Temporomandibular Disorder (TMD, TMJ)

Author:
Published: May 3, 2017
Last reviewed: May 27, 2017

Temporomandibular Disorder (TMD) Definition

Temporomandibular disorder (TMD) refers to pain and dysfunction of the chewing muscles and temporomandibular joints (TMJs) from various causes. TMJs are symmetrical joints that connect the temporal bones of the skull to the jawbone (the mandible). TMD most commonly develops in women between 20 and 40 years of age [1].

The main approach to TMD should be the prevention and removal of the underlying causes rather than physiotherapy and jaw exercises.

What do TMJ, TMD and TMJD stand for?

  • TMJ stands for temporomandibular joint, but the acronym is also often used as short for temporomandibular disorder.
  • TMD stands for temporomandibular disorder and TMJD for temporomandibular joint dysfunction, which are two names for the same condition.

Symptoms and Signs of TMD

  • Intermittent dull or severe pain in the jaw, in front of the bottom part of the ear (tragus) on one or both sides, especially when opening the mouth or chewing or when exposed to cold wind
  • Tenderness or swelling in front of the ear
  • Stiffness and tightness of the chewing muscles, decreased range of motion of the jaw (lockjaw or trismus) and clicking, popping or grating sounds during the jaw movements
  • Trigger points in the chewing muscles from which pain can radiate to the ears, cheeks, temples, behind the eyes, to the neck or shoulders (myofascial pain[47].
  • Lateral deviation of the jaw
  • Fullness or ringing in the ears (tinnitus), vertigo
  • Throat pain without infection, difficulty swallowing
  • Numbness in the hands
  • References: [1,2,30,31,40,45]

Individuals with TMD also often suffer from insomnia, tension headache, migraine, chronic lower back pain, fibromyalgia, chronic fatigue syndrome (CFS), irritable bowel syndrome, interstitial cystitis, dizziness and vulvar pain (vulvodynia) [8,9,32,33,43]. Sometimes, these problems can be a part of a psychosomatic disorder (due to psychological stress) or central sensitization disorder (due to increased perception of pain by the brain).

Symptoms not typical for TMD:

  • Nausea (more likely in acid reflux and stomach problems)
  • Fever (more likely in strep throat)
  • Facial numbness (can occur in TMD, but more likely results from damage to the trigeminal or cervical nerve, multiple sclerosis or stroke)

Causes and Risk Factors for TMD

1. Increased tension in the chewing muscles

Increased tension in the chewing muscles can result from:

  • Psychological problems, such as stress [3], frustration, fear and repressed anger [6], anxiety [17], depression [16], bipolar disorder [24] and schizophrenia [18]
  • Overuse of the chewing muscles: gum chewing, eating hard-to-chew foods, nail biting, singing, playing a wind instrument [2,1]
  • Poor posture (poking chin, holding your head up by cradling the jaw in a hand, holding the phone between the ear and shoulder, playing violin) or wearing a helmet [23,24]
  • Sleep deprivation, obstructive sleep apnea [7]
  • Whiplash [5] or other neck or head trauma

2. Disorders of the Temporomandibular Joint (TMJ)

The following disorders of TMJ can cause TMD:

  • TMJ disc displacement [1,47,48]
  • TMJ dislocation (luxation or subluxation, which is usually bilateral) due to over function, for example, forceful opening of the mouth while yawning, singing, laughing, yelling, vomiting or during dental work or due to TMJ hypermobility (in Marfan and Down’s syndrome) [46]
  • Infection or arthritis (osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus (SLE) [13] gout, psoriasis or ankylosing spondylitis), which can result in inflammation of the TMJ synovial membrane (synovitis) or capsule (capsulitis) or abnormal adhesion of the jaw and temporal bones (ankylosis)
  • Tumors in the TMJ [36]
  • TMJ hypomobility (in scleroderma) [1]

Video 1. Temporomandibular disorder due to disc displacement

3. Other Risk Factors for TMD

  • Genetic predisposition [43]
  • Increased sensitivity to pain [43]
  • Wisdom tooth extraction [42]

The following may not be as important factors in the development of TMD as previously believed:

  • Uneven bite (dental malocclusion) and other congenital disorders of the teeth and mouth [2]
  • Teeth grinding and clenching (bruxism) [19,20,21,22,34]

Diagnosis of TMD

A doctor can often make a diagnosis of TMD after a simple physical examination. Sometimes a careful dental, orthopedic or neurological examination is required.

Computer tomography (CT) or magnetic resonance imaging (MRI) can reveal TMJ dislocation, disc displacement or arthritis.

