What is TMJ/TMD?

As earlier explained, the TMJ is the joint that connects your jawbone to the skull. It is located on either side of the head, just in front of the ears, where the lower jaw (mandible), connects to the skull’s temporal bone. The TMJ allows you to perform essential movements like chewing, talking, and yawning.

According to the National Institute of Dental and Craniofacial Research, TMD occurs when there are problems with the TMJ or the surrounding muscles and tissues. TMD can cause discomfort, pain, and limitations in jaw movement, impacting your ability to perform everyday activities.

Common Causes of TMJ/TMD

Various factors can contribute to the development of TMJ/TMD. According to WebMD, here are some common causes:

• Bruxism — Habitual clenching or grinding of the teeth, especially during sleep, puts excessive pressure on the TMJ. This may lead to inflammation, pain, and dysfunction.
• Jaw misalignment — An uneven bite or malocclusion can cause the jaw not to align properly. This may result in TMD symptoms.
• Trauma or injury — Direct trauma to the jaw, such as a blow to the face, can damage the TMJ or surrounding tissues, resulting in TMD symptoms.
• Stress — Emotional or psychological stress can result in muscle tension, including in the jaw muscles, contributing to TMJ/TMD symptoms.
• Arthritis — Inflammatory conditions like arthritis can affect the TMJ, causing pain, stiffness, and limited jaw movement.
• Chewing gum or tough foods — Excessive chewing of gum or consuming tough or hard-to-chew foods can strain the TMJ and exacerbate TMD symptoms.
• Poor posture — Slouching or poor posture can affect the alignment of the jaw and neck, leading to muscle tension and TMJ discomfort.
• Genetic factors — Some individuals may be predisposed to TMJ/TMD due to genetic factors, such as variations in jaw structure or muscle function.
• Dental procedures — Certain dental procedures, such as prolonged dental work or orthodontic treatment, may temporarily exacerbate TMJ symptoms in some individuals.
• Hormonal changes — Hormonal fluctuations, such as those experienced during puberty, pregnancy, or menopause, can affect muscle function and contribute to TMJ/TMD symptoms.

Signs and Symptoms of TMJ/TMD

Common indicators of TMJ/TMD include tenderness or jaw pain. This discomfort or tenderness in the jaw joint area may worsen with chewing, speaking, or jaw movement. Clicking, popping, or grinding noises may also be present when closing or opening the mouth, accompanied by sensations of friction or movement in the jaw joint.

Difficulty or discomfort when chewing is another hallmark symptom of TMJ/TMD. This is particularly true when eating hard, chewy, or tough foods.

Some individuals may experience limited jaw movement. These individuals may find it challenging to open their mouths wide. In some cases, they may feel as though the jaw is “locking” or getting stuck in a certain position. Muscle stiffness or fatigue in the muscles of the jaw, face, and neck can also occur, resulting in difficulty maintaining normal jaw movement.

Headaches are a common symptom associated with TMJ/TMD. These headaches are often described as tension-type headaches occurring in the temples, forehead, or back of the head. They may be related to jaw muscle tension or dysfunction.

Additionally, ear pain or fullness, along with ringing in the ears (tinnitus), may occur. This may be due to referred pain from the TMJ or related muscle tension.

Facial pain, particularly around the jaw, cheeks, temples, or in front of the ears, may worsen with jaw movement or prolonged talking. Some individuals may also experience shoulder and neck pain, resulting from compensatory muscle movements or postural changes related to TMJ/TMD. Tooth sensitivity or pain may also occur even in the absence of dental issues.

Not everyone with TMJ/TMD will experience all of these symptoms. Furthermore, the severity of these symptoms can vary over time.

How Do Dentists Diagnose TMJ/TMD?

Typically, dentists use various methods to diagnose TMJ/TMD. They begin by thoroughly reviewing your medical history, including any previous dental treatments, surgeries, or trauma to the jaw or face. They will also inquire about your current symptoms, including the duration, frequency, and intensity of jaw pain or discomfort.

A comprehensive clinical examination of the TMJ and surrounding structures is then performed. This may involve palpating (feeling) the jaw joint for tenderness, assessing jaw movement and function, and evaluating the alignment of the teeth and bite.

