(TMD; Temporomandibular Joint Disorder; Temporomandibular Joint Dysfunction; TMJ Syndrome; TMJ Osteoarthritis)
Temporomandibular disorder (TMD) is a painful problem of the jaw joints. These are the small joints in front of each ear. They attach the lower jaw to the skull. TMD problems may be in the joint in the jaw or the muscles around it. Treatment can help.
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The cause of TMD is often not clear. It may be due to:
- An injury of the jaw or face
- Too much tension in the jaw muscles
- Displacement or poor position of the jaw joint or cartilage disc inside it
- The upper and lower teeth not being in line
- Disturbed movement of the jaw joint
- Arthritis or a swelling in the joint
- Too much or not enough motion of the joint
TMD is more common in women. People from 20 to 40 years old are most at risk. Other things that may raise the risk are:
- An injury of the jaw and neck
- Clenching or grinding of teeth
- Poorly fitting dentures or crowns
- Fingernail biting
- Playing a wind instrument
TMD may cause:
- Pain in the jaw or face
- Pain that may be worse with chewing, yawning, or opening and closing the mouth
- Clicking, popping, or grating sounds with movement of the jaw
- A feeling of the jaw catching or locking briefly while attempting to open or close the mouth, or while chewing
- Neck or shoulder pain
The doctor or dentist will ask about symptoms and past health. A physical exam will be done. It will focus on the jaw, teeth, face, and head. This is often enough to make the diagnosis.
Pictures can help confirm the diagnosis. They may be done with:
The goal of treatment is to manage symptoms. Options are:
- Lifestyle changes, such as ice or heat packs and avoiding gum chewing
- Counseling to learn how to manage stress
- Physical therapy to stretch and strengthen the jaw
- Dental devices to relax the jaw muscles and prevent the teeth from clenching and grinding
- Medicine, such as:
- Pain relievers like ibuprofen
- Muscle relaxants
- Antidepressants to ease pain
- Cortisone injections to ease swelling and pain
- Botulinum toxin (Botox) injections to ease tension in the jaw
- Certain antidepressants—to treat long-term TMD
Some people may need surgery when other methods are not helpful. This is not common.
To lower the risk of TMD, avoid:
- Jaw clenching
- Nail biting
- Teeth grinding
- Excessive chewing of hard foods, gum, or the lip
- Kapos FP, Exposto FG, ET AL. Temporomandibular disorders: a review of current concepts in aetiology, diagnosis and management. Oral Surg. 2020;13(4):321-334.
- Temporomandibular disorders. American Association of Oral and Maxillofacial Surgeons website. Available at: https://www.aaoms.org/docs/practice_resources/clinical_resources/tmd_disorders.pdf.
- Temporomandibular joint (TMJ) dysfunction . EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/temporomandibular-disorders.
- TMJ. American Dental Association Mouth Healthy website. Available at: http://www.mouthhealthy.org/en/az-topics/t/tmj.
- TMJ. ENThealth—American Academy of Otolaryngology—Head and Neck Surgery website. Available at: https://www.enthealth.org/conditions/temporo-mandibular-joint-tmj-pain.
- TMJ (temporomandibular joint and muscle disorders). National Institute of Dental and Craniofacial Research website. Available at: https://www.nidcr.nih.gov/health-info/tmd.
- Mark D. Arredondo, MD
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