Temporomandibular joint syndrome

What is Temporomandibular joint syndrome?

Temporomandibular joint syndrome (TMJ) is a disorder that causes persistent pain in the jaw joint. The pain exists where the jaw comes together with the jaw, in front of the ears. The term myofascial pain is also sometimes used to describe this condition.

The temporomandibular joints are at each end of the jawbone. They play an active role in our speech, chewing capabilities, swallowing, and the facial expressions we make. These joints are prone to various abnormalities, including problems noted at birth, rheumatoid arthritis or osteoarthritis (inflammation of the joint).

TMJ syndrome occurs more frequently in women than men. Usual causes of TMJ include clenching of the jaw or bruxism (grinding of the teeth), which may occur due to stress, poor tooth alignment, or trauma, as in a blow to the jaw. Movement of the jaw by chewing or yawning can aggravate TMJ.

How is it diagnosed?

History: The most common complaint is jaw pain in close location to the ears and difficulty with jaw movement. The character of the pain may vary from dull to sharp, and may be constant or occasional. Clicking noises in the joint may be heard. Tinnitus (ringing sensation in the ears), as well as hearing problems may be present. Individuals may also complain of headache. Frequent gum chewing or a history of dental work may also be reported.

Physical exam may reveal tenderness in the jaw and lack of mobility. Limitation in jaw movement when opening the mouth may be apparent. Poor dental alignment or missing teeth may be obvious, as well. Any unusual sounds as popping or clicking may be noted. There may be point tenderness at the TMJ joints. There may be evidence of hearing problems. Records of recent dental procedures may be reviewed.

Tests: X-rays of the joint may confirm abnormalities with the anatomy of the jaw. Laboratory blood tests, and a hearing test may be done; results are usually normal. An anesthetic medication may be injected in the joint (if relief of pain is noted, this helps in confirming the diagnosis).

How are temporomandibular joint disorders treated?

It is important to avoid overuse of the jaw. Gum chewing is eliminated. Jaw clenching or grinding is avoided (if this is done during sleep, a mouth device to stop teeth grinding may be recommended). Local application of heat as well as medications to decrease joint inflammation and/or pain may be beneficial. Stress may be a contributing factor to the pain. If this is the case, counseling and/or medication to deal with stress may help. In some cases, referral to a physical therapist for treatment such as massage may be given.

A visit to a dentist may be recommended if there is a problem with poor tooth alignment affecting biting. Surgery is rarely required. Consultation with various medical professionals should be obtained before surgical intervention (preferably with a TMJ specialist).

Medications

• Tranquilizers or muscle relaxants for a short time may be prescribed.
• Nonsteroidal anti-inflammatory drugs may be recommended.
• For minor pain, you may use non-prescription drugs, such as aspirin or acetaminophen.

Valium (Diazepam), Motrin (Ibuprofen), Aleve (Naprosyn)

What might complicate it?

The following conditions may complicate the diagnosis: arthritis, pain disorders affecting the nervous system, blood or immune system disturbances.

Predicted outcome

Joint pain or discomfort may persist and proceed until dental care, stress reduction, and muscle tension relief is obtained. Most people with TMJ disorders respond well to conservative medical treatment and self care over time.

Alternatives

Myofascial pain syndrome, tumor, and arthritic conditions may present with similar symptoms.

Appropriate specialists

Neurologist, dentist, oral surgeon, and otorhinolaryngologist.

Last updated 8 August 2011