Temporomandibular joint dysfunction

The temporomandibular joints (TMJ) connect your lower jaw to your skull. There are two matching joints, one on each side of your head, just in front of your ears. They let your jaw move up and down and from side to side.

The abbreviation "TMJ" refers to the joint but is often used to refer to any problems with the joints. Such problems include:

• Popping sounds in your jaw
• Not being able to completely open your mouth
• Jaw pain
• Headaches
• Earaches
• Toothaches
• Other types of facial pain

Most people with TMJ problems have pain that comes and goes, but some have chronic (long-term) pain.

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Signs and Symptoms

TMJ problems often cause the following symptoms:

• Pain, particularly in the chewing muscles or jaw joint or an ache around your ear .
• Limited movement or locking of the jaw.
• Pain in the face, neck, or shoulders, or near the ear.
• Clicking, popping, or grating sounds when opening your mouth.
• Trouble chewing.
• Headache.
• A sudden change in the way your upper and lower teeth fit together.

Also, sometimes earaches, dizziness, and hearing problems.

What Causes It?

Sometimes TMJ dysfunction can be caused by an injury, such as a heavy blow, to the jaw or temporomandibular joint. But in other cases there may not be a clear cause. Other possible causes include:

• A bad bite, called malocclusion.
• Orthodontic treatment, such as braces and the use of headgear.
• Wearing away of the disk or cartilage in the joint.
• Stress or anxiety. People with TMJ problems often clench or grind their teeth at night, which can tire the jaw muscles and lead to pain.

Who is Most At Risk?

The risk for TMJ problems may be higher with these factors:

• Gender. Mmore women than men seek treatment.
• Age. People ages 30 to 50 have the most problems.
• Children and adolescents with arthritis.
• Grinding teeth, clenching jaw.
• Malocclusion (bad bite).
• High stress levels.

What to Expect at Your Provider's Office

If you have symptoms of TMJ dysfunction, see your doctor or dentist. They can make a diagnosis and help determine which treatment will work best for you.

Your health care provider will check muscles in the area of the TMJ, and will:

• Look for asymmetry or inflammation in your face
• Listen for joint clicking or scraping sounds
• Test the range of motion in your jaw
• Look at your teeth for evidence of jaw clenching or teeth grinding

If you are having any neurological symptoms, such as numbness, your provider will give you a neurological exam. Your provider may also order imaging tests, such as an x-ray, computerized tomography (CT) scan, or magnetic resonance imaging (MRI) scan to look for degenerative disease or disk problems.

Treatment Options

Prevention

Reducing stress and keeping yourself from grinding your teeth or clenching your jaw may help prevent TMJ problems or lessen the symptoms.

Treatment Plan

In many cases, you can treat TMJ dysfunction at home. Your doctor may:

• Ask you to change your eating habits: cut food into small pieces, avoid too much chewing, and stop chewing gum.
• Give you exercises that stretch the muscles around your jaw.

Your doctor may also recommend:

• If your bite is out of alignment, your dentist may suggest you wear a biteplate over your teeth to help bring your upper and lower jaw into alignment.
• If you grind your teeth in your sleep, you may be asked to wear a night guard over your teeth.
• If stress is causing you to clench your jaw, your doctor may suggest stress reduction techniques or cognitive behavioral therapy to help you manage anxiety and tension.

Drug Therapies

Your doctor may recommend the following medications:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). To relieve pain. These drugs include ibuprofen (Advil, Motrin) and naproxen (Aleve).
• Minor tranquilizers or muscle relaxants at bedtime to reduce spasms and pain.
• Injections of a local anesthetic.
• Corticosteroid injections, for severe cases.
• Botox (botulinum toxin A) injections. To prevent joint clicking.

Surgical and Other Procedures

In some cases, removing fluid from the joint may help reduce pain, especially for people whose jaws lock. When other measures have failed, surgery may be needed to repair or take out the disk between the temporal bone and the jaw.

Complementary and Alternative Therapies

A comprehensive treatment plan for TMJ dysfunction may include a range of complementary and alternative therapies (CAM). Work with a health care provider who has experience treating TMJ and be sure to tell all of your doctors about any medications, herbs, and supplements you are taking. Treatments, including physical medicine, may help.