An endoscopic investigation (arthroscopy) can reveal problems within the temporomandibular joint in detail.

Treatment of TMD

Home Remedies

Heat pads applied for 15 minutes each hour, several hours during a day, may help relieve pain caused by increased muscle tension [39].

Ice packs wrapped in a cloth and applied for 10-15 minutes several times per day may reduce pain in inflammation of the TMJ with swelling, for example, due to rheumatoid arthritis [39].

Sleeping on the side with a pillow support between your shoulder and jaw can keep your neck muscles relaxed and thus decrease jaw pain that arises from the neck overuse [39].

Medications and Physiotherapy

There is INSUFFICIENT EVIDENCE about the effectiveness of analgesics [15], such as over-the-counter nonsteroidal anti-inflammatory drugs (acetaminophen, aspirin, ibuprofen), steroid (prednisone) injections, trigger point injections of a local anesthetic [44], muscle relaxants or tricyclic antidepressants, physiotherapy including jaw exercises [28,29] and manual therapy (massage, myofascial release) [25,26,29], behavioral therapy [28], bite guards (occlusal splints, braces) [17,35], transcutaneous electric nerve stimulation (TENS) [37,38], prolotherapy [41], botulinum toxin [12], hyaluronic acid [27] or acupuncture [4,14] in the prevention or treatment of TMD.

There seems to be NO EVIDENCE of the effectiveness of magnesium supplements and swishing of the essential oils in the mouth (“oil pulling”) in the treatment of TMD.

Surgery

Surgical treatment can help in jaw fractures, chronic TMJ luxation, ankylosis or congenital abnormalities.

Unless an obvious organic abnormality has been found, AVOID treatments that permanently change the bite or jaw, such as crown and bridgework, orthodontics, occlusal adjustment, repositioning splints, surgery or implants, because they may not be necessary or effective and may even worsen the pain [10,12].

Prevention of TMD

To prevent pain, learn how to deal with stress. Accept personal and work challenges that bring peace to you and decline those that do not.

Avoid caffeinated drinks (coffee, tea, cola, energy drinks), chewing gum, hard-to-chew foods and extreme jaw movements (laughing, yawning, yelling, singing). Do not poke your chin forward during computer work and do not cradle the phone between the ear and shoulder or carry heavy bags over a shoulder.

Frequently Asked Questions

Do you always feel pain in TMD?

TMD is usually associated with pain but sometimes only with other symptoms, such as lockjaw, jaw clicking or fullness in the ears.

How long does TMD last?

TMD can last as long as the underlying cause (anxiety, rheumatoid arthritis, etc.) persists. The condition is rarely permanent.

Is TMD hereditary?

In most cases, TMD is an acquired condition. There are certain genetic predispositions, such as anatomical variants of the TMJ or genetic diseases, such as Marfan syndrome, which increase the risk of TMD.

What does temporomandibular arthralgia mean?

Pain in the temporomandibular joint.

Which specialist treats TMD?

Your primary doctor can perform a basic physical examination of your mouth, ear and jaw. Depending on the suspected cause the doctor can refer you to a dentist, orthopedist, neurologist or maxillofacial surgeon.

What is the cost of TMD surgery?

Surgery cost in the United States may vary greatly and can range from $300 to $70,000 [49,50]. Nonsurgical treatment can cost from $200 to $10,000 [49].

Can jaw exercises help in TMD?

Exercises may not be very helpful in TMD that results from anxiety or overuse of the chewing muscles. In these cases, prevention is more important. It is your doctor who can tell if and which exercises can help in your case.

