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From Webmd
Temporomandibular Joint Disorders (TMD, TMJ) Your temporomandibular joint is a hinge that connects your jaw to the temporal bones of your skull, which are in front of each ear. It lets you move your jaw up and down and side to side, so you can talk, chew, and yawn. Problems with your jaw and the muscles in your face that control it are known as temporomandibular disorders (TMD). But you may hear it wrongly called TMJ, after the joint. |
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What Causes TMD?
We don’t know what causes TMD. Dentists believe symptoms arise from problems with the muscles of your jaw or with the parts of the joint itself.
Injury to your jaw, the joint, or the muscles of your head and neck -- like from a heavy blow or whiplash -- can lead to TMD. Other causes include
TMD often causes severe pain and discomfort. It can be temporary or last many years. It might affect one or both sides of your face. More women than men have it, and it’s most common among people between the ages of 20 and 40.
Common symptoms include:
We don’t know what causes TMD. Dentists believe symptoms arise from problems with the muscles of your jaw or with the parts of the joint itself.
Injury to your jaw, the joint, or the muscles of your head and neck -- like from a heavy blow or whiplash -- can lead to TMD. Other causes include
- Grinding or clenching your teeth, which puts a lot of pressure on the joint
- Movement of the soft cushion or disc between the ball and socket of the joint
- Arthritis in the joint
- Stress, which can cause you to tighten facial and jaw muscles or clench the teeth
TMD often causes severe pain and discomfort. It can be temporary or last many years. It might affect one or both sides of your face. More women than men have it, and it’s most common among people between the ages of 20 and 40.
Common symptoms include:
- Pain or tenderness in your face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide
- Problems when you try to open your mouth wide
- Jaws that get "stuck" or "lock" in the open- or closed-mouth position
- Clicking, popping, or grating sounds in the jaw joint when you open or close your mouth or chew. This may or may not be painful.
- A tired feeling in your face
- Trouble chewing or a sudden uncomfortable bite -- as if the upper and lower teeth are not fitting together properly
- Swelling on the side of your face
How Is TMD Diagnosed?
Many other conditions cause similar symptoms -- like tooth decay, sinus problems, arthritis, or gum disease. To figure out what’s causing yours, the dentist will ask about your health history and conduct a physical exam.
He’ll check your jaw joints for pain or tenderness and listen for clicks, pops, or grating sounds when you move them. He’ll also make sure your jaw works like it should and doesn’t lock when you open or close your mouth. Plus he’ll test your bite and check for problems with your facial muscles.
Your dentist may take full face X-rays so he can view your jaws, temporomandibular joints, and teeth to rule out other problems. He may need to do other tests, like magnetic resonance imaging (MRI) or computer tomography (CT). The MRI can show if the TMJ disc is in the proper position as your jaw moves. A CT scan shows the bony detail of the joint.
You may get referred to an oral surgeon (also called an oral and maxillofacial surgeon) for further care and treatment. This doctor specializes in surgery in and around the entire face, mouth, and jaw area. You may also see an orthodontist to ensure your teeth, muscles, and joints work like they should.
Medications. Your dentist can prescribe higher doses of NSAIDs if you need them for pain and swelling. He might suggest a muscle relaxer to relax your jaw if you grind or clench your teeth. Or an anti-anxiety medication to relieve stress, which may bring on TMD. In low doses they can also help reduce or control pain. Muscle relaxants, anti-anxiety drugs, and antidepressants are available by prescription only.
A splint or night guard. These plastic mouthpieces fit over your upper and lower teeth so they don’t touch. They lessen the effects of clenching or grinding and correct your bite by putting your teeth in a more correct position. What’s the difference between them? You wear night guards while you sleep. You use a splint all the time. Your dentist will tell you which type you need.
Dental work. Your dentist can replace missing teeth and use crowns, bridges, or braces to balance the biting surfaces of your teeth or to correct a bite problem.
Treatments
If the treatments listed above don’t help, your dentist may suggest one or more of the following:
Transcutaneous electrical nerve stimulation (TENS). This therapy uses low-level electrical currents to provide pain relief by relaxing your jaw joint and facial muscles. It can be done at the dentist's office or at home.
Deep heat applied to the joint can relieve soreness or improve mobility.
Trigger-point injections. Pain medication or anesthesia is injected into tender facial muscles called "trigger points" to give relief.
Radio wave therapy. Radio waves stimulate the joint, which increases blood flow and eases pain.
Low-level laser therapy. This lowers pain and inflammation and helps you move your neck more freely and open your mouth wider.
Surgery for TMDIf other treatments can’t help you, surgery is an option. Once it’s done, it can’t be undone, so get a second or even third opinion from other dentists.