In some cases, diagnostic imaging tests such as X-rays, MRI (Magnetic Resonance Imaging), or CT (Computed Tomography) scans may be ordered. These tests will help the dentist obtain detailed images of the TMJ and surrounding tissues. These imaging studies can help dentists assess the internal structure of the joint, identify any abnormalities or damage, and rule out other underlying conditions.

Dentists may also assess your range of motion and symmetry of jaw movement. They may do so by asking you to open and close your mouth, move your jaw from side to side, and protrude or retract your jaw. Any limitations, clicking, popping, or deviation of the jaw during movement may be noted during this examination.

Additionally, dentists will examine the alignment of the teeth and bite to determine if malocclusion or bite irregularities may be contributing to TMJ/TMD symptoms. This may involve assessing how the upper and lower teeth fit together (occlusion) and identifying any signs of teeth grinding or clenching.

Furthermore, dentists may evaluate the function and strength of the muscles involved in jaw movement, such as the masseter and temporalis muscles. This may involve palpating these muscles for tenderness or performing muscle strength tests to assess muscle function.

Dental Treatment Options for TMJ/TMD

Dental treatment options for TMJ/TMD aim to alleviate symptoms, improve jaw function, and address underlying causes. Below are some dental treatment options commonly used for TMJ/TMD:

Oral Appliances

Oral appliances, also known as occlusal splints, mouthguards, or nightguards, are commonly used dental treatment options for TMJ/TMD. They are designed to stabilize the position of the jaw and prevent excessive jaw movement, especially during activities like teeth grinding. By providing a stable resting position for the jaw, oral appliances help reduce strain on the TMJ and surrounding muscles, thereby alleviating pain and discomfort associated with TMJ/TMD.

They also help distribute forces more evenly during jaw movement. This can help reduce pressure on the TMJ and prevent further damage to the joint structures, promoting healing and recovery.

Moreover, oral appliances help promote muscle relaxation by reducing muscle activity in the jaw and facial muscles. By preventing excessive muscle tension and spasms, oral appliances can alleviate soreness, stiffness, and fatigue in the jaw muscles. In some cases, oral appliances may be used to improve bite alignment and correct minor dental misalignments that contribute to TMJ/TMD symptoms.

Oral appliances are custom-fitted to each patient’s mouth to ensure optimal comfort and effectiveness. Your dentist will carefully design and adjust your oral appliance based on your jaw anatomy, bite relationship, and TMJ/TMD symptoms. Regular follow-up appointments allow for adjustments to be made as needed to ensure the appliance continues to provide optimal support and relief.

Dental Adjustments

Dental adjustments are also known as occlusal adjustments or equilibration. They involve reshaping or adjusting the surfaces of the teeth to create a more harmonious bite relationship and alleviate strain on the TMJ and surrounding muscles. This process may include selectively grinding down or reshaping specific areas of the teeth to improve their contact with opposing teeth during biting and chewing.

The goal of dental adjustments is to achieve balanced occlusion, where the upper and lower teeth come together evenly and function harmoniously during jaw movement. By correcting bite irregularities and eliminating premature contacts or interferences between the teeth, dental adjustments can help distribute forces more evenly throughout the jaw. This reduces stress on the TMJ and promotes jaw joint health.

Your dentist may recommend dental adjustments if you have malocclusion, dental misalignments, or bite discrepancies that contribute to your symptoms. These bite irregularities can cause uneven distribution of forces during chewing, leading to excessive strain on the TMJ and surrounding muscles, which can exacerbate TMJ/TMD symptoms.

During the dental adjustment procedure, the dentist will carefully remove small amounts of tooth structure from specific areas of the teeth using specialized dental instruments. This process is performed gradually and selectively to ensure that the bite is adjusted in a controlled and precise manner, maintaining proper function and aesthetics.

After dental adjustments are made, you may experience some temporary changes in your bite or tooth sensitivity. These changes typically resolve within a few days as the jaw muscles and tissues adapt to the new bite relationship. Regular follow-up appointments may be scheduled to monitor the effectiveness of the dental adjustments and make any necessary refinements.

