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Temporomandibular disorders (TMD) is the name given to several problems with jaw movement and pain in and around the jaw joints.
You may also hear TMD called TMJ or TM problems.
The jaw joints, or temporomandibular (TM) joints, connect the lower jawbone (mandible) to the skull. These flexible joints are used more than any other joint in the body. They allow the jaw to open and close for talking, chewing, swallowing, yawning, and other movements.
Many people have problems with jaw movement and pain in and around the jaw joints at some time during their lives. These joint and muscle problems are complex. So finding the right diagnosis and treatment of TMD may take some time.
Temporomandibular disorders (TMD) can affect the jaw and jaw joint as well as muscles in the face, shoulder, head, and neck. Common symptoms include joint pain, muscle pain, headaches, joint sounds, trouble with fully opening the mouth, and jaw locking.
In most cases, symptoms of TMD are mild and don't last long. They tend to come and go without getting worse and usually go away without a doctor's care.
Some people who have TMD develop long-lasting (chronic) symptoms. Chronic pain or difficulty moving the jaw may affect talking, eating, and swallowing. This may affect a person's overall sense of well-being.
The most common cause of TMD symptoms is muscle tension, often triggered by stress. When you are under stress, you may be in the habit of clenching or grinding your teeth. These habits can tire the jaw muscles and lead to a cycle of muscle spasm, tissue damage, pain, sore muscles, and more spasm.
TMD can start when there is a problem with the joint itself, such as:
Although there is no one way to identify a TMD, your doctor can most likely check your condition with a physical exam and by asking questions about your past health. In some cases, an X-ray, CT scan, or MRI is also used to check for bone or soft tissue problems related to symptoms of TMD.
TMD symptoms usually go away without treatment. Simple home treatment can often relieve mild jaw pain. There are things you can do at first to reduce pain.
Getting physical therapy and learning ways to reduce stress may also help to reduce pain and TM joint problems. Continue to use some of these methods over time to prevent and manage symptoms that might come back. If your pain is chronic or severe or is caused by problems with how the joint is shaped, your doctor may recommend other treatments.
Splints, also called bite plates, are a common dental treatment for TMDs. Splints are usually clear pieces of plastic that fit between the upper and lower teeth. They help reduce grinding and clenching. Splints are used for a short time so that they do not cause permanent changes in the teeth or jaw.
Before you try treatments such as surgery or reshaping or shaving down the teeth, think it over. These treatments cannot be reversed and can even damage the TM joint.
For most people, surgery is not used to treat TMDs. Surgery has few benefits, and there is the chance of causing more serious problems. You and your doctor can carefully weigh a decision to have surgery. Talking with another doctor to get a second opinion can also help you make your decision.
Chronic pain can lead to depression, anxiety, and other problems. If you have chronic pain, talk to your doctor about medicine and mental exercises to manage the pain. Give special attention to treating any related anxiety or depression.
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Temporomandibular disorders (TMD) can result from a single cause or, more commonly, a combination of causes.
The main causes of TMDs include:
In many cases, TMD symptoms appear to be caused by both muscle tension (tightness) and joint dysfunction. It is not always clear which came first. For example, osteoarthritis can cause changes in the joint, which may then bring on muscle spasms. Conversely, muscle spasms over time hinder jaw function and can eventually cause osteoarthritis in the jaw joint. A similar relationship appears to exist between muscle tension and disc displacement within the joint.
Orthodontic treatment and malocclusion do not seem to trigger TMDs or make them worse.
When jaw joint problems are caused by diseases such as rheumatoid arthritis, treatment for that condition is important. Many other conditions cause symptoms similar to those of TMDs, such as migraine headaches and infections.
Symptoms of temporomandibular disorders (TMDs) are usually mild and temporary and typically do not get worse with time. Common symptoms include:
Sometimes pain around the ear, with pressure or ringing in the ears (tinnitus), develops with TMDs. Some people with these symptoms report that they also have hearing loss, although test results show that their hearing is normal.
Symptoms often go away on their own. And they may recur over time without getting much better or worse. Occasional discomfort in the jaw joint or chewing muscles is quite common and usually is not a cause for concern. But for some people symptoms can be very painful, disabling, and last a long time.
The course of temporomandibular disorders (TMDs) caused by muscle tension varies depending on the cause of the muscle tension.