There are three types of surgery for TMD. The type you need depends on the problem.
Arthrocentesis is used if you have no major history of TMJ but your jaws are locked. It’s a minor procedure that your dentist can do in his office. He’ll give you general anesthesia, then insert needles into the joint and wash it out. He may use a special tool to get rid of damaged tissue or dislodge a disc stuck in the joint, or to unstick the joint itself.
Arthroscopy is surgery done with an arthroscope. This special tool has a lens and a light on it. It lets your doctor see inside your joint. You’ll get general anesthesia, then the doctor will make a small cut in front of your ear and insert the tool. It’ll be hooked up to a video screen, so he can examine your joint and the area around it. He may remove inflamed tissue or realign the disc or joint. This type of surgery, known as minimally invasive, leaves a smaller scar, has fewer complications, and requires a shorter recovery time than a major operation.
Open-joint surgery. Depending on the cause of the TMD, arthroscopy may not be possible. You may need this type of surgery if:
Many other conditions cause similar symptoms -- like tooth decay, sinus problems, arthritis, or gum disease. To figure out what’s causing yours, the dentist will ask about your health history and conduct a physical exam.
He’ll check your jaw joints for pain or tenderness and listen for clicks, pops, or grating sounds when you move them. He’ll also make sure your jaw works like it should and doesn’t lock when you open or close your mouth. Plus he’ll test your bite and check for problems with your facial muscles.
Your dentist may take full face X-rays so he can view your jaws, temporomandibular joints, and teeth to rule out other problems. He may need to do other tests, like magnetic resonance imaging (MRI) or computer tomography (CT). The MRI can show if the TMJ disc is in the proper position as your jaw moves. A CT scan shows the bony detail of the joint.
You may get referred to an oral surgeon (also called an oral and maxillofacial surgeon) for further care and treatment. This doctor specializes in surgery in and around the entire face, mouth, and jaw area. You may also see an orthodontist to ensure your teeth, muscles, and joints work like they should.
Medications. Your dentist can prescribe higher doses of NSAIDs if you need them for pain and swelling. He might suggest a muscle relaxer to relax your jaw if you grind or clench your teeth. Or an anti-anxiety medication to relieve stress, which may bring on TMD. In low doses they can also help reduce or control pain. Muscle relaxants, anti-anxiety drugs, and antidepressants are available by prescription only.
A splint or night guard. These plastic mouthpieces fit over your upper and lower teeth so they don’t touch. They lessen the effects of clenching or grinding and correct your bite by putting your teeth in a more correct position. What’s the difference between them? You wear night guards while you sleep. You use a splint all the time. Your dentist will tell you which type you need.
Dental work. Your dentist can replace missing teeth and use crowns, bridges, or braces to balance the biting surfaces of your teeth or to correct a bite problem.
Treatments
If the treatments listed above don’t help, your dentist may suggest one or more of the following:
Transcutaneous electrical nerve stimulation (TENS). This therapy uses low-level electrical currents to provide pain relief by relaxing your jaw joint and facial muscles. It can be done at the dentist's office or at home.
Deep heat applied to the joint can relieve soreness or improve mobility.
Trigger-point injections. Pain medication or anesthesia is injected into tender facial muscles called "trigger points" to give relief.
Radio wave therapy. Radio waves stimulate the joint, which increases blood flow and eases pain.
Low-level laser therapy. This lowers pain and inflammation and helps you move your neck more freely and open your mouth wider.
Surgery for TMDIf other treatments can’t help you, surgery is an option. Once it’s done, it can’t be undone, so get a second or even third opinion from other dentists.
There are three types of surgery for TMD. The type you need depends on the problem.
Arthrocentesis is used if you have no major history of TMJ but your jaws are locked. It’s a minor procedure that your dentist can do in his office. He’ll give you general anesthesia, then insert needles into the joint and wash it out. He may use a special tool to get rid of damaged tissue or dislodge a disc stuck in the joint, or to unstick the joint itself.
Arthroscopy is surgery done with an arthroscope. This special tool has a lens and a light on it. It lets your doctor see inside your joint. You’ll get general anesthesia, then the doctor will make a small cut in front of your ear and insert the tool. It’ll be hooked up to a video screen, so he can examine your joint and the area around it. He may remove inflamed tissue or realign the disc or joint. This type of surgery, known as minimally invasive, leaves a smaller scar, has fewer complications, and requires a shorter recovery time than a major operation.
Open-joint surgery. Depending on the cause of the TMD, arthroscopy may not be possible. You may need this type of surgery if:
- The bony structures in your jaw joint are wearing down
- You have tumors in or around the joint
- Your joint is scarred or full of bone chips