Orthodontic Treatment

Orthodontic treatment includes braces, clear aligners, and other orthodontic appliances. It aims to correct dental misalignments, malocclusions, and jaw irregularities that may contribute to TMJ/TMD symptoms.

Braces are one of the most common orthodontic treatments used to correct dental misalignments and malocclusions. They consist of brackets, wires, and bands that apply gentle pressure to the teeth, gradually moving them into the desired position over time. By realigning the teeth, braces can help create a more harmonious bite relationship, reducing the risk of TMJ/TMD symptoms caused by bite irregularities.

Clear aligners, such as Invisalign, are another orthodontic treatment option that can be used to correct mild to moderate dental misalignments and malocclusions. Clear aligners are custom-made, removable trays that gradually move the teeth into alignment using gentle, controlled forces. They offer a discreet and convenient alternative to traditional braces, making them popular among individuals seeking orthodontic treatment for TMJ/TMD.

In addition to correcting dental misalignments, orthodontic treatment can also address skeletal discrepancies and jaw irregularities that contribute to TMJ/TMD symptoms. Orthodontic appliances such as expanders, headgear, or functional appliances may be used to modify the position or growth of the jaws, improve bite alignment, and alleviate strain on the TMJ.

Before undergoing orthodontic treatment for TMJ/TMD, you will undergo a comprehensive evaluation by a dentist to assess your bite relationship, jaw alignment, and TMJ health. This evaluation may include clinical examinations, diagnostic imaging, and bite analysis to determine the most appropriate orthodontic treatment plan.

During orthodontic treatment, you will typically undergo regular follow-up appointments to monitor your progress and make any necessary adjustments to your treatment plan. After the treatment is completed, you may be advised to wear retainers to maintain the results and prevent the relapse of dental misalignments.

Restorative Dentistry

Depending on your situation, you can opt for restorative dentistry as a treatment option for your TMJ/TMD. Options for restorative dentistry include dental crowns and bridges, dental fillings, and dental bonding.

Dental crowns and bridges can restore damaged and missing teeth. They also help improve bite alignment and stability. By restoring proper tooth function and alignment, crowns and bridges can help alleviate strain on the TMJ and reduce TMJ/TMD symptoms. 

Dental implants are a permanent solution for replacing missing teeth. Implants provide stability and support for dental restorations such as crowns, bridges, or dentures, restoring proper bite function and alignment.

Dental fillings are used to repair cavities and restore tooth structures lost due to decay or damage. By restoring the integrity of the tooth, dental fillings can improve bite stability and reduce the risk of dental misalignments that contribute to TMJ/TMD symptoms.

Dental bonding involves applying a tooth-colored composite resin material to repair chipped, cracked, or misshapen teeth. Bonding can help improve the appearance and function of the teeth, restoring proper bite alignment and reducing strain on the TMJ.

In severe cases of TMJ/TMD where multiple dental issues are present, full mouth reconstruction may be recommended. This comprehensive treatment approach involves restoring or replacing all of the teeth in the mouth to improve bite function, aesthetics, and overall health.

Trigger Point Injections

Trigger points are localized areas of muscle tension or “knots” that can develop in the muscles of the jaw, face, and neck as a result of TMJ/TMD-related muscle strain or overuse. These trigger points can contribute to jaw pain, muscle stiffness, and limited jaw movement commonly experienced by individuals with TMJ/TMD.

The administration of trigger point injections involves the direct injection of medication into the trigger points to help alleviate muscle pain and tension. The medication typically includes a combination of anesthetic agents such as lidocaine or bupivacaine to provide immediate pain relief and reduce muscle spasms, as well as corticosteroids to reduce inflammation and promote healing of the affected muscles.

Trigger point injections provide rapid pain relief by temporarily numbing the affected muscles and reducing muscle spasms. Additionally, trigger point injections can help promote the healing of the affected muscles over time. Corticosteroids included in the injection solution have anti-inflammatory properties that can help reduce inflammation and promote tissue healing, leading to long-term improvement in TMJ/TMD symptoms.

Trigger point injections are typically performed in the office. You may require multiple sessions for optimal results.

