Temporomandibular Joint (TMJ) Disorders

TM (temporomandibular) disorders are a family of problems related to your complex jaw joint. If you've had symptoms like pain or a clicking sound, you'll be glad to know that these problems are more easily diagnosed and treated than they were in the past. Since some types of TM problem scan lead to more serious conditions, early detection and treatment are important. No one treatment can resolve TM disorders completely, and treatment takes time to be effective. But with the help of your health care team, you're more likely to have a healthier and more comfortable jaw.

Why do TM disorders develop?

TM disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. Or, you may have a damaged jaw joint due to injury or disease. Whatever the cause, the results may include a mis-aligned bite, pain, clicking or grating noises when you open your mouth, or trouble opening your mouth wide

• Are you aware of grinding or clenching your teeth?

• Do you wake up with sore, stiff muscles around your jaws?

• Do you have frequent headaches or neck aches? Does the pain get worse when you clench your teeth?

• Does stress make your clenching and pain worse?

• Does your jaw click, pop, grate, catch, or lock when you open your mouth?

• Is it difficult or painful to open your mouth, eat, or yawn?

• Have you ever injured your neck, head, or jaw?

• have you had problems (such as arthritis) with other joints?

• Do you have teeth that no longer touch when you bite?

• Do your teeth meet differently from time to time?

• Is it hard to use your front teeth to bite or tear food?

• Are your teeth sensitive, loose, broken, or worn?

Your dental evaluation

A dental and medical evaluation helps pinpoint the causes of your TM disorder and is the first step in planning a treatment program for you. A dental and medical history provides information about your overall health, begins to reveal the kinds of symptoms you're experiencing, and hints at their possible causes. A physical exam helps identify your TM-related symptoms, such as joint pain, clicking, or a limited range of motion.

Diagnostic tests pinpoint even further the possible causes of your TM disorder, indication what the best treatment might be for you.  A variety of tests help confirm or rule out a diagnosis of TM disorder. Tomographic or transcranial x-rays are head x-rays that record images of bones and reveal joint damage, fracture, or tumors. MRI (magnetic resonance imaging) produces detailed images of soft tissue, revealing damage in disks or ligaments.

Dental casts may help determine whether your teeth are coming together correctly and how your bite may be affected by your joint and surrounding muscles. Dental casts are models of your teeth, which are made by taking an impression of your mouth and forming plaster models, which may be mounted on a jaw movement simulator. This mechanical device helps reproduce the movement of your lower jaw.

Treatment options

There are many treatment options that improve the harmony and function of your jaw. But in large part, relief hinges on you. The most important role you can play throughout your treatment program is resting your jaw, so it can heal and regain stability. Other self-care techniques that may relieve your symptoms are ice, heat and exercise. At Dr. Marlais' direction, you may need to practice these techniques until your symptoms subside, if symptoms flare up in the future, or along with other kinds of treatment. Self-care will help other kinds of treatment be more effective in resolving your TM disorder.

Managing daily stress is one of the best ways to help restore harmony between your muscles and joints. You can ask Dr. Marlais about specific relaxation techniques. Biofeedback teaches you how to relax tightening muscles. Other methods, like deep breathing, relax your mind and body. Getting support helps you cope with the stress and pain that often accompany a TM disorder.

A variety of physical therapy techniques, such as jaw exercises, postural training, or mobilization, help you regain the harmony in your jaw and muscles. Physical therapy is often used after surgery or when your disc, ligaments, or other joint tissues are injured. It promotes healing and reduces pain and swelling and may also aid in muscle relaxation and increase your jaw's range of motion. 

Your doctor may recommend that you wear a splint - a clear plastic appliance that fits over your top or bottom teeth - to establish harmony between your muscles and joints. There are three types of splints that work in various ways, but accomplish many of the same goals. Splints may reduce bruxism by keeping your teeth apart, help relax muscles and reduce pain. They also can change jaw posture enough to stabilize some bite problems and reduce pressure in your joints. 

If your TM disorder has caused problems with how your teeth fit together, you may need treatment to correct your bite, although this is seldom necessary. Often a splint alone is all that's needed. But you may need other treatment, such as orthodontics or restorative work, to correct more serious bite problems resulting from TM disorders.

Surgery can help restore your jaw joint and eliminate the pain and other symptoms of TM disorders. With other treatment available, surgery is rarely needed, especially if a problem is diagnosed and treated early. In some cases, however, the joint becomes so severely damaged that surgery is needed to correct it.

Relief from TM Pain

From biting and talking to chewing and yawning, your TM joints always come into play. So when something goes wrong with your jaw joint, it can cause you much discomfort. But with the right diagnosis and treatment, most people do find relief from the pain and other symptoms of a TM joint disorder. 

* This article was excerpted and adapted from "TM Disorders, A Guide to Managing Your Temporomandibular Joint Problem," © 1994, Krames Communications.