Nutrition and Supplements

The following nutritional tips may help prevent or reduce symptoms of TMJ dysfunction:

• Eat soft foods high in flavonoids, such as cooked fruits and vegetables. Flavonoids are plant-based antioxidants that may help decrease joint pain.
• Avoid saturated fats, fried foods, and caffeine. These foods may increase inflammation.
• DO NOT chew gum.

Some supplements that may help:

• Glucosamine. May reduce pain and help rebuild cartilage in the joint, which helps improve range of motion. Some studies show that glucosamine helps reduce pain in people with arthritis, which involves painful joints. One study found that glucosamine worked as well as ibuprofen (Advil, Motrin) for relieving pain and other TMJ symptoms. Glucosamine is often combined with chondroitin sulfate. Glucosamine may increase the risk of bleeding, especially if you also take blood thinners like warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Some doctors think glucosamine might interfere with medications used to treat cancer. Ask your doctor before taking glucosamine and chondroitin.
• Vitamin C. Is also used by the body to make cartilage. It may improve range of motion in your joints, including your jaw, although there are no scientific studies investigating vitamin C for TMJ problems. Vitamin C supplements may interact with other medications, including chemotherapy drugs, estrogen, warfarin (Coumadin), and others.
• Calcium and magnesium. May help the jaw muscle relax, although there are no scientific studies using them for TMJ problems. Magnesium and calcium interact with several medications, herbs, and supplements. They can also affect your heart and blood pressure, so be sure to tell your doctor before you take them.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects, and can interact with other herbs, supplements, or medications. For these reasons, take herbs with care, under the supervision of a health care provider.

Cramp bark (Viburnum opulus) and lobelia (Lobelia inflata) may help reduce muscle spasms, although there are no scientific studies to support using them for TMJ problems. Use on the skin only and do not apply to broken skin. DO NOT take these herbs by mouth (orally).

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of TMJ dysfunction based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Causticum. For burning pains.
• Hypericum perforatum. For sharp, shooting pains.
• Ignatia. For tension in the jaw.
• Kalmia. For face pain, especially with other joint pains or arthritis.
• Magnesia phosphorica. For muscle cramps.
• Rhus toxicodendron. For pains that feel better in the morning and in dry weather, and worse after movement or in wet weather.
• Ruta graveolens. For pains from overuse or injury.

Physical Medicine

Contrast hydrotherapy, which is alternating hot- and cold-water applications, may:

• Lower inflammation
• Provide pain relief
• Speed healing

Use hot packs and ice wrapped in a clean, soft cloth and apply to area. Alternate 3 minutes hot with 1 minute cold. Repeat 3 times for 1 set. Do 2 to 5 sets per day.

Acupuncture

Very good evidence suggests acupuncture can treat TMJ dysfunction. Several well-designed studies found that acupuncture can relieve pain long term for TMJ problems. In treating TMJ dysfunction, acupuncturists often find a deficiency of qi in the liver meridian and an excess of qi in the gallbladder meridian. Moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) may boost the therapy.

Chiropractic

No well-designed studies have looked at using chiropractic to treat TMJ problems. However, chiropractors and some people say that manipulation of the joint and nearby areas in the upper spine may improve TMJ symptoms. In these cases, chiropractors believe that manipulation helps the joint to move better (increases the range of motion).

Craniosacral Therapy

This therapy is a very gentle form of body work. Practitioners use their hands to get rid of restrictions in the craniosacral system, the fluid and membranes surrounding the spine and brain. Although there are not many studies, some people say they feel better after craniosacral therapy. Find a practitioner who has training and experience with TMJ problems. You can interview several practitioners before deciding which one is right for you.

Massage

Some types of massage and chiropractic manipulation may help:

• Reduce muscle spasms
• Provide pain relief
• Prevent symptoms from coming back

Biofeedback

Biofeedback teaches you how to reduce muscle tension through relaxation and visualization techniques. At first, sensors are placed on your jaw, and a machine shows the amount of tension in your muscles. Using relaxation and visualization techniques, you learn to reduce the amount of tension around your jaw while the machine provides instant feedback so you can see how you are doing. Once you have mastered the technique, you can do the relaxation and visualization techniques anywhere, without the machine.

Improving posture

Two types of movement therapy can sometimes help treat TMJ problems: the Alexander technique and the Feldenkrais method.

