Temporomandibular Joint Disorders

TMJ disorders may be classified into:

• Myofascial pain-related disorders: Pain and discomfort in the jaw muscles that control movement.
• Internal derangement of the joint: A displaced articular disk, dislocated jaw, or injury to the condyle.
• Arthritis-related disorders: Inflammation or degeneration of the TMJ caused by conditions such as osteoarthritis or rheumatoid arthritis.

The symptoms of TMJ disorders include the following:

• Soreness or stiffness in the jaw muscle
• Frequent headaches, neck pain, and migraines
• Clicking or popping of the jaw
• Trismus (lockjaw)
• Pain when eating or yawning
• Misaligned bite
• Pain and swelling around the jaw joint
• Tenderness of the jaw muscles

The combination of a hinge-like action and sliding motions is responsible for the movement-related functions performed by the TMJ. Problems occur when the cartilage covering the joint or the articular disk is damaged, displaced, or worn down. TMJ disorders, which are often quite painful, can occur due to the following causes:

• Erosion of the articular disk or its displacement and misalignment
• Arthritis-induced damage to the cartilage in the TMJ
• Damage to the joint caused by a blow or other accidents
• Teeth grinding or jaw clenching (Bruxism)
• Stress-related habits that strain the jaw

Usually, TMJ disorders are diagnosed during an oral examination. The dentists will: 

• Check for clicking sounds, popping, or pain when the jaw moves
• Assess the range of motion of the jaw
• Gently palpate some areas around the jaw joint to locate any sites of pain 

If any problem is suspected based on the findings of the aforementioned tests, the following procedures may be needed:

• Dental X-ray: To examine the jaw and/or teeth and identify any bone-related problems
• CT scan: For a detailed analysis of the bones involved in the functioning of the TMJ
• MRI: To detect problems in the articular disk or surrounding soft tissues
• TMJ arthroscopy: Involves insertion of a small thin tube (cannula) into the joint space and visualisation of the joint region using a small camera (arthroscope)

The symptoms of TMJ disorder sometimes improve without treatment. In case of persistent symptoms, one or more of the following treatment options (often performed simultaneously) are recommended:

• Medications: The following medications may help alleviate TMJ disorder-induced pain (when administered along with other nonsurgical treatments):
  • Pain killers and anti-inflammatories
  • Tricyclic antidepressants for controlling bruxism and sleeplessness and relief from pain
  • Muscle relaxants, such as antispasmodics, for a few days or weeks to provide relief from the pain attributed to muscle spasms
• Nondrug therapies: TMJ disorders may also be treated using nondrug therapies:
  • Mouth guards or splints: These occlusal devices, which may be soft or firm depending on the nature of use, reduce strain on the joint when inserted over the teeth.
  • Physical therapy: To maintain the flexibility and strength of the jaw muscles, dentists often recommend exercises along with the administration of moist heat/ice packs and ultrasound therapies.
  • Counselling: Awareness, education, and counselling can help patients identify problematic habits that may exacerbate pain, such as leaning on the chin, tooth clenching/grinding, or onychophagia (biting fingernails). Accordingly, patients may be trained to avoid such habits via corrective psychotherapy.
• Surgeries and other related procedures: If other conservative approaches fail to provide relief from symptoms, surgical procedures to correct the jaw and the TMJ may be recommended.

Patients should seek medical attention if they have:

• Persistent jaw pain or stiffness
• Sudden jaw locking or inability to chew properly
• Difficulty opening or closing the mouth
• Frequent headaches or earaches related to jaw movement

While not all TMJ disorders can be prevented, symptoms may be reduced by:

• Avoiding habits like clenching, grinding, or chewing gum excessively
• Practicing stress management techniques
• Maintaining good posture to reduce strain on the neck and jaw

For TMJ disorders, consult a:

• General dentist: for initial evaluation and treatment
• Oral and maxillofacial surgeon: for complex or surgical cases
• Orthodontist: if misaligned teeth/jaws contribute to the problem
• Physiotherapist: for exercises and physical therapy support