�Diseases, Conditions and Injuries

Temporomandibular Joint (TMJ) Syndrome

(Temporomandibular Joint Disorder; Temporomandibular Joint Dysfunction; Myofacial Pain Dysfunction Syndrome)

En Espa�ol (Spanish Version)

Definition

Temporomandibular joint syndrome is a painful condition involving the joint that opens and closes the mouth. The temporomandibular joints are the small joints in front of each ear that attach the lower jaw (mandible) to the skull. The disorder may affect the jaw joint or the muscles surrounding it.

The Temporomandibular Joint

Causes

The exact cause of TMJ syndrome is often unclear. Possible causes include:

Excess tension in the jaw muscles
Faulty alignment between the upper and lower teeth and jaws
Disturbed movement of the jaw joint
Displacement or abnormal position of the jaw joint or cartilage disc inside the jaw joint
Inflammation of the joint
Excess or limited motion of the joint
Injury of the jaw or face

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Sex: female
Age: 30-50 years old
Clenching or grinding of teeth
Poorly fitting dentures
Fibromyalgia
Stress
Arthritis

Symptoms

Symptoms include:

Pain in the temporomandibular joint or the jaw
Pain that may be worse with chewing, yawning, or opening the mouth
Clicking, popping, or grating sounds with movement of the jaw
A sensation of the jaw �catching� or �locking� briefly, while attempting to open or close the mouth, or while chewing
Difficulty opening the mouth completely
A bite that feels "off," uncomfortable, or as if it is frequently changing
Swelling in the affected side of the face or mouth
Muscle pain/spasm in the area of the temporomandibular joint
Facial pain
Headache
Earache
Neck, back and/or shoulder pain

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. The physical exam may include:

Range of motion tests
Listening for sounds in the joints
Examining your teeth, jaw joints, and muscles of your face and head
Palpation of the jaw joints and the muscles of the face and head

Other tests may include:

X-rays � plain x-rays or panoramic dental x-rays of the jaw and jaw joint. They show the bony structures well but not soft tissues.

Arthrogram � x-rays taken after dye is injected into the jaw joint. Sometimes the movements of the jaw are videotaped.

Tomogram � can show x-ray "slices" through the joint

CT Scan � a type of x-ray that uses a computer to make pictures of the inside of the jaw joint

MRI Scan � a test that uses magnetic and radio waves to make pictures of the inside of the jaw joint

Treatment

Treatment may include:

Pain Relief

A soft diet may be recommended to reduce pain while chewing. Pain can be treated with warm or cold packs, restriction of jaw movement, or medications. The most commonly used medicines are acetaminophen, nonsteroidal anti-inflammatory drugs, muscle relaxants, and antidepressants. In some cases the jaw joint may be injected with pain relieving medicine such as cortisone or lidocaine.

Physical Therapy

Gentle massage or stretching exercises, transcutaneous electrical nerve stimulation (TENS), and biofeedback may reduce pain and help muscles to relax.

Stress Reduction

Counseling to learn stress management and relaxation techniques may help some patients with TMJ.

Dental Procedures

A splint or mouth guard can be made that you wear in your mouth to relax your jaw muscles and prevent clenching and grinding of your teeth. Correction of bite abnormalities by a dentist or orthodontist is sometimes recommended.

Surgical Procedures

Surgical correction may be a last resort if other treatments have not succeeded and the pain becomes unbearable. Many of the available procedures have not been scientifically proven to treat TMJ syndrome. Types of surgery include:

Arthroplasty � procedures that involve operating on the jaw joint

Condylotomy � surgical removal of part of the jaw bone

Prevention

There are no guidelines for preventing TMJ. If you have TMJ, the following may help prevent symptoms:

Ask your dentist if you need a night guard for grinding and clenching of the teeth
Don't use a pillow for sleeping.
Try to limit jaw movements and learn to relax your jaw. Block a yawn by putting your fist under your chin.
Avoid yelling or loud singing.
Don't chew gum.
Learn relaxation techniques and better, healthier ways to cope with stress.

RESOURCES:

The TMJ Association
http://www.tmj.org/

SOURCES:

"The relationship between clinical and MRI findings in patients with unilateral temporomandibular joint pain." Journal of the American Dental Association, April, 2001.

National Institute of Dental and Craniofacial Research

Triage Reviewed by EBSCO Medical Review Board in September 2005