors

Experts feel that TMD is caused by several interacting factors. However, there is disagreement about the specific factors involved and the roles they each play. These factors may play a role in developing TMD:

• Trauma to the jaw or neck
• Arthritis of the joint
• Oral habits, such as teeth grinding, teeth clenching, or lip biting
• Bite problems that affect how the teeth fit together
• Muscle tension

Psychological conditions such as depression and anxiety are also associated with TMD.

What Are the Symptoms?

TMD symptoms include:

• Pain or discomfort in and around the jaw joints, ears, or muscles of the jaw, face, temples, or neck
• Headaches
• Limited movement or locking of the jaw
• Chewing problems
• Painful clicking, popping, or grating sounds when moving the jaw joint
• Ear problems, such as aches, or sensitivity to noise or wind
• Reduction in the your quality of life, which may contribute to depression

Fortunately TMD is usually temporary. It may go away on its own or with conservative treatment. Chronic or debilitating TMD only occurs in a small group of affected people.

A Complex Diagnosis

Diagnosing TMD can be difficult due to the lack of scientific evidence and the controversies over the disorder. Most cases are diagnosed based on your own description of symptoms, your medical and dental history, and a physical examination of the jaw, head, and neck.

Tailored Treatment

Treatment should be tailored to your symptoms and contributing factors. It may be difficult to resolve and treatment focuses on management of the symptoms and restoring function. Simple treatment to relieve the discomfort and restore proper functioning is often all that is needed. Most clinicians and researchers strongly recommend conservative treatment that causes no permanent changes in the structure or position of the jaw or teeth.

Self-care practices that often ease TMD symptoms include applying heat or ice, and avoiding movements that strain the jaw, such as chewing gum and laughing or yawning with your mouth wide open. Other conservative treatments include stress management, physical therapy with exercises you can do at home, and medications to reduce pain and inflammation. Oral appliances, commonly referred to as splints or night guards, are sometimes used to help decrease clenching and grinding and ease the strain on the joints and muscles.

For people who have a more chronic course, the addition of cognitive behavioral therapy (CBT) has been useful in reducing pain and depression associated with TMD. CBT is a problem-solving approach that helps you change the way you think about and manage your TMD symptoms.

Getting Help

If you think you have TMD, talk with your dentist or doctor. If necessary, they will refer you to a dentist who specializes in orofacial pain.