TMJ
The temporomandibular joint is the joint of the jaw, the hinge that connects the jaw to the skull. The name comes from “temporo-,” referring to the temporal bones on the sides of the skull, and “-mandibular” which is the medical term for the lower half of the jaw. The temporomandibular joint is supported and stabilized by several muscle groups. It is the joint that allows you to open and close your mouth, eat, talk, and make facial expressions.
TMJ is very common, with approximately 35 million people affected each year.
Affects up to 15% of adults (some studies estimate a prevalence as high as 25%). But at most, only half will seek treatment.
TMJ, especially when chronic, can significantly affect quality of life, with a significant financial burden from lost work days.
Causes
What causes TMJ?
There are various causes of TMJ. Jaw muscle tightness or spasm is a common cause. Teeth grinding (“bruxism”) is often the culprit, as this overworks the jaw muscles. Many people grind their teeth at night without being aware of it, and may wake up with noticeable tightness or soreness of the jaw muscles or teeth.
True joint disorders cause a minority of TMJ cases. This category would include arthritic joints in osteoarthritis, inflamed joints in rheumatoid arthritis, or loose/hypermobile joints in certain genetic connective tissue disorders.
Poor head and neck posture may contribute to TMJ, due to dysfunction or suboptimal alignment of the muscles connecting the head, neck, and jaw. Issues with the neck, most commonly instability or hypermobility of the cervical spine, may also play a role.
Finally, injury or trauma to the joint may set off or exacerbate TMJ.
In all of these cases, the way in which the brain processes pain signals from the head and body can be a contributing factor. In some people, the nerves may continue to transmit pain messages to the brain even after an initial injury has healed.
Symptoms
What are the symptoms of TMJ?
The most common symptom of TMJ is a dull ache or pain on the side of the face or in the area of the jaw (just in front of the ears), which gets worse with chewing or talking. It may come and go.
Other symptoms include limitation in opening the jaw, clicking or popping noises, and headache (especially in the temple area). Some people may develop tinnitus (ringing in the ears) or earache.
My jaw joint clicks, but isn’t painful. Should I be concerned?
Generally, no! A jaw that clicks or pops without any discomfort or limitation in opening is typically not a cause for concern and does not need to be treated.
What other common problems may stem from, or be associated with TMJ?
As mentioned above, both headaches and tinnitus may stem from TMJ, though people are often unaware of the connection.
Diagnosis
How is TMJ diagnosed?
TMJ is typically a clinical diagnosis, meaning it is diagnosed on the basis of a medical history and physical examination. Most people will not need imaging (such as an X-ray or MRI) unless many initial treatments have been unsuccessful, or your clinician suspects that something less common may be causing your TMJ.
Treatment
How is TMJ treated during acute flare-ups?
Long-acting anti-inflammatory medications (eg, naproxen) can be helpful when symptoms are flaring. Heat (in the form of warm/moist compresses or heating packs) is also helpful to relieve muscle spasm. Jaw rest is important: stick with soft foods for a couple weeks, and avoid crunchy foods, gum, fingernail biting, and excessive talking or singing. If it seems likely that the symptoms are related to jaw muscle spasm, a few days of a prescription muscle relaxant may help, though these medications can be sedating.
It’s also important to incorporate the longer-term measures detailed below as much as possible during periods of flare.
TMJ will often resolve on its own, and the majority of people will experience resolution of their symptoms with initial basic treatments.
How can I keep TMJ at bay in the future?
First, it’s important to become aware of tooth grinding/clenching, and to limit this habit as much as possible. Stress management in the form of exercise, meditation, or biofeedback can help stop the urge to grind. A dental appliance called a bite guard or nightguard may help some people who grind excessively at night. Typically this is a plastic mouthpiece that covers the top teeth and prevents direct contact of the upper and lower teeth. They are available over-the-counter inexpensively, or can be custom made by a dentist. Unfortunately, dental insurance does not usually cover the full cost of these devices.
Let your dentist know you have experienced TMJ symptoms, and work with them to minimize the length of dental visits, or request frequent breaks during procedures. Dentists understand TMJ well, and are happy to work with patients to make dental cleanings more comfortable.
Gentle physical therapy, especially when guided by someone with expertise in the jaw and TMJ can be greatly beneficial. A skilled physical therapist can help you find the correct resting position for your head and neck, which puts less strain on the muscles of the jaw. Physical therapists can also work with you to strengthen and stabilize the core muscles of the cervical spine, which offloads tension from the temporomandibular joint.
To find the healthy resting position of the jaw on your own, try the following: swallow, then let the front of the tongue gently touch the upper palate, and feel the bottom jaw relax. Your upper and lower teeth should remain a few millimeters apart, not touching each other at all unless you are eating.
Are there other treatments for more persistent or chronic TMJ?
Low doses of certain antidepressant medications can be utilized for chronic pain associated with TMJ. Trigger point or Botulinum toxin (Botox®) injections may be helpful in relaxing the muscles of the jaw. Acupuncture can benefit some people. Surgery is done rarely.
Which treatments have not been proven to be helpful?
Generally, treatments for “malocclusion” (a misaligned bite) are not helpful, though were widely employed a few decades ago. Interventions such as grinding the teeth down, extracting teeth, and braces or retainers to realign the teeth are also not helpful in the great majority of cases. Jaw immobilization is not helpful and can be harmful.
Is TMJ likely to get better with time?
Yes. In the majority of people, TMJ symptoms will respond to treatment and/or resolve on their own. A smaller number of people will experience more chronic symptoms from TMJ. Sometimes these symptoms will come and go in response to triggers (eg, a day with more talking than usual, eating a large crunchy salad, or a visit to the dentist).
Which health care practitioners are involved in treating TMJ?
Aside from primary care clinicians, dentists and physical therapists are key players in TMJ management. In difficult-to-treat cases, your primary care clinician may refer you to an oral and maxillofacial (OMF) surgeon or pain specialist.
Useful Links
TMJ Disorders (National Institute of Dental and Craniofacial Research)
Summary of TMJ (American Association of Oral and Maxillofacial Surgeons)
TMJ: a patient education resource (UpToDate)
Diagnosis and Treatment of Temporomandibular Disorders (American Family Physician)
Connect with our physicians
Joanna Mandell, MD and Nora Lansen, MD are both members of the Galileo Clinical Team. Connect with one of our physicians about TMJ or any of the many other conditions we treat.