All about temporomandibular disorders (TMD)

Learn all about the causes, symptoms and treatment of TMD.

Temporomandibular disorders (TMD) are problems with the jaw muscles, temporomandibular (jaw) joints, and/or the nerves linked to chronic facial pain. Any problem that prevents this complex system of muscles, bones and joints from working together in harmony may result in temporomandibular disorder. 

The temporomandibular joints (TMJ) are the two joints that connect the lower jaw to the skull. More specifically, they are the joints that slide and rotate in front of each ear. They include the lower jaw (mandible) and the temporal bone (the side and base of the skull). The TMJs are among the most complex joints in the body, partly because of the TMJ disc within the joint, between the lower jaw, and the temporal bone. These joints, along with several muscles, allow the lower jaw to open and close, move side to side, and forward and back.

When they are healthy, the TMJs make no noise. They rotate and glide smoothly, and they don’t hurt. They support chewing, talking, singing, yawning and swallowing. Some or all of the features of a healthy TMJ and jaw muscles may be impaired in TMD.

The National Institute of Dental and Craniofacial Research categorizes TMD with these criteria: 

• Myofascial pain. This is the most common form of TMD. It results in discomfort or pain in the connective tissue covering the muscles (fascia) and the muscles that control how the jaw works.
• Internal derangement of the joint. This means a displaced disk. The disk is a cushion of cartilage between the head of the jawbone (the condyle) and the skull (the fossa).
• Osteoarthrosis. This is the underlying disease process of the jaw joint that may lead to disc displacement and possibly deformity of the head of the jawbone.
• Degenerative joint disease. This includes osteoarthritis or rheumatoid arthritis in the jaw joint. It leads to deterioration of the surfaces of the joint.

You can have more than one of these conditions at the same time.

Causes of TMD

In many cases, the actual cause of this disorder may not be clear. Sometimes the main cause is too much strain on the jaw joints and the muscle group that controls chewing, swallowing and speech. This strain may be due to bruxism. This is the habitual, involuntary clenching or grinding of the teeth. Injury to the jaw, the head or the neck may also cause TMD. Arthritis and displacement of the jaw joint disks can also cause TMD pain. In other cases, another painful health condition such as fibromyalgia or irritable bowel syndrome may overlap with or worsen TMD pain. A recent study by the NIDCR identified clinical, psychological, sensory, genetic and nervous system factors that may put a person at higher risk of developing chronic TMD. 

Symptoms of TMD

These are the most common symptoms:

• Jaw discomfort or soreness, most often in the morning or late afternoon.
• Headaches, usually in the temples.
• Pain spreading behind the eyes, in the face; it’s worse when the jaw moves.
• Earaches or ringing in the ears that is not caused by an ear infection.
• Clicking or popping of the jaw.
• Locking of the jaw.
• Limited mouth motions.
• Clenching or grinding of the teeth.
• Poor sleep — light, restless sleep.
• Teeth sensitivity without dental disease.
• A change in the way the upper and lower teeth fit together, especially overbite and open bite.

The symptoms of TMD may look like other conditions or health problems. See a dentist or your healthcare provider for a diagnosis. 

Diagnosing TMD

There are several ways to determine whether someone has TMD:

• Health history. Your health care provider will ask if you have a past history of facial or jaw pain when you chew, bite or open your mouth. Your provider will ask if you have had cracking, popping or noise when opening or closing your mouth. 
• Physical exam. Your provider will check if you have facial or jaw pain when moving your jaw, or if can’t open your mouth wide. They will also check for TMJ noises when you open or close your mouth. 
• Imaging tests. X-rays, CT scans and/or MRIs may be ordered to clarify the diagnosis.

How to treat TMD

Treatment will depend on your symptoms, age and general health. It will also depend on how severe the condition is. 

Treatment may include:

• Resting the jaw joint and muscles with changing the diet to softer foods.
• Medicine, such as anti-inflammatory medications and possibly others, for tooth clenching at night.
• Relaxation methods and stress management.
• Behavior changes, to reduce or stop clenching your teeth.
• Physical therapy.
• An orthopedic appliance or mouthguard worn in the mouth, to reduce grinding of the teeth.
• Ice and hot packs.
• Botox.
• Local anesthetic and steroid injection of sore tendons.
• Surgery.

TMD symptoms can come back during times of stress if you tend to clench or grind your teeth. It helps to be aware of what triggers your symptoms so you can help prevent repeated problems. See your dentist regularly to have your TMD checked.  

Vanderbilt’s oral and maxillofacial surgeons care for people with complex injuries, diseases or deformities of the jaws and face. The team has the expertise to manage or repair a wide variety of problems, with a goal of reducing pain and providing better quality of life. For an appointment, call 615-322-2377.

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