Medications

Medications can be an integral part of the treatment plan for individuals with TMJ/TMD. Medications help to alleviate pain, reduce inflammation, and manage symptoms.

Here is an overview of the medications commonly used for TMJ/TMD treatment:

• Nonsteroidal Anti-inflammatory Drugs (NSAIDs) — NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve) are commonly used to relieve pain and reduce inflammation associated with TMJ/TMD. These medications can help alleviate jaw pain, muscle soreness, and discomfort caused by inflammation in the TMJ and surrounding tissues.
• Muscle relaxants — Muscle relaxants such as cyclobenzaprine (Flexeril) or diazepam (Valium) may be prescribed to help reduce muscle tension and spasms in the jaw and facial muscles. By promoting muscle relaxation, these medications can help alleviate TMJ/TMD symptoms such as jaw stiffness, limited jaw movement, and muscle pain.
• Tricyclic antidepressants — Low-dose tricyclic antidepressants such as amitriptyline or nortriptyline may be prescribed to help manage chronic pain associated with TMJ/TMD. These medications can help improve sleep quality, reduce bruxism, and alleviate TMJ/TMD symptoms such as jaw pain, headaches, and muscle tension.
• Anxiolytics — Anxiolytic medications such as benzodiazepines may be prescribed to help manage anxiety or stress-related symptoms that exacerbate TMJ/TMD. By promoting relaxation and reducing stress levels, these medications can help alleviate jaw tension and muscle stiffness associated with TMJ/TMD.
• Topical analgesics — Topical analgesic medications such as lidocaine patches or gels may be applied directly to the skin over the jaw joint or affected muscles to provide localized pain relief. These medications can help reduce jaw pain, muscle soreness, and discomfort associated with TMJ/TMD.

Do not use any medication before you consult with a dentist. The choice and dosage of the medication will depend on the severity of your symptoms and the underlying causes of the TMJ/TMD.

Surgery

Surgery is typically considered a last resort treatment option for individuals with severe or refractory cases of TMJ/TMD who do not respond to conservative treatments. Here is an overview of the surgical options available for TMJ/TMD:

• Arthrocentesis — Arthrocentesis is a minimally invasive surgical procedure used to treat TMJ/TMD by irrigating the TMJ with sterile fluid. This procedure involves inserting small needles into the joint space to flush out inflammatory byproducts, debris, and other substances that may be contributing to TMJ/TMD symptoms. Arthrocentesis can help reduce inflammation, alleviate pain, and improve jaw function.
• Arthroscopy — Here, a dentist inserts a small, flexible instrument called an arthroscope into the TMJ. This allows the surgeon to visualize the internal structures of the joint and perform surgical interventions such as removing adhesions, scar tissue, or displaced disc material, and repairing damaged joint structures.
• Open joint surgery — Open joint surgery is a more invasive surgical procedure used to treat severe cases of TMJ/TMD that do not correspond to conservative treatments. During open joint surgery, the TMJ is accessed through a small incision in front of the ear. This allows the surgeon to repair or replace damaged joint structures, reposition the disc, or modify the joint anatomy to improve jaw function and alleviate symptoms.

Preventive Measures for TMJ/TMD

As highlighted by Penn Medicine, preventive measures play a crucial role in reducing the risk of TMJ/TMD. One such preventive measure is maintaining good posture. This is because poor posture can contribute to TMJ/TMD by putting strain on the jaw and surrounding muscles. Similarly, avoiding habits that put excessive strain on the jaw joint and muscles, such as clenching the jaw or grinding the teeth, is important.

Stress and anxiety can exacerbate TMJ/TMD symptoms by increasing muscle tension in the jaw and face. Therefore, practicing stress reduction techniques like deep breathing or meditation can help relax the jaw muscles and reduce tension.

In addition, maintaining proper dental hygiene is crucial. Poor dental hygiene can contribute to TMJ/TMD by leading to tooth decay, gum disease, and dental infections that affect the jaw joint.

Avoiding chewing on hard foods that strain the jaw joint and muscles is also recommended. Moreover, it is important to avoid excessive or repetitive jaw movements that can strain the TMJ and surrounding muscles, such as yawning widely or speaking for extended periods without breaks.