The Alexander technique teaches you how to properly align your head, neck, and spine, and move your body. It can help relieve tension in your head and jaw muscles, which may reduce the symptoms of TMJ dysfunction.

The Feldenkrais method teaches you to recognize bad posture habits and movements that cause your body to tense. It is a gentle therapy aimed at making you more aware of how your body moves, and helping you develop an inner awareness of your body. Feldenkrais is popular with dancers and musicians, who often do repetitive motions that can lead to overuse injuries.

Prognosis and Possible Complications

About 75% of people with TMJ problems who follow a treatment plan with more than one treatment find relief. In rare cases, long-term teeth clenching or grinding, injury, infection, or connective tissue disease may cause degenerative joint disease or arthritis. If you have severe grinding, wearing a nighttime bite guard inside your mouth may help.

Following Up

You may need to see your health care provider regularly to make sure your treatment plan is working for you.

Supporting Research

Abe S, Kawano F, Kohge K, et al. Stress analysis in human temporomandibular joint affected by anterior disc displacement during prolonged clenching. J Oral Rehabil. 2013;40(4):239-246.

Abramowicz S, Susarla HK, Kim S, Kaban LB. Physical findings associated with active temporomandibular joint inflammation in children with juvenile idiopathic arthritis. J Oral Maxillofac Surg. 2013;71(10):1683-1687.

Bergström I, List T, Magnusson T. A follow-up study of subjective symptoms of temporomandibular disorders in patients who received acupuncture and/or interocclusal appliance therapy 18 - 20 years earlier. Acta Odontol Scand. 2008;66(2):88-92.

Berguer A, Kovacs F, Abraira V, et al. Neuro-reflexotherapy for the management of myofascial temporomandibular joint pain: a double-blind, placebo-controlled, randomized clinical trial. J Oral Maxillofac Surg. 2008;66(8):1664-1677.

Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010;18:3.

Emara AS, Faramawey MI, Hassaan MA, Hakam MM. Botulinum toxin injection for management of temporomandibular joint clicking. Int J Oral Maxillofac Surg. 2013;42(6):759-764.

Gavish A, Winocur E, Astandzelov-Nachmias T, Gazit E. Effect of controlled masticatory exercise on pain and muscle performance in myofascial pain patients: A pilot study. Cranio. 2006;24(3):184-190.

Howard JA. Temporomandibular joint disorders in children. Dent Clin North Am. 2013;57(1):99-127.

Jung A, Shin BC, Lee MS, Sim H, Ernst E. Acupuncture for treating temporomandibular joint disorders: a systematic review and meta-analysis of randomized, sham-controlled trials. J Dent. 2011;39(5):341-350. Review.

Loria Chami A, Balcazar Vazquez R, Sanchez Vargas K. Value of magnetic resonance imaging for diagnosis of temporomandibular joint dysfunction. Gac Med Mex. 2014;150(Suppl 2):255-258.

Pihut M, Ferendiuk E, Szewczyk M, Kasprzyk K, Wieckiewicz M. The efficiency of botulinum toxin type A for the treatment of masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache. J Headache Pain. 2016; 17:29.

Rosted R. Practical recommendations for the use of acupuncture in the treatment of temporomandibular disorders based on the outcome of published controlled studies. Oral Dis. 2000;7:109-115.

Shen YF, Goddard G. The short-term effects of acupuncture on myofascial pain patients after clenching. Pain Pract. 2007;7(3):256-264.

Stoll ML, Morlandt AB, Teerawattanapong S, Young D, Waite PD, Cron RQ. Safety and efficacy of intra-articular infliximab therapy for treatment-resistant temporomandibular joint arthritis in children: a retrospective study. Rheumatology (Oxford). 2013;52(3):554-559.

Syrop, SB. Initial management of temporomandibular disorders. Dent Today. 2002;21(8):52-57.

Thie NM, Prasad NG, Major PW. Evaluation of glucosamine sulfate compared to ibuprofen for the treatment of temporomandibular joint osteoarthritis: a randomized double blind controlled 3 month clinical trial. J Rheumatol. 2001;28:1347-1355.

Zakrzewska JM. Diagnosis and management of non-dental orofacial pain. Dent Update. 2007;34(3):134-136, 138-139.

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Review Date: 1/1/2017  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.

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