TMDs caused by problems in the structure of the jaw joint may:
In some cases, TMDs can be extremely painful and disabling and last a long time. Such chronic pain can affect a person's overall quality of life by increasing stress, making it hard to do a job, and interfering with personal life. Depression and anxiety are common results of chronic pain. Treatments may not relieve pain due to the lasting psychological and biological impact of chronic pain. These biological effects can lead to a sense of helplessness and biochemical changes in the body that perpetuate pain. In these cases, it is especially important to seek treatment for TMD pain and for related depression and anxiety.
Risk factors for temporomandibular disorders (TMDs) include:
Call your dentist or doctor immediately if you have had an injury to your jaw or face and:
Call your dentist or doctor if you:
Your treatment for temporomandibular disorder (TMD) may involve several different health professionals.
Initial evaluation can be done by a:
Further diagnosis and treatment may be done by a:
Additional treatment may be provided by:
If a doctor suggests that you try a treatment that might make permanent changes to your jaw, be sure to get a second opinion.
Health and dental insurance plans might not cover diagnosis and treatment. Because some tests and treatments are quite expensive, you may want to check your coverage before incurring expenses.
Currently there is no widely accepted standard test for identifying the cause of temporomandibular disorders (TMDs). But your dentist or doctor will most likely be able to accurately diagnose your condition with information from a medical history and physical exam.
Most TMDs are caused or made worse by muscle tension (tightness). Expect your doctor to suggest treatment that does not involve surgery or permanent changes to the jaw (conservative treatment) to relieve your jaw pain, muscle tension, and TM joint problems.
If you have sudden pain after a facial or jaw injury, your doctor is likely to order some type of imaging test, such as an X-ray, a CT scan, or magnetic resonance imaging (MRI).
If conservative treatment has not worked and your jaw is locking in place (a sign of disc displacement), your pain is severe or chronic, or you have other medical problems, such as rheumatoid arthritis, other tests may be needed. These tests are usually done only if knowing their results could change your recommended treatment plan.
If you still have symptoms after the first period of treatment, your doctor may begin to look for problems in the jaw joint structure. Other tests may include:
The goal of treatment for temporomandibular disorders (TMDs) is to relieve pain in the jaw and restore normal jaw movement and function. Several treatment approaches are effective. The first treatments that are tried for TMDs are called conservative, because they are simple and temporary. They are not invasive or permanent. They can be stopped or reversed. They include over-the-counter pain medicine and self-care that you can do at home.
Often, simple home treatment measures can successfully relieve jaw pain. Less than 1 out of 10 adults have jaw problems or pain that is so severe that they need medical or dental treatment.footnote 1
For chronic, muscle-related TMDs, standard medical care can include muscle relaxation measures, biofeedback, stress management, or cognitive-behavioral therapy.
For chronic pain caused by a TMD, it is important to seek treatment for pain and for related depression and anxiety.
Dental splints are the most common dental treatment for TMDs. These splints or bite plates are typically used for a short period of time. They can help relieve muscle tension and pain.
Most people do not need permanent dental work or surgery. Permanent dental work might include orthodontic treatments involving permanent changes to the jaw. At best, permanent treatments or surgery may not work any better than physical therapy and temporary treatments. At worst, they can cause irreversible damage. If your doctor recommends surgery or other treatment that involves permanent changes, be sure to get a second opinion before you start treatment.
Often, structural problems in the jaw, such as disc displacement, can be improved with conservative (nonsurgical) treatment, especially when they are treated early.
To prevent temporomandibular disorders (TMDs), try to reduce muscle tension in your jaw. You can reduce muscle tension in these ways:
In the past, various procedures such as dental restoration and orthodontic treatment were used to prevent joint sounds from developing into TMDs. Such measures are not only unneeded but also potentially damaging to a joint that may never become painful on its own.
See Home Treatment for other ways to prevent or reduce muscle tension in your jaw.
If your temporomandibular disorder (TMD) symptoms are mild, try home treatment for at least 2 weeks. If your symptoms don't get better or if they get worse during this time, call your doctor or dentist.
Home treatment involves reducing your stress, resting your jaw (by eating only soft or pureed foods), taking steps to reduce pain, and exercising your jaw.
To help relieve pain and restore jaw function:
If you have been diagnosed with a TMD, these home treatment measures will optimize the treatments prescribed by your doctor or dentist, such as a splint therapy or physical therapy.
