Temporomandibular Joint (TMJ)

Temporomandibular joint (TMJ) syndrome is a condition that causes frequent pain in the jaw joint. The pain occurs where the jaw meets the skull in front of the ear on each side of the face. Another term for this disorder is myofascial pain dysfunction of the jaw. TMJ syndrome is more common in women than men.

How TMJ Occurs

The exact cause of TMJ is not known. Possible causes of TMJ are:

• Frequent clenching of the jaw or grinding of the teeth (the most common cause). You may clench your jaws or grind your teeth when you are feeling stressed or sleeping. If you do it mainly when you are sleeping, you may not even know you are doing it.
• Ill-fitting dentures
• Frequent chewing of gum or ice
• Anatomic or dental abnormalities, such as problems of teeth alignment
• Injury from prolonged or repeated opening of the jaw, or a direct blow to the joint. Pain from the injury may seem to go away after just a short time, but months to years later painful traumatic arthritis may develop in the joint.
• Other forms of arthritis in the jaw, such as rheumatoid arthritis or osteoarthritis

Symptoms of TMJ

The most common symptom is pain in the jaw joint. The pain is usually dull but sometimes sharp. In most cases the pain is worse when you move your jaw, especially when you are chewing. If you are grinding your teeth at night the pain may also be worse first thing in the morning. The pain may be felt predominantly in the ear, making one suspicious for an ear infection.

Other possible symptoms are:

• Clicking, popping, or grating sounds when you move your jaw
• Trouble completely opening your jaw or an uncomfortable bite
• Headache
• Ear pain or earache

Diagnosing TMJ

Your health care provider will want to know when your jaw hurts and how long it has been hurting. He or she will ask if your jaw has been injured or if you have had dental work recently. Your health care provider will examine your jaw for tenderness and check how it moves. An X-ray may be taken.

Treating TMJ

To help relieve your symptoms:

• Avoid overusing your jaw. Rest your jaw by eating only soft food. Do not chew gum or ice.
• Try not to clench your jaw or grind your teeth. Your health care provider may recommend a bite block — a plastic mouthpiece that stops the teeth from grinding together. Bite blocks are usually worn only at night.
• Apply a heating pad set at low for 20 minutes four to eight times a day.
• Put a cloth-covered ice pack on your jaw for 20 minutes four to eight times a day.

Ask your health care provider about taking an anti-inflammatory medicine, such as ibuprofen, to help the joint become less irritated. In some cases your provider may recommend a shot of steroid or cortisone in the joint to treat the inflammation.

Other treatments may include taking muscle relaxants for a few days, using relaxation techniques, and learning ways to have less stress. Your health care provider may refer you to a physical therapist for treatment, such as massage and exercises that gently stretch the muscles and help with relaxation. If your pain is clearly related to stress, counseling and medicine can help.

If there is a problem with the way your teeth fit together when you bite, you may need to see a dentist. Surgery is rarely necessary. Before you have jaw surgery, get a second opinion, preferably from a health care provider who specializes in TMJ syndrome.

Preventing TMJ

Because the cause of TMJ is not known, doctors do not know how to prevent it. But the following may help:

• Avoid overusing your jaw (for example, avoid chewing gum or ice)
• Try not to grind your teeth

Referrals are required. Follow up with your dentist or primary care provider to request a referral to see a TMJ specialist.