  • References

      1. TMD basics  The TMJ Association
      2. Temporomandibular disorder (TMD)  NHS Choices
      3. Akhter R et al, 2007, Association between experience of stressful life events and muscle-related temporomandibular disorders in patients seeking free treatment in a dental hospital  PubMed Central
      4. Acupuncture  The TMJ Association
      5. Goldstein BH et al, 2002, Whiplash and jaw pain: A multifactorial non-structural relationship
        BC Medical Journal
      6. Castelli L et al, 2013, Alexithymia, anger and psychological distress in patients with myofascial pain: a case-control study  PubMed Central
      7. Sanders AE et al, 2013, Sleep Apnea Symptoms and Risk of Temporomandibular Disorder, OPPERA Cohort  PubMed Central
      8. Aaron LA et al, 2000, Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder  PubMed
      9. What is fibromyalgia?  The American Fibromyalgia Syndrome Association
      10. TMJ home remedies  The TMJ Association
      11. Less Is Best When Treating TMJ Disorder  International Musician
      12. TMJ disorders  National Institute of Dental and Craniofacial Research
      13. Johnson R et al, 1983, Temporomandibular joint involvement in systemic lupus erythematosus  PubMed
      14. Cho S et al, 2010, Acupuncture for temporomandibular disorders: a systematic review  PubMed
      15. Mujakperuo HR et al, 2010, Pharmacological interventions for pain in patients with temporomandibular disorders  Cochrane
      16. Minghelli B et al, 2014, Association of temporomandibular disorder symptoms with anxiety and depression in Portuguese college students  PubMed
      17. Reissmann DR et al, 2014, Temporomandibular disorder pain is related to the general disposition to be anxious  PubMed
      18. de Araújo AN et al, 2014, Temporomandibular disorders in patients with schizophrenia using antipsychotic agents: a discussion paper  PubMed Central
      19. Barbosa Tde S et al, 2008, Temporomandibular disorders and bruxism in childhood and adolescence: review of the literature  PubMed
      20. Raphael KG et al, 2012, Sleep bruxism and myofascial temporomandibular disorders;
        A laboratory-based polysomnographic investigation  PubMed Central
      21. Manfredini D et al, 2010, Relationship between bruxism and temporomandibular disorders: a systematic review of literature from 1998 to 2008  PubMed
      22. Pergamalian A et al, 2003, The association between wear facets, bruxism, and severity of facial pain in patients with temporomandibular disorders  PubMed
      23. Temporomandibular joint dysfunction  University of Maryland, Medical Center
      24. Temporomandibular disorder  Physiopedia
      25. Calixtre LB et al, Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomised controlled trials  PubMed
      26. Clar C et al, 2014, Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report  PubMed Central
      27. Manfredini D et al, 2010, Hyaluronic acid in the treatment of TMJ disorders: a systematic review of the literature  PubMed
      28. List T et al, 2010, Management of TMD: evidence from systematic reviews and meta-analyses  PubMed
      29. Armijo-Olivo S et al, 2016, Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis  PubMed Central
      30. Pierson MJ et al, 2011, Changes in Temporomandibular Joint Dysfunction Symptoms Following Massage Therapy: A Case Report  PubMed Central
      31. TMJ  Appalachian State University
      32. What Conditions May Overlap with TMD?  The TMJ Association
      33. Wiegel W, 1990, Diagnosis and therapy of myo-arthropathy (Costen’s syndrome)  PubMed
      34. Jiménez-Silva A et al, 2016, Sleep and Awake Bruxism in Adults and Its Relationship With Temporomandibular Disorders: A Systematic Review From 2003 to 2014  PubMed Journals
      35. Forssell H et al, 1999, Occlusal treatments in temporomandibular disorders: a qualitative systematic review of randomized controlled trials  PubMed
      36. Koyam J et al, 2001, Synovial Chondromatosis in the Temporomandibular Joint Complicated by Displacement and Calcification of the Articular Disk: Report of Two Cases  American Journal of Neuroradiology
      37. Linde C et al, 1995, Outcome of 6-week treatment with transcutaneous electric nerve stimulation compared with splint on symptomatic temporomandibular joint disk displacement without reduction  PubMed
      38. Shanavas M et al, 2014, Transcutaneous electrical nerve stimulation therapy: An adjuvant pain controlling modality in TMD patients — A clinical study  PubMed Central
      39. Help yourself first – remember less is best  The TMJ Association
      40. TMJ disorder symptoms  TMJ Hope
      41. Houser RA et al, 2016, A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain  PubMed Central
      42. Huang GJ et al, 2006, Third-molar extraction as a risk factor for temporomandibular disorder  PubMed Central
      43. Wilentz J, Pain Sensitivity and Genetic Factors: Act Two of the OPPERA Study  The TMJ Association
      44. Ozkan F et al, 2011, Trigger point injection therapy in the management of myofascial temporomandibular pain JournalAgent
      45. Fernández-de-Las-Peñas C et al, 2010, Referred pain from muscle trigger points in the masticatory and neck-shoulder musculature in women with temporomandibular disorders  PubMed
      46. Sharma NK et al, 2015, Temporomandibular joint dislocation  PubMed Central
      47. Manfredini D et al, 2011, Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings  PubMed
      48. Mehta NR et al, Internal Temporomandibular Joint Derangement  Merck Manual, Professional Version
      49. TMJ disorder  DocShop
      50. How Much Does TMJ Treatment Cost? CostHelper

Leave a Reply

Your email address will not be published. Required fields are marked *