You can use medicine to relieve the pain of a temporomandibular disorder (TMD). Short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, muscle relaxants, or antidepressant medicines can relieve or reduce inflammation, control pain, and relax the jaw muscles. Be safe with medicines. Read and follow all instructions on the label.
Nonsteroidal anti-inflammatory drugs (NSAIDs) do not cure TMDs. But they may reduce pain and inflammation, which allows you to do prescribed jaw exercises that can start the healing process. NSAIDs may be prescribed on a regular basis for 1 to 2 weeks to help reduce inflammation even though the pain has subsided.
Your doctor may prescribe an antidepressant, not necessarily because you suffer from depression but to help treat chronic pain or nighttime bruxism.
Surgery is rarely used to treat temporomandibular disorders (TMDs). Surgical treatment does not guarantee a cure and can further damage the temporomandibular joint. Because most TMDs can be treated nonsurgically, most doctors believe that surgery should be the last option tried and should be avoided if possible.
Surgery may be a treatment option for you if both of the following apply:
The goals of surgery for TMDs are to:
Surgery may include:
Another type of surgery, called total joint replacement, is rarely done. It has sometimes resulted in permanent jaw damage. Total joint replacement replaces the jaw joint with artificial parts. In some cases the artificial parts have not worked correctly or have broken. The available technology for this surgery is still considered to be experimental and risky.
Further pain complications or joint dysfunction can result from temporomandibular joint surgery.
Surgery is not needed in most cases of disc displacement.footnote 2 Splint therapy (a dental treatment), jaw rest, and physical therapy, including moist heat and jaw exercises followed by an ice pack, can work very well for treating this condition. If this and other nonsurgical treatment to relax the muscles are not successful, arthrocentesis may effectively treat your condition.
If you are thinking about surgery, get a second opinion on your condition and treatment.
Many types of treatment can successfully relieve temporomandibular disorder (TMD) symptoms. Different doctors will suggest different treatments, any of which may work to relieve jaw and facial pain.
If a doctor recommends that you try a treatment that might make permanent changes to your jaw or teeth, get a second opinion.
Depending on your condition, one of the following choices may be more effective than another. Safe options for treatment of TMD include:
Treatments considered safe and effective for some people include:
Many different types of treatment for temporomandibular disorders (TMD) have potential for successfully relieving your condition. If your problem is linked to muscle tension, any treatment that helps you relax your jaw muscles with no adverse effects is likely to be helpful. Different treatments work for different people.
Treatments vary greatly in safety, cost, and how well they work.
Scrivani SJ, et al. (2008). Temporomandibular disorders. New England Journal of Medicine, 359(25): 2693–2705.
Tucker MR, et al. (2008). Management of temporomandibular disorders. In JR Hupp et al., eds., Contemporary Oral and Maxillofacial Surgery, 5th ed., pp. 629–649. St. Louis: Mosby Elsevier.
Other Works Consulted
American Academy of Pediatric Dentistry (2010). Guideline on acquired temporomandibular disorders in infants, children, and adolescents. American Academy of Pediatric Dentistry Clinical Guidelines Reference Manual, 32(6): 232–237. Also available online: http://www.aapd.org/media/policies.asp.
American Association for Dental Research (2010). Temporomandibular Disorders (TMD). Available online: http://www.aadronline.org/i4a/pages/index.cfm?pageid=3465#TMD.
American Society of Temporomandibular Joint Surgeons (2003). Guidelines for diagnosis and management of disorders involving temporomandibular joint and related musculoskeletal structures. Cranio, 21(1): 68–76.
Goddard G (2008). Temporomandibular disorders. In AK Lalwani, ed., Current Diagnosis and Treatment in Otolaryngology – Head and Neck Surgery, 2nd ed., pp. 389–396. New York: McGraw-Hill.
Okeson JP (2011). Temporomandibular disorders. In ET Bope et al., eds., Conn's Current Therapy 2011, pp. 1008–1011. Philadelphia: Saunders.
Current as of: October 3, 2018
Author: Healthwise StaffMedical Review: Adam Husney MD - Family MedicineMartin J. Gabica MD - Family MedicineKathleen Romito MD - Family Medicine
Current as of:
October 3, 2018
Medical Review:Adam Husney MD - Family Medicine & Martin J. Gabica MD - Family Medicine & Kathleen Romito MD - Family Medicine
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